The Medical Residency in Neurosurgery

I start to use this space to also write about medical education. In addition to my passion for the nervous system and surgeries, I have always been interested in education. As a residency preceptor, conversations with residents are not just about clinical cases and surgical strategies, but also involve personal situations and situations related to teamwork. Anguish, uncertainty, insecurity, stubbornness, fear, euphoria, hope and overconfidence are some of the feelings/behaviours that I observe in the residents along their path in the five years of specialization. And it's easy to see that, because I was also a resident and I nurtured all these feelings that I now observe and try to soften or improve.

The transition from college to residency is not always easy. The person leaves an environment where there is a set time to attend classes, the teacher guides the bibliography that falls on the test and the responsibility is to pass the period, and enters the day-to-day of the medical specialty, without classes, without teachers with a defined class schedule, without bibliographies for exams, without papers to be presented, but charged with solving patients' problems, making important decisions and acting as a specialist doctor - all without a manual or a reference guide! That is, the resident is charged as a doctor and as a student/apprentice.

The day-to-day involves visiting hospitalized patients, participating in surgeries, outpatient care, emergency shifts and academic activities. In addition, there is direct contact with other health professionals (nurses, nursing technicians, physiotherapists, speech therapists, psychologists) and with different sectors (ICU, hospitalization, emergency, outpatient). Each sector and each professional has particularities and the interpersonal relationship is gradually developed, focusing on the patient's well-being (and, obviously, enabling the resident's professional growth). Routine is a difficult word for the surgeon and even more so for the surgical specialty resident. A day's lull with few inpatients can turn into chaos, with emergency surgeries and inpatient complications. Therefore, family dinners, social commitments or even that time allotted for study are usually rarer than you might think, and it takes understanding from friends, boyfriend, husband and family about this stage of life. The Neurosurgery residency has no prerequisites as in other surgical specialties (such as urology and plastic surgery, for example), that is, it is a direct access specialty. From a practical point of view, it is normal for first-year residents to lack basic notions of surgery. This has little impact as the program is over a period of five years and in a short time the concepts can be taught. Speaking of concepts, I consider them fundamental for the evolution of the resident. It is important to learn to place screws in the spine or to dissect the brain tumor, but much more important is to learn about the pathophysiology of the disease, understand the indication for surgery and study the surgical technique step by step. The performance of the act is only the final part of the learning stage. Of course, “learning by doing” is not prohibited or does not give results, but performing the act after having studied and understood what will be done allows the consolidation of knowledge and greatly facilitates the ability to solve problems.

The long period of residency has pros and cons: it allows training the resident for the main surgeries of the specialty, with the possibility of refining and perfecting the techniques, creating contact networks with service staff, residents and staff from other areas; on the other hand, there is clear wear and tear with the difficulties of the health system (relevant to each hospital) and the concern with allocation in the labor market. The latter is legitimate, but it should not interfere with the resident's work and behavior - it is far better to be recognized on its own merits. During the five years, satisfaction with good surgical results far outweighs frustration with complications and unfavorable outcomes. But it is in these situations of adversity that great learning takes place.

A good part of neurosurgical diseases end up creating a bond between patient and surgeon (it is not easy for anyone to allow their head or spine to be operated on), and it is this doctor-patient relationship that ends up determining an integral treatment: the patient's trust with the surgeon is so great that he seeks him out for matters often unrelated to surgery; and it is part of our role as a doctor to welcome the patient, help him and guide him. Finally, I need to make it clear that there is no cake recipe for a good residence. It is a completely new phase for the newly graduated doctor, in which there is growth as a doctor and learning a surgical specialty. Regardless of the place of residence, the advice I leave is the same: dedicate yourself, “wear the shirt” of the hospital, have goals, study, invest in your career, enjoy the moments of rest and vacation, and the main thing: BE A DOCTOR !