neurosurgeon in making

How can I become a neurosurgeon? Should I take up General surgery first?
How can I become a neurosurgeon? Should I take up General surgery first?

This are exact same words that an MBBS student asked me the other day. He didnt tell me why he wanted to take up neurosurgery. He said he didn’t have any particular reason. Or maybe he didn’t want to tell me. In any case, it didn’t matter to me. Rational thought and expressed reasoning are not for everyone. For some it’s a calling and that’s fine. That's legit.

More importantly, we have to answer the second question: Should he take up general surgery first? If one has decided on taking neurosurgery as the end speciality, does one really need to go through three years of general surgical training before going through another round of entrance test and three more years of dedicated neurosurgery MCh training?

Lets break this question up…

Why is neurosurgery different from any other surgical field?

I feel that it is because the surgical motor skill that is required is quite different. It is unlike any of the catching-a-bleeder-tying-it-and-dissecting sort of thing that you do in general surgery.
Joints and muscles maketh the man!

May I take the liberty to propose a ‘Motor classification of surgeons” depending on the movements that are required at various joints?

1. If you are a ‘’shoulder-surgeon”, you are a good orthopedician
2. If you are an “elbow-surgeon”, take up general surgery, surgical gastro or cardiothoracic surgery
3. If you are a “wrist-surgeon”, its plastic surgery for you.
4. If you are good with fine finger generated surgical movements, neurosurgery and microvascular surgical fields may be good for you. You are basically restricted to metacarphalangeal and interphalangeal joints and rest of the joints are better stabilized and rested.

Neurosurgery is also not for the claustrophobic and the impatient. Expect narrow corridors and long hours on the operating microscope.

Neurosurgery is not for the morbidity-phobic surgeon either. It’s a fact that despite all the care one takes, one might end up injuring a patient forever… and many patients in a career. This happens in neurosurgery more than any other surgical field, mainly because of the density of functional tissue in the operative field.

Again back to the second question, does one really have to prime oneself with general surgery before taking up neurosurgery?

I believe that it is not necessary. If you have really decided on taking up neurosurgery, why not plunge straight in and save at least one year and be more focused on the subjects that matter – neurology, neuroradiology and operative neuroanatomy.
I am sure that many of you will not agree with me. What about ‘the broader outlook’ to patient management that a post MS general surgery resident is supposed to possess? May be there is a difference. May be you are better off managing a multiply injured patient. But how often has one managed a patient with blunt abdominal trauma and head injury and how often have you operated on a blunt injury patient while managing head injury? May be one can better diagnose the condtion and manage shock and resuscitate better. But does this really require three years of learning hernioraphy, mastectomy and abdominoperineal resection?

But there are caveats. It’s possible that a person who is post MBBS may have deep, nagging doubts throughout the five years whether the decision he has taken was too brave and whether he is up to it. And in the unlikely and unfortunate event of dropping out of the course, one will have nothing but MBBS left even if you have spent many years in the course. Yet, once he has completed the course he might be more focused on the subject and will have saved one year.

Skill, of course depends on the resident.

Lets see another angle to this question.

What type of residents do consultants prefer? For example, Sree chitra [SCTMST] favours post MS candidates of late. I’m not sure of the reasons. May be someone can enlighten on this point.
courtsy m s gopalakrishnan (neurosurgery@nimhans)