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How a Small Education Campaign Helped Change the Landscape of Concussion Education and Policy

By Guest Post, TBI, Trauma, Traumatic Brain InjuryNo Comments

Figure 1: CDC HEADS UP materials 2003 through present

This March, in recognition of Brain Injury Awareness Month, we want to take a moment to reflect on the momentous progress that has been made related to concussion education over the last 20 years. During that time, the Centers for Disease Control and Prevention’s (CDC) HEADS UP concussion education initiative started as a small campaign and grew to become an integral part of concussion education. This had a substantial impact on concussion laws and policies nationwide.

In the Children’s Health Act of 2000 (H.R. 4365) (Library of Congress, 1999–2000), Congress charged CDC to develop a public information campaign to broaden public awareness of the health consequences of traumatic brain injury. In response, in 2003, CDC released the HEADS UP: Brain Injury in Your Practice tool kit for health care providers. The goal of the tool kit was to improve awareness among primary care providers about the diagnosis and management of mild traumatic brain injury, an under-diagnosed and under-identified injury. Since then, CDC HEADS UP has become the go-to resource for concussion prevention and education — reaching millions of Americans with concussion information. CDC HEADS UP materials cover how to prevent, recognize and respond to a possible concussion or other serious brain injury. It has grown to include materials for health care providers, coaches, parents, school professionals, sports officials, and kids and teens (Figure 1). Some successes of CDC HEADS UP include:

  • Reaching more than 200 million people through ad campaigns, PSAs and more;
  • Partnering with more than 85 organizations (including the American Association of Neurological Surgeons and the Congress of Neurological Surgeons) across the fields of athletics, health care, public health, education and scientific research; and
  • Creating over 100 communication products to promote concussion prevention and care.

Educating People and Communities

One of the biggest achievements of CDC HEADS UP has been its ability to support the implementation of Concussion in Sports laws that now exist in all 50 states and the District of Columbia. Concussion in sports laws (sometimes referred to as return-to-play laws) was first passed in Washington state in 2009. These laws focus on concussion safety for youth. Most require that coaches and others involved in youth sports receive training on concussion identification and response before the start of the sports season. CDC HEADS UP provides six online training courses designed for coaches, health care providers, school professionals, athletic trainers and sports officials (Figure 2). The availability of these quality training courses (at no cost) allows states, sports programs and schools to comply with education requirements contained in concussion in sports laws and policies. To date, more than 10 million people nationwide have completed at least one of these six training courses.

Figure 2: CDC HEADS UP online training courses on concussion used nationwide to implement state concussion policies and laws

Importantly, CDC HEADS UP educational initiatives and materials align with the best scientific

evidence available on concussion prevention and management. Studies show that CDC HEADS UP materials:

  • Increase communication about concussion between athletes and their parents;1
  • Reach a large number of coaches and parents and improve their knowledge about concussions;2-4
  • Lead coaches and others to view concussion more seriously;3,5,6
  • Increase the capacity of youth sports coaches to prevent, recognize and respond to sports-related concussions appropriately;6
  • Improve knowledge about symptom resolution and return-to-play recommendations;3,6 and
  • Improve awareness of underreporting of concussions among athletes.3

CDC HEADS UP to the Future!

CDC HEADS UP has contributed to a new landscape of concussion awareness in the United States — building, improving and supporting concussion safety around the country. However, the work of the campaign is not yet done. Exciting upcoming CDC HEADS UP initiatives include:

  • An updated and expanded training for youth sports coaches—the most popular CDC HEADS UP product;
  • Resources to help parents of toddlers and young children learn about concussion safety, prevention and care; and
  • Enhanced efforts to reduce disparities through concussion educational materials tailored for American Indian/Alaska Native, Black and Hispanic parents and youth.
  • Make a Difference Where You Live

CDC works to put HEADS UP concussion materials into the hands of parents, healthcare and school professionals, coaches, athletes and others. You can support this mission by:

In 2023, we celebrate 20 years of CDC HEADS UP’s contribution to the substantial strides in educating the public about concussion. Together we all can play a part in ensuring that the next generation of children is better protected from concussions and their potentially serious effects.

References:

  1. Zhou, H., Ledsky, R., Sarmiento, K., DePadilla, L., Kresnow, M.J., Kroshus, E. (2022).Parent–Child communication about concussion: What role can the Centers for Disease Control and Prevention’s HEADS UP concussion in youth sports handouts play? Brain Injury, 36:9, 1133-1139, https://doi.org/10.1080/02699052.2022.2109740.
  2. Parker, E. M., Gilchrist, J., Schuster, D., Lee, R., & Sarmiento, K. (2015). Reach and Knowledge Change Among Coaches and Other Participants of the Online Course: “Concussion in Sports: What You Need To Know.” Journal of Head Trauma Rehabilitation, 30(3), 198–206. https://doi.org/10.1097/HTR.0000000000000097.
  3. Daugherty, J., DePadilla, L., & Sarmiento, K. (2019). Effectiveness of the US Centers For Disease Control and Prevention Heads Up Coaches’ Online Training as an Educational Intervention. Health Education Journal, 78(7), 784–797. https://doi.org/10.1177/0017896919846185.
  4. Rice, T., & Curtis, R. (2019). Parental Knowledge of Concussion: Evaluation of the CDC’s “HEADS UP to Parents” Educational Initiative. Journal of Safety Research, 69, 85–93. https://doi.org/10.1016/j.jsr.2019.02.007.
  5. Daugherty, J., DePadilla, L., Sarmiento, K. (2020). Assessment of HEADS UP online training as an educational intervention for sports officials/athletic trainers. Journal of Safety Research, 74:133-141. https://doi.org/10.1016/j.jsr.2020.04.015.
  6. Covassin, T., Elbin, R. J., & Sarmiento, K. (2012). Educating Coaches About Concussion in Sports: Evaluation of the CDC’s “HEADS UP: Concussion In Youth Sports” Initiative. The Journal of School Health, 82(5), 233–238. https://doi.org/10.1111/j.1746-1561.2012.00692.x.
March 22, 2023
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Cross-Post: Neurosurgery Announces Global Neurosurgery ‘Moon Shot’ with New Editorial Board Section

By CNS Spotlight, Cross Post, Guest PostNo Comments

From time to time on Neurosurgery Blog, you will see us highlighting items from other places when we believe they hit the mark on an issue. To this end, we want to bring attention to the new Neurosurgery Editorial Board Section, “Global Neurosurgery,” highlighted by Section Editor Gail L. Rosseau, MD, FAANS, FACS, in the October issue of Neurosurgery.

As highlighted in a recent announcement about the new feature, “Despite rapid advancements in neurosurgical techniques and capabilities, much of the world’s population has limited or no access to modern care for brain and spinal trauma, stroke, tumors, and other neurological conditions.” To remedy this inequity, the Editor-in-Chief of Neurosurgery, Douglas S. Kondziolka, MD, FAANS, introduced this new section to help advance timely, safe and affordable neurosurgical care to all who need it. Comprised of experts from every generation and continent where neurosurgery is practiced, this new Neurosurgery feature is working to attract the highest-quality global neurosurgery manuscripts, emphasizing policies to assure equity in authorship, access and use of local data.

Dr. Rosseau likens the Global Neurosurgery initiative to President John F. Kennedy’s commitment to land American astronauts on the moon, “no specialty and no nation which expects to be a leader can expect to stay behind in the quest for highest quality health care for all people.”

To read the full Editorial in Neurosurgery, click here.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NeurosurgeryCNS.

October 19, 2022
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The Long Game: The CNS’ Investment in the NINDS/CNS Getch K12 Scholar Award

By Career, DEI, Guest Post, HealthNo Comments

In 2012, the Neurosurgeon Research Career Development Program (NRCDP) set a goal to grow a diverse corps of neurosurgeon scientists at institutions across the United States. The Congress of Neurological Surgeons (CNS) and the CNS Foundation became early partners in this effort by establishing the National Institutes of Neurological Disorders and Stroke (NINDS)/CNS Getch K12 Scholar Award, named in honor of the CNS Past President Christopher C. Getch, MD, FAANS, a respected neurosurgeon, friend and leader, who passed away unexpectedly soon after his presidency.

Having invested $500,000 to fund Getch Scholars alternate years since 2015, why is the CNS doubling down with a $1,200,000 pledge for the next five years to make the Getch K12 award annual?

According to the CNS Past President Ganesh Rao, MD, FAANS, who championed the CNS’s investment in the K12 Awards, “NRCDP is a major driver for improving neurosurgical patient care. Support for neurosurgical research is critical, particularly at the beginning of one’s career; the commitment to mentorship is unparalleled, and we are seeing increasingly diverse awardees. I am a firm believer that the K12 program will improve neurosurgery overall.”

New data from Emad N. Eskandar, MD, FAANS, director of the NRCDP, reveals that the program has successfully hit the three drivers mentioned by Dr. Rao. The result is a remarkable increase in overall grant support for neurosurgeons.

Protected Research is Linked to Subsequent Funding

The following data points demonstrate the continued success of K12 scholars:

  • From 2013 through 2017, the NRCDP supported thirteen scholars. Eleven out of the thirteen scholars received subsequent National Institutes of Health (NIH) funding for an overall success rate of 85%.
  • The second five-year cycle, 2018 through 2022, looks equally promising. During this period, the NRCDP supported sixteen scholars. Thus far, six have completed the program, and three have received additional substantive grants.
  • The number of years from a scholar’s initial NRCDP application until they obtained subsequent NIH funding also revealed success. Within five years, 50% of program alumni received NIH funding, and 85% received NIH funding within nine years.

According to 2017 winner Jennifer Strahle, MD, FAANS, “Winning a K12 award provided me with time and resources to complete the foundational hydrocephalus and iron metabolism experiments that laid the groundwork for my subsequent successful R01.”

While all K12 awards provide two years of protected research time, unique to the Getch award, the awardee may remain at their institution. Preserving this continuum of established relationships and research in their home laboratory is essential to the CNS.

Babacar Cisse, MD, of Weill Cornell Medical School and a 2018 winner of the NINDS/CNS Getch K12 Scholar Award, explained, “When I was hired by my chairman, we both agreed that I needed at least 50% of protected research time. The K12 solidified that agreement and extended it to 5 years.” Three years later, Dr. Cisse is about to publish his findings for the first time.

Diversity of Neurosurgeon Scientists is Just Beginning

The CNS shares the NIH goal to increase the diversity of all health care providers and, in particular, researchers. According to NRCDP data, the K12 program has seen critical areas of improvement since 2012:

  • In the first five years (2013-2017) of the NRCDP, two (15%) of the total thirteen scholars were women, and zero (0%) were underrepresented minorities.
  • In the second five years (since 2018), female scholars increased to three (20%) and underrepresented minorities increased to four (27%).

Sustainable Mentorship

Like all early-career neurosurgeons, mentorship and a community of colleagues are valuable to the K12 awardees. All awardees must attend the annual retreat hosted by the CNS for five years, and new awardees seek the guidance of the Advisory Committee and past K12 winners. Since awardees are committed to attending the retreat for five years, mentees naturally transition into mentors. One awardee responded, “the NRCDP K12 community represents an important community of mentors and colleagues with whom we can envision and affect future paradigm changes in the care of patients with neurological diseases.”

Galvanizing Investment

Compared to other surgical specialties — including orthoapedic surgery, otolaryngology and urology — neurosurgery saw a significant increase in grant funding from 2012 to 2021 (265%). One cannot help but marvel at the increased funding that has occurred since the inception of the NRCDP.

The CNS and the CNS Foundation are proud partners of the NIH, the Foundation for the National Institutes of Health, the NINDS and the NRCDP. The future for our specialty is bright.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery, @CNS_Update and @NINDSnews.

Alexander A. Khalessi, MD, MBA, FAANS
UC San Diego Medical Center
San Diego, Calif.

May 6, 2022
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Neurosurgery Lost a Leader, and I Lost a Dear Friend — Randall W. Smith, MD, FAANS(L)

By Guest Post, Loss of LifeNo Comments

On Oct. 25, neurosurgery lost a leader, and I lost a dear friend. Randy’s accomplishments in organized neurosurgery, especially in California, are too numerous to list and have been chronicled by others in recent days. Today, I want to tell you the main lessons Randy taught me over our decade-long friendship.

  • Your biggest supporters may not be who you think. As a young female neurosurgeon starting in the California Association of Neurological Surgeons (CANS) and the Western Neurosurgical Society (WNS), Randy didn’t care who I was or what I looked like as long as I showed up and worked hard. Once I proved myself, he went to great lengths to support me and promote my career. This is the very definition of sponsorship, which I have found much more helpful than mentorship.
  • Actions speak louder than words. Randy could spot nonsense from a mile away and did not hesitate to call it out. I have met very savvy and politically correct leaders in my time who have done nothing to help foster diversity and inclusion in neurosurgery. When it came to supporting equality, he made the necessary changes in our organizations to make them better.
  • Work-life balance is best when you don’t try to separate them. Randy loved neurosurgery. When he retired from clinical practice in 2004, he was still very engaged in organized neurosurgery. In California, it is no secret that Randy was the backbone of the two influential organizations: CANS and WNS. He attended all the board and executive committee meetings and was part of every critical decision until his death. Randy was constantly curious about the advances in the field of neurosurgery and strived to make the lives of working neurosurgeons better. He involved his whole family — his wife Flo is like a surrogate mom to many of us. Randy taught me that I wouldn’t constantly feel like I had to choose by blending my life and family with my work. He has seen my children grow up and developed an independent friendship with my husband. It well-demonstrated that we are all happier and less likely to develop “burnout” if we feel part of a community.
  • Listen to your instincts. As the COVID-19 Delta variant surge was starting to wane in September, there was still considerable uncertainty about holding an in-person meeting for the WNS. After much planning and consideration, we decided to go for it and held the annual meeting in New Mexico. I do not regret that decision for one minute. It was an engaging, safe and productive meeting and allowed us to connect in person for the first time in nearly two years. This felt even more precious with my older colleagues. I didn’t know at the time that the picture you see here would be the last night I would spend time with Randy. I can just hear him saying: “Just go for it, kid.” Thanks, Randy. I will.

As we get ready to sit down with our families and friends for Thanksgiving, I encourage you all to reflect on how fortunate neurosurgery is to have had such an icon in our field. He will be missed.

Editor’s Note: An issue of the CANS newsletter that will be entirely dedicated to commemorating Randall W. Smith, MD, is planned for mid-December. You are encouraged to submit personal remembrances if you’d like them included in this issue. Please send your memories to mabousamra@aol.com or emily@cans1.org. The deadline for submission is Nov. 28. Additionally, we encourage everyone to follow @Neurosurgery and @CaNeuroSurgeons.

Ciara D. Harraher, MD, MPH FAANS
Stanford Department of Neurosurgery
Dominican Hospital
Santa Cruz, Calif.

November 23, 2021
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Permanently Funding CHIP is Essential for the Health of Our Children

By Guest Post, Health Reform, PediatricsNo Comments

The Children’s Health Insurance Program (CHIP) is a health insurance program that provides coverage to children from low-income families. CHIP was established in 1997 with strong bipartisan support and is an essential state-federal partnership. As many as 15% of children lacked health insurance coverage at the time. According to the American Academy of Pediatrics (AAP), Medicaid and CHIP provided health insurance to more than 50% of U.S. children in 2012, making both programs combined the nation’s largest insurer. These children and their families depend on federally subsidized state Medicaid for their health insurance.

As a pediatric neurosurgeon in New Jersey, I have seen how these programs help children and allow them to have their well visits, sick visits and hospitalizations covered. The program is not perfect — for example, provider reimbursements are typically well below market rates and fail to cover physician practice costs. Thankfully, however, many physicians in our state — and across the U.S. — accept CHIP-covered patients providing access to care is needed for these children who otherwise would not receive the medical and surgical care that they so desperately need. And as we know, healthy children grow up to become healthy adults.

Unfortunately, since the program’s inception, Congress must reauthorize CHIP every few years, putting this vital coverage in jeopardy. In fact, at one point in 2018, CHIP funding lapsed for an unprecedented 114 days. While Congress extended CHIP funding through 2027, the program remains vulnerable without permanent financing.

Fortunately, Congress is currently considering legislation to fund CHIP permanently. One such effort is being led by Reps. Vern Buchanan (R-Fla.) and Lucy McBath (D-Ga.). Endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons, the Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act (H.R. 66) would ensure that gaps in CHIP coverage would never again happen.

Kids need access to care, and pediatric neurosurgical patients depend on CHIP funding. We need to provide adequate health care for children from low-income households. We have a fiduciary responsibility and an ethical obligation to support permanent funding for the CHIP. This is not just my opinion, but truth and reality. If Congress does not act, federal funding for CHIP will expire.

CHIP has provided access to care that low-income families would not have had otherwise. As a nation, we need to come together to support permanently funding CHIP through the CARING for Kids Act or similar federal legislative efforts so our children will have access to health care that they so desperately need.

Please help make permanent funding a reality by taking a moment to contact Congress and ask your representative to co-sponsor H.R. 66. Click here to go to neurosurgery’s Advocacy Action Center to send an email to your elected officials asking them to co-sponsor H.R. 66. A sample message, which can be personalized, is provided. It takes less than a minute to make a difference in the lives of millions of children and their families, so please act today!

 Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FundCHIP.

Catherine A. Mazzola, MD, FAANS
New Jersey Pediatric Neuroscience Institute
Morristown, N.J.

October 25, 2021
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Prior Authorization Burdens March On, Even During COVID-19

By COVID-19, Guest Post, Prior AuthorizationNo Comments

For much of 2020, as COVID-19 case surges threatened to overwhelm the U.S. health system, physicians faced onerous, business-as-usual insurer policies on top of a public health emergency.

In December, as the Centers for Disease Control and Prevention (CDC) data showed daily new COVID-19 cases reaching the once unthinkable total of 200,000, the American Medical Association (AMA) surveyed practicing physicians to measure the impact of health plans’ prior authorization (PA) requirements on patient care and practice burdens. The results were grim: surveyed physicians reported completing an average of 40 PAs during the previous week of practice, and this weekly PA workload for a single physician consumed 16 hours — the equivalent of two business days — of physician and staff time.

The fact that these significant administrative burdens taxed our practices during an unprecedented public health crisis is extremely disturbing. While many health insurers modified their PA policies during the pandemic’s early stages, nearly 70% of surveyed physicians reported that PA requirements were relaxed only temporarily or not at all, illustrating the limited reach of health plans’ policy adjustments.

PA Hurts Patients

Beyond these practice hassles, the AMA survey also captured the harmful effect of PA on patients and their health. An overwhelming majority (94%) of physicians reported that PA can delay access to medically necessary care. These delays represent far more than just the inconvenience of waiting for treatment, as physicians linked PA to adverse effects on care delivery and outcomes:

  • 79% reported that PA can lead to treatment abandonment;
  • 90% stated that PA can result in negative clinical outcomes; and
  • 30% indicated that PA has led to a serious adverse event for a patient in their care, with 21% reporting that PA has led to a patient’s hospitalization.

These alarming data show the very real human costs of PA and raise serious questions about health plans’ claims that PA ensures appropriate, safe care and reduces costs. How can a process that so frequently leads to serious adverse events and patient hospitalizations reduce overall health care costs?

PA Burdens Are Growing

Despite the solid evidence that PA negatively impacts patients and physician practices, health plans continue to ramp up their utilization management programs. Health plans agreed over three years ago in the Consensus Statement on Improving the Prior Authorization Process — which was signed by America’s Health Insurance Plans and Blue Cross Blue Shield Association — to reduce the overall volume of PAs, yet they continue to introduce additional requirements. In the AMA survey, a strong majority of physicians reported that the number of PAs required for prescription medications and medical services has increased over the last five years. Even Medicare, which traditionally has not imposed PA, is now in the PA business: the 2020 Medicare Outpatient Prospective Payment System (OPPS) rule established PA requirements for five services that have cosmetic uses in addition to therapeutic indications, which burdens my specialty of plastic surgery. The 2021 OPPS rule hit close to home for readers of this blog, as it added PA to two neurosurgical service categories — cervical fusion with disc removal and implanted spinal neurostimulators. The AMA, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons and numerous other concerned stakeholders recently sent a letter to the acting administrator of the Centers for Medicare & Medicaid Services urging a delay in implementing these new requirements.

Take Action

We see the growing harm that PA inflicts both on our profession and our patients with every passing year. It is time we step up and demand change. The AMA Advocacy Group has been active in Washington, urging Congress to support the reintroduction of the Improving Seniors’ Timely Access to Care Act (H.R. 3107 and S. 5044 in the 116th Congress). If passed, Medicare Advantage plans would be required to make many of the critical PA reforms outlined in the previously mentioned Consensus Statement, such as improving transparency and streamlining the process. All of you can play a role here in contacting your representatives to do the same. Since the problem is broader than just Medicare Advantage, the AMA is currently investigating further legislative moves to address insurance companies’ onerous PA policies.

The AMA has developed model legislation for use at the state level. We urge you to also work with your state medical association to support state PA legislation — you can join grassroots efforts to draw more attention to this critical issue. Visit FixPriorAuth.org to share your PA horror stories, watch videos of other physicians and patients telling how PA harms care delivery, engage on social media and sign a petition pushing for change.

Please also share this information with your patients — this is their problem, too. It is going to take all of us to FixPriorAuth, and legislators are more likely to respond to issues about which their constituents complain.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @AmerMedicalAssn, using the hashtag #FixPriorAuth.

Russell Kridel, MD, FACS
Chair, AMA Board of Trustees

May 13, 2021
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Congressional Docs Urge Americans to Take Action and Get the COVID-19 Vaccine

By Congress, COVID-19, Guest Post, HealthNo Comments

Last year, the entire world was forced to face the COVID-19 pandemic head on. And now, we — the American people — have the opportunity to achieve peace of mind and live life as free as before by choosing to receive a COVID-19 vaccine. Concerned for the health and safety of our nation, I recently joined some of my fellow colleagues in Congress — each of us are also health care professionals — in a public service announcement encouraging Americans to get vaccinated. Very soon we will have more COVID-19 vaccines than we have people willing to take it. In fact, almost half of adults in my home state of Kansas are uncertain about getting vaccinated.

Operation Warp Speed brought us safe and effective vaccines in record time. The process was rigorous and transparent, and a process that I personally followed very closely, resulting in a clear path to the eradication of the pandemic. The Food and Drug Administration (FDA) did not skip any steps. Instead, the FDA cut bureaucratic red tape — not corners — and got the job done in record time. By now, over 200 million vaccines have been given in our country.

Doctors, nurses and pharmacists nationwide recommend the COVID-19 vaccine to their patients, and over 90% of doctors in the U.S. have already chosen to get vaccinated. But, we have much more work to do. I encourage all neurosurgeons, primary care doctors, nurses, and community pharmacists to discuss the vaccine with your patients. Who better to have that conversation than someone who knows their medical history and has their trust? As a physician from Small Town, USA, I’ve given critical advice to my patients facing a number of issues including getting a vaccine for disease prevention. The most respected advice comes from a person’s own health care provider or pharmacist, and it’s conversations with them that help make the best health decisions.

I look forward to the freedom I, along with my loved ones, will regain once the vast majority of Americans are vaccinated. If everyone does their part, in the coming weeks we will once again be able to worship together as a congregation, gather with extended family, and travel near and far with friends.

Please join me in watching and sharing this important message!

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtags #VaccinesWork and #ThisIsOurShot.

U.S. Senator Roger W. Marshall, MD (Kansas)

 

 

May 3, 2021
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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.

January 8, 2021
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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.

January 4, 2021
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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

November 25, 2020
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