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Diversity in Neurosurgery: Forcing Change Leads to Greater Success

By Career, Guest Post, Women in NeurosurgeryNo Comments

Should we take a stand to increase diversity? Yes! As neurosurgeons, we should talk about diversity in neurosurgery. If we don’t urge, even force change, it will not happen, or it will happen unbearably slowly. One hundred years into the history of neurosurgery, only 5% of all board-certified neurosurgeons are women. African-Americans are also underrepresented. The Association of American Medical Colleges (AAMC) calculates that African-Americans represent 4% of all active neurosurgeons in the U.S.

Why does diversity matter? There is a compelling business case to be made for supporting equity and striving for inclusion. Companies with 30% or more women in the C-suite have reported higher profits than companies without women in their leadership team. A diverse workforce brings diverse perspectives, experiences and skills to the table, and it pays off.

The benefits of diversity aren’t limited to the corporate world. Diversity of opinion leads to better outcomes and fosters innovation and creativity across a variety of disciplines. The diversity of our patients should be reflected in the physicians who provide them care. Although we are all the same under the scalpel — cultural, religious, socioeconomic, ethnic and racial differences play a significant role in patient-physician relationships and impact patient satisfaction, patient compliance and health care outcomes. As surgeons, we need to continually enhance our awareness of and ability to manage our biases and racial/ethnic identity. We need to apply our critical appraisal skills, honed to perfection, to treat our seriously ill patients, to recognize that both explicit (conscious) and implicit (subconscious) biases can stand in the way of increased diversity and inclusion and prevent some of our patients from having the best outcomes possible.

Although neurosurgery has a more diverse group of residents than ever before, we need to work hard to retain these residents long-term and make sure they succeed. Female gender is one of the leading factors associated with burnout and attrition in our specialty. This is not due exclusively to the long and unpredicted work schedules related to the specialty. Microaggressions, lack of collegial relationships and tolerance of unacceptable behavior by faculty should be considered as well. These insidious factors can fester in a workplace culture because of a lack of mechanisms and implicit barriers for reporting, such as fear of shame, retaliation, or not advancing. Many minorities experience overt and implicit forms of discrimination. This may be exhibited openly from patients who mistake someone for a nurse of a janitor or refuse care from a minority physician. Sadly, this can come in more hidden ways from peers who won’t put a resident in a challenging case because of race or gender.

It is not enough to focus on micro-level interventions — we also need to look at organizational structures and attitudes that push women and minorities away from neurosurgery. It has been shown that interventions focused on cultural competencies in health care organizations improved the hospital’s diversity climate. These interventions have focused, among other aspects, on diversity attitudes, implicit bias and racial/ethnic identity status. However, too many health care organizations and departments approach diversity with a sense of tokenism instead as a business imperative and driver of strategy.

In his 2004 bestseller, “Moneyball,” Michael Lewis wrote: “What begins as a failure of the imagination ends as a market inefficiency: when you rule out an entire class of people from doing a job simply by their appearance, you are less likely to find the best person for the job.” All medical specialties want to attract the best and brightest young people. Diversity strengthens neurosurgery. Attracting people with different strengths and backgrounds to our profession can help unleash new sources of talent and creativity that can only benefit our profession and our patients.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #WomenInNeurosurgery and #CelebratingWINSat30.

Martina Stippler, MD, FAANS, FACS
Beth Israel Deaconess Medical Center
Boston, Mass.

The Use of Social Media in Addressing Gender Disparities in Neurosurgery

By Career, Guest Post, Healthcare Social Media, Women in NeurosurgeryNo Comments

The importance of social media in neurosurgery, and medicine in general, has increased significantly over the past several years. As searched on PubMed, academic publications that include the search terms “social media neurosurgery” have increased over the last 10 years. Through various social media platforms, neurosurgeons can participate in educational endeavors, share scientific findings, build their brand and collaborate with others in the field despite geographical distance. The interactions that social media offers also provide an opportunity to network — to find mentors, role models and even friends outside one’s local academic and geographic environment.

A recent article by Norton et al. in the Lancet Neurology hypothesized that social media could address the gender gap in neurosurgery. As stated by Jamie S. Ullman, MD, FAANS, FACS, in a recent Medscape article, 12% of residents in neurosurgery are female, but only 5% of practicing neurosurgeons are women. Social media platforms allow females to identify other women in the field and provide a way to interact with these colleagues. Traditionally, a primary venue for networking has been conferences, such as the annual meetings of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons. While these meetings provide opportunities to meet others in the field, they can be daunting for a young neurosurgeon, particularly a woman, as most attendees and speakers are male. The internet is easily searchable — undergraduates, medical students and residents can identify females in all levels of academic neurosurgery, including multiple chairwomen. Using social media platforms, interacting with other women is straightforward and often less daunting than doing so in person. Organizations such as Women in Neurosurgery (WINS) can promote and amplify women’s voices in the field and bring attention to challenges unique to female surgeons. Seeing that other women have overcome these challenges to become faculty, full professors and the president of the AANS can offer encouragement and may prevent attrition.

Social media’s utility in addressing the gender imbalance does not apply just to women but to all minorities who have difficulty seeing themselves in a field with so many challenges. Identifying someone of similar gender, race, ethnicity or background who has achieved one’s desired goal makes it easier to believe that it is possible. Although academic interest regarding gender and neurosurgeons has increased — as evidenced by the number of articles devoted to this topic — the same cannot be said for other underrepresented groups. Literature searches in PubMed for “diversity,” “minority” or “underrepresented” in combination with neurosurgery did not identify articles assessing the impact of any minority status on entering neurosurgery, neurosurgical success or attrition. This may be due to the small number of minority practitioners.

Social media may be particularly useful for establishing connections within groups that are underrepresented in neurosurgery, and medicine in general. Our specialty can only improve as its practitioners reflect the diversity of our patients and as we continue to attract the best and brightest minds from all available backgrounds, demographics and socioeconomic groups.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #WomenInNeurosurgery and #CelebratingWINSat30.

Angela M. Richardson, MD, PhD
Skull Base and Cerebrovascular Fellow
University of Wisconsin – Madison
Madison, Wisc.

 

 

Sheri Dewan, MD, MS, FAANS
Northwestern University Feinberg School of Medicine
Chicago, Ill.

Women in Neurosurgery — A Legacy of Achievement and Breaking Barriers

By Career, Guest Post, Women in NeurosurgeryNo Comments

The past century has demonstrated tremendous progress in all disciplines of medicine. Parallel to this progress, and often a direct contributor to breakthroughs and achievements, has been the increasing role women have played in the profession. Neurosurgery is no exception. Although their ranks are small, especially compared to other specialties, the women of neurosurgery have played an outsized role in its rise as a specialty in the last hundred years.

The first major female contributor to the specialty was Louise Eisenhardt, MD. Dr. Eisenhardt had a unique and close working relationship with Harvey W. Cushing, MD, who is regarded as the father of modern neurosurgery. Dr. Eisenhardt was considered Dr. Cushing’s “right hand.” Before deciding to go to medical school, she began work in 1915 as an editorial assistant for Dr. Cushing. She continued to work for him while enrolled at Tufts University School of Medicine. Dr. Eisenhardt later rejoined Dr. Cushing as a neuropathologist and served as his surgery associate from 1928 to 1934, making on-the-spot diagnoses of tumors and tissues as Dr. Cushing removed them. While continuing to make pathologic diagnosis of tumor tissues, she kept a cumulative case log, co-authored papers with Dr. Cushing and taught neuropathology at Tufts. In 1938, Dr. Eisenhardt became the curator of the Yale University Brain Tumor Registry, which she and Dr. Cushing established. In 1944, she became the first Editor of the Journal of Neurosurgery — the official journal of the American Association of Neurological Surgeons (AANS) — and remained in that role for 22 years. From 1938-1939, Dr. Eisenhardt served as the first female president of the AANS (formerly known as the Harvey Cushing Society).

Over the years, other female neurosurgeons continued to expand the role of women in the specialty and made significant impacts in the field of neurosurgery. In 1986, Frances K. Conley, MD, MS, FAANS (L), became the first female to be appointed to a full tenured professorship of neurosurgery at a medical school in the U.S. In 1991, she made national headlines when she announced her intention to resign her tenured position as a neurosurgery professor at Stanford University Medical School in protest against the sexist attitudes of a male colleague who had recently been promoted. In 1998, her book Walking Out on the Boys was published, in which she recounted her experiences as a female surgeon and the sexism within the medical profession.

Ruth Kerr Jakoby, MD, FAANS (L), became the first female diplomate of the American Board of Neurological Surgery (ABNS) in 1961. In addition to her many other accomplishments, she served as president of the Washington Academy of Neurosurgery in 1972. In 1986, she became the first female neurosurgeon to become a lawyer. In 1981, Alexa Irene Canady, MD, FAANS (L), became the first African American female in the U.S. to become a neurosurgeon. She was also the recipient of two honorary doctorate degrees and was inducted into the Michigan Woman’s Hall of Fame in 1989.

In recent years female neurosurgeons have risen to the very top ranks of the specialty. In 2005, Karin M. Muraszko, MD, FAANS, became the chair of the University of Michigan Department of Neurosurgery, making her the first woman to chair an academic neurosurgical department in the United States. She also became the first female appointed as a director of the ABNS. In 2018, Odette Harris, MD, MPH, FAANS, obtained a tenured neurosurgery professor position at Stanford University School of Medicine, making her the first Black female to do so in the U.S. From 2018-2019, Shelly D. Timmons, MD, PhD, FAANS, was the first female neurosurgeon to serve as AANS president and the second female to rise to this position — 79 years after Dr. Eisenhardt. In 2019, Dr. Timmons also became the chair of the Department of Neurosurgery at the University of Indiana.

Thankfully, the upward trend of women in neurosurgery continues. According to the ABNS, 7.4% of the 6,069 active diplomates are women, and 16% of the 1,489 neurosurgery residents are women. These percentages are expected to rise as more women enter neurosurgery training programs. This promises to make the second century of our specialty full of even more notable breakthroughs and achievements.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #WomenInNeurosurgery and #CelebratingWINSat30.

Disep I. Ojukwu, MD, MBA, MPH
St. George’s University School of Medicine, Class of 2019

 

 

 

Laura Stone McGuire, MD
University of Illinois College of Medicine at Chicago
Neurosurgery Resident

Progress Incremental: Understanding Sexual Harassment in Neurosurgery

By Career, Guest Post, Women in NeurosurgeryNo Comments

Under the table, his hand landed uncomfortably high on my thigh. Our conversation had drifted from our mutual interests in molecular biology research of brain tumors to books and music. Until that moment, I had felt really positive about our connection. It was 1984, and my infatuation with neurosurgery had led me to try and break into an overwhelming male subspecialty. I knew it would take something special to convince a program to make the leap and accept a woman. Throughout the lavish dinner event for the visiting resident applicants, I had foolishly thought, perhaps this was such an opportunity. When the hand landed, the conversation abruptly changed, and the senior faculty leaned very close and, with an unmistakable leer, said, “I would really love to help you become the first woman in our residency program. Shall we make those plans later tonight?”

Somehow, I managed to secure a residency training position in neurosurgery despite the odds and for the last four decades have navigated my training, clinical growth, academic advancement and rise in national leadership positions. Fortunately, I never again encountered such a blatant attempt for someone in a powerful position to coerce me into a sexual encounter. Still, there certainly were many times when I experienced other forms of sexual harassment. As is typical, for years, I said nothing — even to close friends or family — because somehow I felt “responsible” or else feared the consequences. All this time, I blindly assumed this was only happening to me and because I lived in a male-dominated surgical specialty.

Slowly over time, I became aware that I was not alone, and my experiences were similar to others. Unfortunately, others experienced far worse. (See Table 1). Those of us in the first wave of women in neurosurgery — training in the 1970s to early 1990s — naively hoped that our increasing numbers, sheer presence and leadership positions would lead to change. We had hoped that such behavior belonged only to the past. Sadly, we realized that was not the case.  When those efforts seemed ineffective, many of us quietly tried to rally neurosurgical leadership around efforts to try and improve the situation. Yet we were often met with disbelief there was a real problem.

When the #MeToo movement hit the media, however, many in neurosurgery recognized our potential vulnerability. And in 2018, the One Neurosurgery Summit established the Neurosurgery Professionalism Taskforce (NSPT). Under the leadership of James T. Rutka, MD, PhD, FAANS, and Karin M. Muraszko, MD, FAANS, the goal of the NSPT was to provide a comprehensive report on policies and recommendations regarding sexual harassment in neurosurgery. While the NSPT undertook many activities, one major initiative was the creation and administration of a survey to assess the depth and breadth of sexual harassment across neurosurgery.

I am proud to have co-authored the manuscript Toward an Understanding of Sexual Harassment in Neurosurgery published in the Journal of Neurosurgery. I genuinely believe it is a huge step forward for our specialty and part of slow but meaningful incremental progress. (See Table 2). The information gleaned from the survey, and the recommended strategies are important and can also serve all of medicine — especially those traditionally male-dominated specialties.

As the saying goes, “we have come a long way, baby,” as we celebrate 100 years of women’s right to vote in the U.S., the 30th anniversary of the Women in Neurosurgery Section (WINS) and now the publication of this landmark article. I hope this means no future neurosurgical residents — of any gender, race or sexual preference — will face the serious challenges of harassment that I and too many others have over many years. I remain ever hopeful.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #WomenInNeurosurgery and #CelebratingWINSat30.

Deborah L. Benzil, MD, FAANS, FACS
Cleveland Clinic, Vice-Chair, Neurosurgery
Cleveland, Ohio

WINS: Celebrating Women in Neurosurgery

By Career, Guest Post, Women in NeurosurgeryNo Comments

Gender diversity is not just good for women; it’s good for anyone who wants results.”

Melinda A. Gates

Modern neurosurgery recently crossed the century threshold as a medical discipline. The profession has a rich history, and women have played critical roles throughout the development of the specialty. The role of women in neurosurgery began with Louise Eisenhardt, MD, who was at the side of Harvey Cushing, MD, through much of his career. Ruth K. Jakoby, MD became the first woman diplomate of the American Board of Neurological Surgery in 1961. Later, Frances K. Conley, MD, achieved several ‘firsts’ as a woman in academic neurosurgery, culminating in a promotion to a full professorship at Stanford University in 1986.

These women have set examples for all of us by overcoming obstacles and biases based on their gender. As more women have entered this noble profession, the need for a forum to celebrate achievement and address issues specific to women became evident. Eventually, the Women in Neurosurgery Section (WINS) of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) was formed with a commitment to support professional growth and development and enhance and facilitate interaction among women neurosurgeons. Today, WINS strives to promote an environment supportive of personal values and individual diversity for women neurosurgeons in various career stages.

2020 marks the historic 30th anniversary of the founding of WINS and brings an exciting time to the WINS community and neurosurgery. To celebrate the 30th anniversary of WINS, Neurosurgery Blog will highlight the goals of the section — to educate, inspire and encourage women neurosurgeons to realize their professional and personal goals. WINS also serves women in neurosurgery by addressing the issues inherent to training, and maintaining a diverse and balanced workforce is the mission of this section.

The series will include the following contributions:

  • Deborah L. Benzil, MD, FACS, FAANS, will discuss the origins of WINS and how it shaped her career;
  • Sheri Dewan, MD, FAANS, and Angela M. Richardson, MD, PhD, will discuss using social media in addressing gender disparities;
  • Disep I. Ojukw, MD, MBA, MPH, and Laura S. McGuire, MD, write about breaking barriers and the legacy of achievement of women in our profession;
  • Anahita Malvea and Alexandra Beaudry-Richard contrast the myths and truths of women in neurosurgery from the perspective of medical students; and
  • Martina Stippler, MD, FAANS, will discuss how forcing change leads to greater success.

We will give voice to women from across the spectrum of our profession, from students on the cusp of embarking on this tremendously rewarding personal and professional journey, to women who have dedicated most of the adult lives to advancing the art and science of the specialty. Neurosurgery is not alone in that when given a choice, we should choose and foster diversity, and the long and successful history of WINS is a testament to that. We invite our readers to participate actively and share their own stories of progress and breakthrough.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtags #CelebratingWINSat30 and #WomenInNeurosurgery.

Alia Hdeib, MD, FAANS, FACS
Case Western Reserve University
Cleveland, Ohio

 

 

Jennifer A. Sweet, MD, FAANS, FACS
Case Western Reserve University
Cleveland, Ohio

AANS Neurosurgeon Spotlight: Winter 2020 – The Mind of a Neurosurgeon Part III

By AANS Spotlight, Career, Faces of Neurosurgery, Food for thoughtNo Comments

From training appraisal to relocation, authors explore the neurosurgeon perspective in AANS Neurosurgeon’s The Mind of a Neurosurgeon. Prominent neurosurgeons discuss their unique experiences in a field in which few have the opportunity to work and thrive.

Changing Gears: Mid-Career Relocation as a Catalyst for Better Patient Care
Daniel Orringer, MD, FAANS

  • Inspirational leadership; state-of-the-art facilities; a cumbersome electronic medical record; affiliation with a top-notch medical school; and a culture and history of excellence.
  • Navigating geographic change – from Ann Arbor to New York.
  • Navigating institutional change – evaluating essential components of a routine.
  • A new team – leading with the patients’ interest in mind.

The Mindful Neurosurgeon and the Art of Doing What’s Right
Edward C. Benzel, MD, FAANS

  • The desire for personal gratification, professional advancement and monetary gain can lead one to their neurosurgical calling.
  • The mindful neurosurgeon does not look at a job from the perspective of the job being a commodity generator, but from the perspective of the job as a calling.
  • Good leaders are selfless guides, reflective and empathetic.
  • The truly mindful neurosurgeon values doing what is right over all else.

Building the Neurosurgical Mind: Critical Appraisal in Neurosurgical Training
Beverly C. Walters, MD

  • Neurosurgical training goals focus on specialty knowledge acquisition, development of technical skills involving eye-hand coordination, learning how to collect important patient data and enhancement of critical thinking ability.
  • Look at the structure of research that tries to promote changes in practice to develop skills in evaluation of data and to be able to decide, factually, whether the ideas are worthy of inclusion in clinical practice – or, more importantly, if they are not worthy.
  • This basic concept of understanding the successes and failures of clinical research in our specialty and development of the ability to use data in the treatment of patients became known at the end of the twentieth century as evidence-based medicine.

Read More from The Mind of a Neurosurgeon.