Duke is consistently ranked as one of the top medical schools by U.S. News & World Report.   The Duke Neurosurgery program has a long and successful tradition in the training of neurosurgeons throughout the history of American neurosurgery, including those just starting to investigate the process during medical school.  Visiting medical students are always welcome and encouraged to rotate through the Duke University Neurosurgery program as a subintern.  We encourage you to consider the program after you have completed your basic surgical and medical rotations in medical school – this will greatly facilitate you making the most of your subinternship with us. 

 

Following are several questions and answers that may be helpful to the student interested in our program.

 

You need to register for a 4^th year elective entitled  “Surgery -435C Clinical Neurosurgery” so that you officially get credit (and a grade).  This information is explained on the Duke Registrar's website: Visiting Student Program Policy. You can see a short description of the elective under the "4th year electives" document (page 56) on that website.  Also, if you scroll to the bottom of this registrar website page, beneath the section entitled "Information for Visiting Medical Students at LCME (US Medical) and AOA (Osteopathic) Institution," you will find the link to the application.  First, please contact Steven Wilson, the director of visiting student rotations, in the Duke Registrar's office at (919) 684-2304, or wilso141@mc.duke.edu.  Steven will register you for the desired dates and then will contact our Administrative Manager, Karen Koenig (919-684-3271) to make sure the dates are available.  Karen will communicate with our faculty and residents about your rotation.  Karen can help you with questions, but you should FIRST contact Steven in the registrar's office.  The registrar’s office will let Karen know when you are officially registered and then she can help you with logistics (where to show up the first day).

 

Yes.  We strongly encourage you to email any of the residents with any questions whatsoever.  We enjoy having students on our service and are eager to help make the process as informed, easy, and successful for you as possible.  You may find their email addresses on our website under Education>Neurosurgery Residency Program>current residents.  Residents in their research year will probably be the most helpful.  This year, they are Chuck Kanaly (charles.kanaly@duke.edu) and Steve Parker (stephen.parker@duke.edu).

 

 

1 or 2 students per month during any month of the year. 

 

No.  The subinternship is designed to primarily help you decide if neurosurgery is the career for you and then help you decide if you would be happy with us.  Of course, it may help us get to know you a little bit better, but this rotation is certainly not required to match with us.

 

One month.  You can register for 2 months, but most subinterns find that 1 month is just right.  You will spend three weeks at Duke Hospital and one week at the adjacent Durham VAMC.  The Durham VAMC Neurosurgery is the busiest surgical practice at the VA and has one of the busiest neurosurgery practices in the country.  All VA neurosurgeons and residents are from Duke, so it’s an excellent opportunity for more one-on-one interaction with Duke residents and attendings.

 

There are application and registration fees of about $250.  You may stay with one of our residents to reduce your expenses, so please email them to see if any has a spare bedroom while you are here.  The school of medicine registrar’s office has a list of housing opportunities for visiting students that will be much, much cheaper than a hotel.  If you bring a car, the registrar’s office can help with parking passes, but there will be a parking fee.  You should bring a little spending money to cover all your meals and enjoy the city of Durham. 

 

Duke neurosurgery is one of the largest and busiest academic programs in the country.  The service at Duke will expose you to a wide array of basically all types of currently performed neurosurgical disciplines, including numerous primary and secondary brain and spinal tumors (one of the largest high grade glioma patient populations in the world), skull base tumors, complex spinal resections and fusions (congenital, trauma, tumor), pain and functional neurosurgical procedures, peripheral nerve procedures, a large pediatric service, open vascular and endovascular procedures.  Additionally, you will have the opportunity to follow residents on inpatient and ER consults, as well as evaluate ICU patients.  There is a large mix of adult and pediatric cases.

 

The subintern will preround with one resident on that resident’s patients and then round with the entire team of residents on the entire service in the morning.  You may elect to follow closely a few patients, presenting them on morning rounds and helping to formulate a care plan.  Following this, you will participate in the operating room of your choice (depending on your own interests, previous exposures, and what procedures are scheduled that day).  You may perform post-operative checks on patients in the PACU and ICU.

 

Yes.  You should take call with residents to better learn about inpatient and ER consults.  This is perhaps the best way to see first-hand what to expect as a neurosurgery resident at Duke.  You are encouraged to take call at least once per week, but may take call up to every third night if you desire. 

 

Absolutely.  There is ample opportunity.  You are not required to make any presentations, but you may certainly participate under the guidance of the chief resident.  You may present a topic of your choice (30 minute talk) at the Wednesday morning “Fundamentals of Neurosurgery” conference.  This can be research you have previously done, literature review of a current patient encounter, or review of an important neurosurgical topic relevant to your subinternship experience (e.g. the indication, technique, and outcome of a particular procedure of interest.  Recommend 1 presentation toward end of rotation).  You may present journal articles at our Wednesday morning “Literature Review” journal club conference.  (Recommend 1 or 2 during one rotation.)  You may also present a patient at the Wednesday morning “Multidisciplinary Case Review” radiology conference if your patient that you are following is being discussed.  (Recommend no more than 1 patient per Wednesday.)

 

As much as you want!  All attendings are excellent to work with!  Generally, you have to designate one attending supervisor when you register for the course.  However, you may elect to attend operations with any attendings of your choosing, but we encourage you to scrub in with as many different attendings as possible so you can get to know us.  You also spend one day per week in our outpatient clinic where you can interact more closely with an attending.

 

Absolutely!  You are encouraged to scrub in on cases (not merely watch) and start learning how to operate.  You can start honing your skills at opening and closing cases with residents.  You may assist with any procedures done outside the operating room as well – lumbar drains, halo and biopsy frame placement, ventriculostomies, and any ICU procedures such as central line placement.

    13.  How is malpractice insurance handled?

 

In the past, this has been a common difficult issue, so you might want to inquire about this at your home institution before starting the process of registration.  Here at Duke, your institution has to cover this during your subinternship.  Surprisingly and unfortunately, not all medical schools provide this benefit, so ask your registrar's office.  Our registrar's office may be able to help with additional questions regarding this.  

 

    14.  Can I visit for just a few days and simply OBSERVE and not sign up for formal subinternship?

Absolutely.  We encourage any exposure you can get to help you choose your career.  If you would like to simply observe for a few days and interact with faculty and residents, then email our Administrative Manager, Karen Koenig (919-684-3271, karen.koenig@duke.edu) to arrange.  She will help you get ID badge and sign "visitor and confidentiality agreements" for observing cases in the OR.  You can round with residents and faculty, observe in outpatient clinics, and attend operative cases.  You will not get any formal credit/grade for this experience.

 

    15.  Do I have to complete the USMLE tests to do a subinternship at Duke?

 

No, but you should be aware of recent new national changes in USMLE test requirements with respect to residency.  All new residents must pass steps 1 and 2 before starting internship and you must pass step 3 before PGY3.  See http://www.gme.duke.edu/hsmanual/usmlepolicy.htm for more details about this policy.

 

    16.   What if my question is not found here?

 

Do not hesitate to contact us!  Feel free to email Dr. Adamson (cory.adamson@duke.edu) or any resident with any questions.