To help address my own anxiety surrounding the final two years of medical school, while helping other students in similar shoes, I have compiled strategies offered by senior medical students, residents and attendings on how to best impress during neurosurgical rounds.

Maintain a strong work ethic

Neurosurgery has long hours including time in the operating room, clinic rounds and independent study. Therefore, a strong work ethic and looking for ways to contribute is required. Being a part of the neurosurgical team is a privilege. You get to work with some of the hardest working professionals in the medical field and care for patients who are coping with diseases that are potentially devastating Maintaining this perspective is key to success on rounds.

Demonstrate a willingness to learn

Neurosurgery is one of the youngest surgical specialties and is continuously evolving. It is important to independently study materials related to neurosurgery. This can include new research, cases, neuroanatomy, neurology, and neuroradiology.  Independent study of neurosurgical materials can help develop insightful questions and demonstrates to your supervisors that you have critically thought about the field and attempted to learn on your own.  It can be intimidating asking questions, but the willingness to learn shows humility. It shows an understanding of one’s personal knowledge gaps and a desire to get better. Ultimately, insightful questions and requests for feedback is not seen as a lack of knowledge, but rather the desire to learn and improve- a quality that will go far in neurosurgery.

Understand the neurological exam and history taking

While medical students are not expected to know everything, it is expected that students are comfortable performing the neurological exam and taking patient history. This takes time, and practice. If possible, attempt to schedule a rotation on neurology prior to conducting neurosurgery rounds. This will allow you to practice history taking and exam skills prior to “auditioning” during the surgical rounds. Understanding the exam and developing an effective method to history taking, will allow you to better identify clinical patterns associated with disease. It will enable you to seek the advice of residents and attendings sooner, and ultimately benefit the patient. 

Learning to read neuroimaging

Another valuable skill apart from taking history and learning the neurological exam, is being able to interpret neuroimaging from the most used imaging modalities. For example, being able to interpret CT head for trauma/bleeds, CTA/DSA for vascular issues, CT spine for traumatic disease, MRI brain for tumor/infections, and MRI spine for degeneration/infection and tumors. It demonstrates a fundamental knowledge base of imaging as well as neuroanatomy. Not only will this improve your ability to help contribute to patient care, but interpreting images is a common question asked of medical students by residents and attendings.

Make a resident’s life easier

A common piece of advice that is given to students is to help make the residents’ life easier.  It is not hard to imagine that a neurosurgical resident is incredibly busy. Working to make their jobs a little bit easier may go a long way in becoming a part of the neurosurgical team. This can take the shape in numerous ways including obtaining vital signs and patient data from lab reports, note writing and helping with discharge, pre-rounding on patients and summarizing findings and taking the initiative to evaluate medically stable patients or new admissions. Moreover, a student can contribute by being good at seeing patients- meaning that their history and physical exam skills are reliable. Lastly, it is recommended that students pay close attention to the OR setup and contribute to setting up if possible.

Collaborating well with others on a neurosurgical team

Neurosurgery is a team sport. There are numerous professionals all playing vital roles including the surgeons, nurses, residents, administrators, physicians assistants, anesthesiologists, and of course students. Understanding that each professional play a key role in neurosurgical patient care, is essential to being a good team player.  The benefits of collaboration may be forgotten when medical students are expected to collaborate with other medical students. Neurosurgery is a competitive specialty, and your fellow medical student may be in competition against you for a residency spot. Maintaining a zero-sum mentality, leads to animosity among students, which is picked up on by your supervisors and results in negative impressions. A collaborative mindset, where the goal of excellent patient care is first and foremost will go a long way in proving you are a professional and can be a part of staff as a future resident.

Maintain Operating Room Etiquette

The last tip can be generalized to all surgical specialties but is worth mentioning for neurosurgery rotations. The first part in maintaining etiquette is to introduce yourself to the staff including the surgeon and nurses during the shift. Secondly, work to maintain the sterile field. This means being wary of your surrounding environment in the operating room and moving cautiously. If you are not scrubbed in for a case, keep a good distance from the sterile field. If you are scrubbed in, keep note of the body parts that are not sterile such as your face, and avoid touching these areas. Thirdly do not take feedback or criticism personally. You are being afforded a learning opportunity during an intense situation. If the surgeon or nurse corrects you roughly, it is not that they are angry but just hyper-focused at the task at hand. Lastly, to set yourself up for a good day in the operating room or clinic, you need to prepare in advance. This means eating beforehand to prevent fainting, and using the washroom before scrubbing in

References:

1. https://www.thesuccessfulmatch.com/post/2017/06/02/how-to-succeed-in-your-neurosurgery-rotation-tips-for-medical-students
2. https://www.statpearls.com/ExamPrep/medical-student-resources/how-do-i-do-well-in-clerkship-and-elective-rotations
3. https://www.neurosurgicalatlas.com/volumes/medical-student-guide-for-matching-in-neurosurgery/preclinical-and-early-clinical-years
4. https://www.ayoungdoctorsjourney.com/operating-room-etiquette-for-students/