MD One M3 elective opportunity: neuro or ENT

[DrRiker]

For context, I’m really into ophtho and have been since a couple years before M1. My goal with electives is to either a) learn more about medicine in general, or b) consider similar specialties that I could end up liking more than ophtho. With the one four-week elective I have free next year (the other is research), I’m considering neuro and ENT.

Neuro pros:
Relevant to ophtho
Lots of research in the field
Broadly relevant, would learn skills that transfer to almost any field
Really interesting from an academic standpoint (broad differentials, thought provoking)

Neuro cons:
From my understanding, there’s not a whole lot that can be done after making the diagnosis (save for some things like MS disease modifying agents and Botox injections) - please correct me if I’m mistaken because this is where I could be sold on
Neuro)
For that reason, not sure if I’d love it as a career

Oto pros:
Similar to ophtho in terms of outpatient surgery and clinic
Skull base procedures seem really cool
Fascinating anatomy

Oto cons:
Lacking some of basic science research that attracts me to ophtho and neuro
Correct me if I’m wrong, but the most thought provoking aspects of the field seem to be less diagnostic and more surgical
I like thinking a lot about pathophys, therefore not sure if I’d love this as a career

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[JP2740]

If you like ophtho, don't consider doing neurology. If you're not going into neurology, then I think the amount of ophtho relevant stuff you learn is going to be limited - just learn it during residency.

Do the ENT rotation if there's a possibility you will like it and do that instead.

 

[mrbreakfast]

From my understanding, there’s not a whole lot that can be done after making the diagnosis

This is a common perception but not correct - if it were, why would there be a need for neurologists? Like every field in medicine, there are things you can cure, things you can manage with medication, and things you can't do much about. One aspect is that we haven't yet figured out how to transplant the brain or nervous system, so you're going to inevitably have irreparable failure of that organ system, but outside of things like MSA, CJD, ALS, GBM, etc (all of which are rare) there's a lot you can treat. Diagnosis in neurology is complicated - a lot rides on the exam and interpretation of imaging, which is tough for med students to learn - so boards focus on things which have very pathognomonic presentations, like ALS or a massive MCA stroke. In reality a lot of what we see are people who have headaches, pain, weakness, difficulty moving, spells of alterations of consciousness, or altered mental status, most of which we can treat.

If you're looking for an alternative to ophtho, neurology is a fine field, though it's a non-operative field, so is pretty different. If you're looking to learn more about ophtho from an elective, there is overlap between the fields, though you may complete a full four-week neuro elective without seeing anything eye-related.

If you're interested in another surgical field, ENT may be fine to try, but just keep in mind you're deciding between applying early (for ophtho) or doing multiple away rotations (for ENT). If I remember correctly from med school, people interested in doing one of those fields spend much of M3 preparing their application.

I think a neuro rotation would be more applicable to medicine in general, but as a neurologist I'm obviously biased. Really you need to decide whether you want to be a surgeon or not and go from there.

 

[DrRiker]

This is a common perception but not correct - if it were, why would there be a need for neurologists? Like every field in medicine, there are things you can cure, things you can manage with medication, and things you can't do much about. One aspect is that we haven't yet figured out how to transplant the brain or nervous system, so you're going to inevitably have irreparable failure of that organ system, but outside of things like MSA, CJD, ALS, GBM, etc (all of which are rare) there's a lot you can treat. Diagnosis in neurology is complicated - a lot rides on the exam and interpretation of imaging, which is tough for med students to learn - so boards focus on things which have very pathognomonic presentations, like ALS or a massive MCA stroke. In reality a lot of what we see are people who have headaches, pain, weakness, difficulty moving, spells of alterations of consciousness, or altered mental status, most of which we can treat.

If you're looking for an alternative to ophtho, neurology is a fine field, though it's a non-operative field, so is pretty different. If you're looking to learn more about ophtho from an elective, there is overlap between the fields, though you may complete a full four-week neuro elective without seeing anything eye-related.

If you're interested in another surgical field, ENT may be fine to try, but just keep in mind you're deciding between applying early (for ophtho) or doing multiple away rotations (for ENT). If I remember correctly from med school, people interested in doing one of those fields spend much of M3 preparing their application.

I think a neuro rotation would be more applicable to medicine in general, but as a neurologist I'm obviously biased. Really you need to decide whether you want to be a surgeon or not and go from there.

This information is great to hear. You're right - I doubt that I'd be able to elegantly pivot to ENT considering how much I've already invested in ophtho. There are elements of surgery that I like, but I don't love the OR enough to consider a field like gen surg. What draws me to surgery is the ability to get hands on, fix, and see results, but I'd prefer to spend more time thinking about diagnostic challenges than surgical technique (much like my engineering background, figure out a problem in the system and apply the fix). Ophtho and the outpatient surgical subspecialties give some of both, as do some of the more procedural internal medicine subspecialties like cardiology. Does neurology offer much of this?

 

[mrbreakfast]

For hands-on diagnosis, certainly, as neurology is one of the few medical fields where every patient needs a physical exam, and there are diagnostic procedures like EMG. Theoretically you can diagnose a large number of conditions exclusively by the physical exam alone, without relying on labs or other things.

If you want to "fix" people with your hands, though, there isn't much. Injections (and, for some people, acupuncture) probably don't count, and while neurology has its own version of interventional cardiology (interventional neurology, which pulls out clots causing strokes, closes aneurysms, and does many other thing) it is more of a niche field which requires 3 years of fellowships and has competition from neurosurgery and IR. The most "immediate" thing I do with my hands is push tPA, which can sometimes have a dramatic effect, but ultimately is just pushing on a syringe.

 

[longhaul3]

I would do ENT. If you're going to do ophtho you will learn everything you need to know about neurology in residency as there is a dedicated neuro-ophthalmology subspecialty.

As a med student I think ENT is a good rotation because you can learn about airway management which is critical for any physician, especially junior residents who will be taking in-house call. I wish I had realized that in med school and gotten some background before all my ICU time as a resident, especially intern year.