Faces of Neurosurgery: Legacy Lineage-Cushing, Van Wagenen and Marko

Guest post from Kristopher T. Kimmell, MD
Neurosurgical Resident, University of Rochester Medical Center
Rochester, NY

The training of all physicians is a long and arduous path. After college, there are four years of medical school. The first years are dedicated to understanding the underpinnings of biologic processes and how diseases derange this normal functioning in the human body. The next two years are devoted to observing in real-time the care of patients with myriad ailments. Following medical school, the period of graduate medical education (GME) begins. For neurosurgeons, GME includes residency and fellowship training that spans seven to ten years. While today’s GME programs have evolved in crucial ways, they remain modeled after the apprenticeship style of passing on skills by working alongside one or more experts in a field. Thus, residency and fellowship are a more hands-on experience of learning to care for patients. Historically physicians who sought a residency were required to fund their way or received a modest stipend from their mentor during their tutelage. For those residents of more modest means, this could severely curtail their training options.

William P. Van Wagenen, MD

Beyond the standard GME programs, some physicians will desire additional specialized training in areas such as research, statistics, genomics, public health and beyond. Having financial support for these endeavors is essential. Fortunately, such an opportunity exists for neurosurgeons. It is the William P. Van Wagenen Fellowship. To understand how this remarkable program started, one must look back to the father of modern neurosurgery — Harvey W. Cushing, MD. Dr. Cushing spent a portion of his own GME time in Europe — including ground-breaking work on increased intracranial pressure with the Swiss surgeon Emil T. Kocher. Dr. Cushing placed great value on his experiences in Europe and encouraged his mentees to seek similar experiences. William Van Wagenen, MD was one who followed this path to great advantage. Because Dr. Van Wagenen came from modest means as a son of farmers from Upstate New York, this opportunity was possible only through the private generosity of Dr. Cushing, who funded this GME experience. Dr. Van Wagenen did not disappoint, completing work in Germany on the biological understanding of meningiomas. He was so moved by his mentor’s generosity and his time in Europe that Dr. Van Wagenen bequeathed a significant portion of his estate when he died to establish a fund for similar training excursions abroad for graduating neurosurgical residents.

Since its inception, the William P. Van Wagenen Fellowship has been a prestigious, highly competitive post-graduate award in neurosurgery. Now overseen by the Neurosurgical Research and Education  Foundation (NREF), the Van Wagenen Fellowship has funded the research of over 40 neurosurgical graduates who have gone on to successful academic careers including department chairs.

Nicholas F. Marko, MD

One of these outstanding fellows is Nicholas F. Marko, MD. Dr. Marko expected a traditional career in clinical neurosurgical oncology and research. After graduating medical school at George Washington University and completing a residency at the Cleveland Clinic, Dr. Marko planned to enter a neurosurgical oncology fellowship at MD Anderson Cancer Center in Houston, TX. Selection as the Van Wagenen Fellow provided Dr. Marko the chance to explore new ways of thinking about neurosurgery and conducting research. Dr. Marko used his fellowship experience to study mathematics and predictive analytics at the Department of Applied Mathematics and Theoretical Physical (DAMTP) at the University of Cambridge and to apply the work to his brain tumor research at Cancer Research UK. When he returned to complete his fellowship at MD Anderson, Dr. Marko quickly found that his 12-month career detour was, in fact, a career accelerator. Today, Dr. Marko is not only the director of neurosurgical oncology at Geisinger Medical Center in Danville, Penn., he is also the first Chief Data Officer for Geisinger Health System. In this role, Dr. Marko oversees the organization’s data warehouse, big data platform, data governance processes and enterprise data strategy. He also leads a team of data scientists developing novel techniques of medical data analysis, creates new models for costs and outcome studies in health care, and architects the data management and governance of the entire health system.

Like Dr. Marko, young neurosurgeons are realizing that the next generation of physician leaders will need not only training in clinical domains but perhaps more so they will need expertise in fields such as economics, business, data science, informatics and others. The current model for GME funding provides no avenue for training in these areas. Thanks to the foresight and generosity of its namesake, as well as the stewardship of the NREF, the Van Wagenen Fellowship continues to provide a unique training opportunity for select neurosurgical trainees. Neurosurgery continues to attract some of the brightest and best graduates from medical school year after year. To provide them with the type of training that will lead to their success in the 21^st Century, opportunities akin to the Van Wagenen Fellowship need to be made available for more trainees to follow an untraditional neurosurgery path. We salute these Faces of Neurosurgery for their outstanding contributions.