Agarwal Neurosurgery Fundamentals

2. Auflage 2025
ISBN: 978-1-68420-731-2
Verlag: Thieme Medical Publishers
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 598 Seiten, ePub

Neurological surgery is a complex, highly selective specialty, so navigating a huge array of neurosurgical information can be overwhelming for medical students and residents. by Nitin Agarwal is a portable reference that enables swift assimilation of neurosurgical care essentials. Pivotal elements of the book include: the roadmap to a career in neurosurgery and advice from the masters, featuring invaluable resources and insights from prominent neurosurgeons. Like the widely acclaimed prior edition, this indispensable textbook simplifies complex concepts without sacrificing depth, thereby enhancing understanding of the core principles and practices of neurosurgery.

Comprehensive technical overviews are provided with topics covered on the neurological examination, neuroanatomy, neuroradiology, neurocritical care, traumatic brain and spinal cord injury, degenerative and deformity spine, neurovascular surgery, neurosurgical oncology, pediatric neurosurgery, functional neurosurgery, stereotactic radiosurgery, neurological infectious diseases, and interdisciplinary care. The book also includes key socioeconomic topics including training, licensure, credentialing, and advocacy. New features include Rapid Review and Holding the Pager.

Key Highlights

• Fundamental diseases, tests, and operative approaches are summarized
• Top Hits feature includes the most salient questions, aiding in retention of knowledge
• High-yield resources are highlighted to augment identification by the reader
• Neurosurgical Pearls offer advice from the masters relevant to each chapter
• High-quality illustrations, photographs, and radiographs enrich understanding

With a fundamental goal to educate and empower neurosurgery trainees, this book provides medical students, advanced practice providers, residents, and fellows with the necessary knowledge and confidence to succeed in clinical and surgical settings.

This print book includes a scratch off code to access a complimentary digital copy on MedOne.

Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product.

Autoren/Hrsg.

Agarwal, Nitin

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie

Inhaltsverzeichnis

1. Roadmap to Neurosurgery Residency
2. History of Neurological Surgery
3. Neurological Examination
4. Neuroanatomy
5. Neuroradiology for the Neurosurgeon
6. Bedside Procedures
7. Operating Room
8. Neurocritical Care
9. Traumatic Brain Injury
10. Spinal Trauma
11. Spine
12. Pain
13. Cerebrovascular
14. Neurosurgical Oncology
15. Pediatric Neurosurgery
16. Movement Disorders and Epilepsy
17. Peripheral Nerve Surgery
18. Stereotactic Radiosurgery
19. Neurological Infectious Diseases
20. Interdisciplinary Care
21. Socioeconomics in Neurosurgery
22. Advice from the Masters
23. Rapid Review
24. Holding the Pager

Leseproben

1 Roadmap to Neurosurgery Residency

Chris Z. Wei, David T. Fernandes Cabral, Andrew D. Legarreta, and Robert M. Friedlander

1.1 Introduction

Neurological surgery is the field of medicine dedicated to the surgical treatment of nervous system pathology within the brain, spine, and periphery. The American Board of Neurological Surgery is responsible for selecting the training requirements for neurosurgery residents. Neurosurgery residency is 7 years (84 months) in duration, which consists of 54 months of core clinical neurosurgery and 30 months of electives. This chapter aims to lay down a framework for preparing for the neurosurgery residency application.

1.2 Applications

1.2.1 Match Data

Between 2013 and 2024, the number of neurosurgery residency programs accredited by the Accreditation Council for Graduate Medical Education increased from 99 to 166 (17.2% increase), and the number of residency positions increased from 204 to 241 (18.1% increase). ? [1], ? [2] Generally, neurosurgery programs accept one to three incoming residents every year, with the larger programs accepting four residents per year. Neurological surgery was among the most competitive specialties in the 2024 match. According to the National Resident Matching Program (NRMP), there were a total of 423 applicants who preferred the specialty for 241 positions (1.76 applicants/positions). ? [3] The total match rate for neurosurgery was 57%. Over the past 10 years, the percentage of international medical graduates (IMGs) who matched into neurosurgery increased from 3.5% to 7%. ? [2]

The NRMP conducts surveys of residency program directors (PDs) every 2 years to determine criteria for selecting and ranking residency candidates. In a survey of 20 out of 115 residency directors (17.4% response rate) for neurological surgery conducted in March 2020, responders were asked to cite factors in interviewing and ranking applicants. Of all factors, most PDs cited the following as important factors for selecting applicants to interview ? [4]:

• Letters of recommendation (92%).

• United States Medical Licensing Examination (USMLE) Step 1 scores (92%).

• Demonstrated involvement and interest in research (69%).

• Performing a neurosurgery rotation in that department (69%).

• Personal statement (62%).

When asked about important factors in ranking applicants, residency directors most frequently cited ? [4]:

• Interpersonal skills (92%).

• Letters of recommendation (92%).

• Feedback from residents (85%).

• Interactions with faculty (85%).

• Interactions with house staff (85%).

Results from the NRMP suggest that academic achievements are most important in selecting applicants to interview, but personality and interactions with others are most influential in ranking applicants. It is important to note that the relative importance of each of these factors varies between programs.

It is worth noting that in 2024, the first wave of applicants with a pass/fail (P/F) grading system for Step 1 will be entering the application process for neurosurgery residency. With Step 1 moving to pass/fail reporting, Step 2 clinical knowledge (CK) is expected to become the main standardized measure of academic performance for neurosurgery residency applications. However, it is important to note that students who have invested extra years in research or pursued MD/PhD programs likely took the Step 1 before the P/F era and will still have their scored Step 1 results reported. For those individuals with lower Step 1 scores, it may still have a negative impact on their overall candidacy.

1.2.2 Qualifications

Historically, USMLE Step 1 scores carried substantial weight in applicant selection due to their universal nature. However, the recent shift to P/F scoring has prompted PDs to reconsider. The survey of PDs attitude toward USMLE Step 1 P/F is summarized in ? Table 1.1 . A survey of PDs found most had reservations. ? [5] Many PDs now emphasize USMLE Step 2 CK scores. Presently, 46% of neurosurgery programs do not use Step 2 CK scores. Among the rest, 29% require a passing score, while 25% set specific target scores. This highlights the rising importance of Step 2 CK scores, potentially surpassing Step 1 as a screening criterion. Students may consider taking Step 2 CK earlier for comprehensive career planning.

Table 1.1 Neurosurgery program director perspectives of binary Step 1 scoring

Statement

Disagree

Neutral

Agree

Changing USMLE Step 1 to P/F

Is a good idea

78.7 (67.0–90.4)*

10.6 (1.8–19.5)

10.6 (1.8–19.5)

Will make it more difficult to objectively compare applicants

6.4 (0.0–13.4)

8.5 (0.5–16.5)

85.1 (74.9–95.3)*

Will increase emphasis on Step 2 CK scores in selecting applicants for my program

4.2 (0.0–9.8)

8.3 (0.5–16.2)

87.5 (78.1–96.9)*

Will put IMGs at a disadvantage

6.5 (0.0–13.7)

30.4 (17.1–43.7)

63.0 (49.1–77.0)*

Will decrease socioeconomic disparities in the application process

62.5 (48.8–76.2)*

27.1 (14.5–39.7)

10.4 (1.8–19.1)

Will decrease medical student knowledge of the basic sciences

4.2 (0.0–9.8)

43.8 (29.7–57.8)

52.1 (38.0–66.2)

Will improve medical student well-being

50.0 (35.9–64.1)

35.4 (21.9–48.9)

14.6 (4.6–24.6)

Will make the applicant screening more arduous

2.2 (0.0–6.5)

17.8 (6.6–28.9)

80.0 (68.3–91.7)*

As a result of changing USMLE Step 1 to P/F

It will now require applicants to submit Step 2 CK scores with ERAS

8.5 (0.0–16.5)

6.4 (0.0–13.4)

85.1 (74.9–95.3)*

Where an applicant goes to medical school will be more important in screening and selection

16.7 (6.1–27.2)

12.5 (3.1–21.9)

70.8 (58.0–83.7)*

...

Where an applicant goes to medical school will be more important in screening and selection for my program

16.7 (6.1–27.2)

12.5 (3.1–21.9)

70.8 (58.0–83.7)*