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What it’s like in neurological surgery: Shadowing Dr. Agarwal

As a medical student, have you ever wondered what it feels like to major in neurosurgery? Meet Nitin Agarwal, MD, a neurosurgeon and a distinguished physician at the AMA Specialized “Shadow Me” series, which provides first-hand advice from clinicians about life in their specialties. Check out his vision to help decide if a career in neurosurgery is right for you.

The AMA Specialty Guide simplifies the medical student major selection process, highlighting major specialties, detailed training information, and providing access to relevant association information. Produced by FREIDA™, the AMA Residency & Fellowship Database®.

Learn more with the AMA about the medical specialty of Neurosurgery.

Shading d. Agarwal

specialty: Neurosurgery, complex and minimally invasive spine, neurotrauma.

Practice setting: Academic medicine.

years in practice: I just graduated from residency. I will start training at Washington University in St. Louis in July of this year.

A typical day as chief resident at my clinic: As a recent graduate of the University of Pittsburgh Medical Center’s Neurosurgical Training Program, I wanted to share a regular day as a principal resident.

The day starts bright and early, arriving at the hospital to begin reviewing the inpatient census chart shortly after 5 am, then senior residents meeting all residents at 6:00 am in the conference room for morning movie tours where new consultations and updates are reviewed Photography as a team. Thereafter, each neurosurgery service line, led by the chief resident, will initiate ICU rounds in conjunction with the critical care medicine team. This is followed by rounds of patients on the ground. Finally, each service line patient list is provided with attendance beginning around 6:45 AM

Once patients on duty have been screened and day care plans made, the day can begin. New patients are examined in the preoperative holding area for the first case of the day. The imaging and surgical plan are also reviewed with the treating surgeon. Surgical cases extend throughout the day of varying lengths and complexity.

It is noteworthy that the critical part of each case actually takes place long before the patient enters the operating room. On the days outside the operating room, residents will be involved in the clinic’s learning to formulate diagnoses and treatment plans.

Evening tours and family meetings will usually start by 6:00 pm and patients from each service line will be screened. Post-operative examinations will also be performed. Once completed, relevant clinical updates are discussed with attendees. At approximately 7:00 PM, the resident team will run the list and discuss patients with the on-call resident. At the end of the day, the chief will prepare and distribute tasks for the next day so that each resident can prepare for the next day’s surgical cases.

The most challenging and rewarding aspect of Neurosurgery: Neurosurgical patient care is always high-risk. It is truly an honor to be able to perform brain and spine surgery. The complexity of neurosurgical diseases and conditions requires time and attention. To this end, a strong patient-physician relationship is built with each patient and their family. As with all physicians, this relationship is one of the most rewarding aspects.

In addition, the complexity of neurological disorders requires a seven-year extension of the training period. This time, however, provides the ability to build a strong friendship with colleagues that I deeply cherish.

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How life in neurosurgery has been affected by the global epidemic: At the start of the pandemic, a myriad of changes affected neurosurgical care, including shortages of personal protective equipment (PPE) and intensive care beds, canceled surgeries, and staff shortages.

Although there are breaks, these issues remain. With each new wave or change, there is a looming threat that elective surgeries will stop. Nowadays, there is already a backlog of patients who need care. Overall, the pandemic has delayed urgent care which often can be disastrous if there are adverse neurological consequences.

Neurosurgery must adapt to continue to accommodate and care for patients through the application of telemedicine to ensure adequate access to providers.

Long-term impact of the epidemic on neurosurgery: The pandemic has changed the way we interact with patients. When possible, visits are conducted by telehealth. While this certainly allows for physical distancing and, as a byproduct, increases patient comfort, the patient-physician aspect of the relationship must not be forgotten.

An essential part of every encounter, especially in neurosurgery, requires a detailed and comprehensive neurological examination. It is critical that this aspect of care remains in place, even as technological advances are incorporated into the healthcare environment.

Three adjectives to describe a typical neurosurgeon: Honest, hardworking and flexible.

How does my lifestyle match or differ from what I imagined: Neurosurgery is not just a craft, it is a way of life.

Every doctor in training should have the skills for neurosurgery but it won’t be tested on the board for exampleA.m: Reflexive thought is hand-eye coordination and dexterity. However, it is the human aspects of each doctor that are vital in the field of neurosurgery. The complexities of brain and spine disorders require the unwavering dedication of the patient and his family. The specialty requires that each physician be not only a surgeon but also a physician to provide optimum care.

One question clinicians in training should ask themselves before pursuing neurosurgery: Can you see yourself choosing another medical field? This classic inquiry for those considering neurosurgery remains valid, even more so in the 80-hour workweek era.

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Books every medical student interested in neurosurgery should read: Exploring some of the notes written by those who have walked the road before can be an inspiration.

  • When the air hits your brainAnd Written by Frank Vertocek Jr., MD.
  • When breathing becomes air, written by Paul Kalanithi, MD.
  • Don’t Hurt: Stories of Life, Death, and Brain SurgeryHenry Marsh, MD.

Finally, I’m showing a book I’ve edited to fill a textbook niche for those specifically in training called Fundamentals of Neurosurgery. This book provides essential information for those preparing to apply for neurosurgery as well as advice from professors now practicing.

Online resource students interested in Neurosurgery should follow: The websites of our parent organization the American Association of Neurological Surgeons and the Conference of Neurosurgeons are great places to start. Information related to those interested in the field – from patients to trainees – is readily available. Information on various scholarships, research awards, and grants is also available.

Quick insights I would give to students considering neurosurgery: Having a mentor in this field is the greatest asset. I highly recommend that students reach out to those already in the field to express their interest. Finding a mentor can be difficult. The trainee should realize that mentorship is a two-way street.

A prospective intern must use “three masters” in his or her approach to medical training: availability, reliability and accountability, which are often cited as keys to being a successful intern in neurosurgery. The first step in the path is appearance. Show up early and often. I carry the message.

The song to the descriptionLife in Neurosurgery: “Tubthumping” Chumbawamba. “I fell down, but I got up again.”

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