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The Use of Social Media in Addressing Gender Disparities in Neurosurgery

By Angela M. Richardson, MD, PhD and Sheri Dewan, MD, MS, FAANSCareer, 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 Disep I. Ojukwu, MD, MBA, MPH and Laura Stone McGuire, MDCareer, 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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Progress Incremental: Understanding Sexual Harassment in Neurosurgery

By Deborah L. Benzil, MD, FAANS, FACSCareer, 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 30^th 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

November 12, 2020

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Honoring Those Who Have Served

By Katie O. Orrico, Esq.Military Faces of NeurosurgeryNo Comments

Each year on Veterans Day, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) pay tribute to the contributions of the many military neurosurgeons who have made significant contributions and sacrifices. Whether on the battlefield, in the operating room or research lab, neurosurgeons have served our country with distinction and grace throughout history.

ICYMI, Neurosurgery Blog has featured many of these stories, and we encourage our readers to take a trip down memory lane. Read how former AANS president Roberto C. Heros, MD, FAANS(L), volunteered for the ill-fated Bay of Pigs invasion. Remember the horrors of the Vietnam War, as seen through the eyes of Patrick J. Kelly, MD, FAANS(L), while he was stationed in Da Nang during the bloodiest year of that conflict. Learn how neurosurgeons, like COL (ret) Rocco A. Armonda, MD, FAANS, have taken their skills from the operating room into the battlefield. Recall the recent efforts of the U.S. Comfort and Mercy, and how neurosurgeons came to the aid of Los Angeles and New York City as COVID-19 stressed the hospital ecosystem in the early days of the pandemic.

Thank you to these and all other veterans who have served our nation with selflessness and dignity to protect the freedoms we have all come to take for granted. Your service can never be honored enough. Happy Veterans Day, one and all.

November 11, 2020

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Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.

Deborah L. Benzil, MD, FAANS, FACS

November 9, 2020

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Medicolegal Issues in Neurosurgery

By Jason D. Stacy, MDCSNS Spotlight, Guest Post, Medical LiabilityNo Comments

Virtually all neurosurgeons will have to deal with a medicolegal issue by the end of their career. Neurosurgeons have the highest annualized rate of lawsuits at >19%. Perhaps shockingly, even by age 45, approximately 88% of surgeons in high-risk subspecialties will have been involved in a lawsuit. This number elevates to >99% by age 65. The concern about professional liability lawsuits is, without a doubt, the highest profile medicolegal issue for neurosurgeons — even though many more issues other than litigation affect our daily medical practices. Medicolegal and socioeconomic topics such as neurosurgical workforce, contracting and employment, and payor/insurance issues such as coverage policies, reimbursement and prior authorization regularly impact each neurosurgeon’s practice in multiple ways — even if it is not immediately apparent.

We are all trained in both the science and art of medicine throughout those seven long years of residency. Yet, historically, very little attention is paid to educating neurosurgeons about myriad medicolegal and socioeconomic issues. There is a relative dearth of information on socioeconomic topics compared to matters concerning the science and practice of medicine in the literature. As such, during our residency and in our daily practice, we learn precious little about issues related to the social, political or economic aspects of neurosurgery. However, these issues consume so much of our time and significantly impact our practices.

To this end, the November issue of Neurosurgical Focus is dedicated to medicolegal issues that can be useful to neurosurgeons at all stages of practice. We hope that this issue will serve as a primer on the subject so that neurosurgeons can develop an appetite for regular reading about and involvement with these critical issues.

Articles in the Neurosurgical Focus’ November issue include:

Lastly, please note the hard work in this area that the Council of State Neurosurgical Societies (CSNS) has done for decades. The CSNS is the group in organized neurosurgery that addresses the confluence of medicolegal and socioeconomic issues and neurosurgical practice as neurosurgeons. It is jointly supported by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons since its inception in 1972. It began as the Joint Socio-Economics Committee. It functions as a grassroots organization whose members are drawn from each state’s neurosurgical society. This structure allows it to be broadly representative of the whole of neurosurgery while at the same time being agile enough to deal with the rapidly changing landscape of these issues. In addition to delving into the November medicolegal issue of Neurosurgical Focus, neurosurgeons are encouraged to participate as active members in your state neurosurgical society to ensure that you remain an integral part of the CSNS.

Click here to read the press release and here for the complete issue of “Medicolegal Issues in Neurosurgery” in Neurosurgical Focus.

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 @CouncilSNS and using the hashtag #Medicolegal.

Jason D. Stacy, MD
North Mississippi Medical Center
Tupelo, Miss.

November 3, 2020

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WINS: Celebrating Women in Neurosurgery

By Alia Hdeib, MD, FAANS, FACS and Jennifer A. Sweet, MD, FAANS, FACSCareer, 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.