2026 Poster Presentations
P457: ENHANCING MEDICAL STUDENT EDUCATION IN NEUROSURGERY: THE IMPACT OF THE SUB-INTERNSHIP ROTATION
Kennedy Carpenter1; Alankrita Raghavan, MD1; Alexander Suarez2; Steven Cook, MD1; 1Duke University; 2University of California, San Francisco
The neurosurgical sub-internship is widely recognized as one of the most influential experiences for medical students pursuing this specialty. These four-week rotations serve multiple roles, including validating specialty choice, expanding involvement in patient care, and developing core competencies. From a residency program perspective, sub-internships are heavily weighted during applicant evaluation. Neurosurgery applicants typically complete between three and four sub-internships, but despite their significance, rotations remain highly variable and unstandardized. As a result, many students enter residency feeling underprepared, with as many as half of surgical interns nationwide reporting gaps in readiness for independent responsibilities. This mismatch between time invested and educational yield highlights the need to objectively assess and refine the sub-internship experience.
To address this gap, we conducted a prospective study evaluating the impact of our institution’s neurosurgery sub-internship on fourth-year medical students between May 2022 and August 2024. A structured survey was designed to assess seven domains of intern-level neurosurgical knowledge: basic neurosurgical patient care, neurologic physical examination, bedside procedures, imaging, drain management, consultations, and operating room experience. Surveys were administered at the start and end of each four-week rotation. Pre- and post-test results were compared using paired t-tests to measure knowledge acquisition and to identify domains of both strength and persistent challenge.
Data were collected from 32 students over the study period. Results demonstrated statistically significant improvements in all seven domains, confirming the sub-internship as an effective educational tool. The most substantial gains were observed in bedside procedures (23.4% improvement, p<0.05) and operating room experience (22.5% improvement, p<0.05), reflecting the value of immersive, hands-on learning that characterizes the rotation. Basic neurosurgical patient care, while achieving the highest baseline score (85.3%), showed the smallest relative improvement (4.96%, p=0.02), possibly due to pre-existing exposure. Drain management, however, emerged as the most challenging area. Despite measurable improvement (17.1%, p<0.05), it remained the lowest-performing domain at both baseline and follow-up (55.5% and 72.5%, respectively), signaling a persistent educational gap.
These findings underscore several important lessons. Neurosurgical sub-internships provide meaningful knowledge gains across multiple domains and serve as a critical bridge between medical school and residency. Objective assessment tools can supplement subjective evaluations, providing data-driven insights into student learning. These tools also promote identification of persistently weak areas, such as drain management, highlighting opportunities for curricular enhancement.
This highlights the need for a standardized neurosurgical sub-internship curriculum. By establishing competency-based benchmarks and integrating objective evaluation, programs can ensure that students enter residency better prepared to assume responsibility for patient care. A standardized approach to subinternships will not only provide better data for programs as they recruit applicants, but will ensure that incoming interns are better prepared for residency.
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