A Day in the Life of the Neurosurgery Resident by @fashionsurgeon MD (former neurosurgery)
Some of you recently matched into the neurosurgery program of your dreams and are likely at orientation getting ready to start your first day of residency in July! Some of you have aspirations of neurosurgery and may be gearing up to start your MS4 years and important sub internships at neurosurgery programs across the country. And some of you are not even yet in medical school but already have neurosurgery on the brain. As much as shadowing, medical school, and subI’s are supposed to prepare you for what your life will look like as a neurosurgery resident, I can say from experience it doesn’t. So with the disclaimer that every program is different I will describe a typical day as a PGY-1 Neurosurgery Resident. Also note – most every program has done away with the traditional “internship” and you may likely start your first day on the neurosurgery service.
A typical day as the low person on the totem pole started for me at 4:30am when i would print off “the list.” Most programs have some sort of “list” with each patient on the service and key details of their surgery and hospitalization. I had one hour to go through each patient chart (electronically in my case), write down morning labs, check for results of any imaging that was expected, check for any notes from consultants or nurses and check in with the “night float” aka resident covering nights to determine if anything significant happened overnight. Sounds like a shit ton to do in an hour, it is – but you will become amazingly efficient. I would then photocopy the list for my co-residents who would arrive for rounds at 5:30am. (sometimes you had a nice PGY-2 who would come in and help you gather info).
Rounds are a whirlwind – they need to be complete by 7am as the first case starts at 7:30 am. As the PGY-1, I took notes on each patient as typically the PGY-2 or 3 will perform the exam and the chief resident will ask questions. (All notes go on the list which becomes your bible). At 7 everyone splits up and depending on the case load PGY-3’s and above go to the OR for the first case. I would then split note writing with the PGY-2 (if not in the OR). By 8:30 am I needed to have my notes complete…at 8:30 I would attend case management conference where a representative of each service discussed the discharge status and needs (i.e. – nursing facilities, home health care) of their patients. Sounds glamorous right?
Next I got down to my to do list (which was dictated by my chief resident during rounds and on my list). About this time is when the 3 pagers I wore started blowing up. I had my personal pager, the team pager (our service was so large we were divided into 3 teams each caring for 30 patients), and if I was unlucky and my team was on call – the call pager. So it becomes a delicate balance of getting all the orders in, drains pulled, shunts tapped, and triaging incoming calls from nurses. Do also pay attention to the requests from nurses to speak to families. I have also been a patient and I know what it feels like to be waiting for results, or reassurance or plans of the day. DO NOT give out any important results (i.e. tumor biopsy path etc without explicit direction from the Attending (Faculty) physician. You can be helpful by telling patients and family when the Attending typically rounds and answer simple questions.
Typically a patient or two will crash…as the least experienced resident I would quickly evaluate the patient, gather info and come up with what I thought was a plan of action while hurrying to the OR to discuss with my chief resident. No one likes to be interrupted during operating so be prepared with the relevant info and an educated guess at the solution.
The day goes by faster than you can imagine, putting out fires, working down your to do list, getting paged by Attending’s to round on their patients. Spending one on one time with an attending is always intimidating, but good face time and your time to learn. Again your presentation skills must be fine tuned as Attendings have little patience and will quickly lose their temper if you don’t an important event that has occurred during the day. You are basically their tour guide leading them to their patients, presenting on the walk (pulling info from the list), and then writing down orders on your list. I get PTSD when I think of the day I lost my list.
Some days as a PGY-1 I would often be invited to assist in an afternoon start case. (TAKE the invitation and pass off the pagers to someone on your team). Yes you will get home later bc your colleagues will likely leave work for you despite that they are out of the OR, but its worth it for your education. This is also your motivation and why you kicked butt to get this position!
At 7pm the night float arrives and technically you are supposed to be ready to “sign out” your patients to that resident. In reality you are working on updating your list at 7pm (at least you get to hand over the call pager) and checking quickly on each of your patients – evening rounds. Night float is an overwhelming job (taking care of all 3 teams patients) so you should leave things as tidy as you can…(i.e. don’t sign out a post-op check on a patient you operated on).
8:30 pm I was usually trying to get out of the hospital without anyone asking me any more questions. Nurses know they should page the night float, but sometimes that person is so busy they will ask you. Do yourself a favor and make friends with the nurses they are your best allies.
I would typically arrive home at 9-9:30 pm, eat something…study for an hour and pass out as the 3:45 am wakeup comes quickly. SO ARE YOU SO EXCITED! 🙂 This post is not meant to dissuade you – just to present the reality. Some days are better, some days are worse. Programs are also different – some have physician assistants to support you as work hour restrictions are being enforced. But if you truly love neurosurgery, those days that you get to operate make it worth the feverish pace and sleep deprivation.