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Career Development in Neurosurgery Research for Medical Students, Residents and Young Neurosurgeons: From Finding Mentorship to Starting and Funding a Lab

By CareerNo Comments

Research has always been integral to the field of neurosurgery. Its purpose is to improve patient treatment paradigms and stimulate innovation. Given these efforts, an emphasis on research quality and productivity has become a minimal requirement to enter and progress in academic neurosurgery. However, the barrier to entry in neurosurgery research remains relatively high for medical students, neurosurgery residents and young neurosurgeons — which may be prohibitive for academic progress. Providing transparency in the research process is a necessary step in reducing the barriers that have been formed.

At all stages of training, the most crucial factor for successful research is mentorship. Identifying the right mentor can open many doors in research and career development. Who is the “right mentor” in research? This person understands the landscape and can provide opportunities that support and guide you to achieve your goals. The right mentor is not given but is sought after. As the emphasis on research continues to increase, so does the average number of publications for matched neurosurgery applicants. Therefore, identifying a mentor where there is a mutual benefit is necessary. Utilizing Pubmed and Google Scholar can provide insight into the type of publications produced through the department of neurosurgery and, more importantly, who is publishing. This can be a resident, attending or research faculty. Once identified, you can reach out with the intention that you will allocate time and effort to completing the projects provided. Not everyone who publishes is a good mentor. However, having a track record of publication is essential and a good start in identifying a potential mentor. Once established, medical student-specific grants such as the American Association of Neurological Surgeons (AANS) Neurosurgery Research & Education Foundation (NREF) Medical Student Summer Research Fellowship can be accessed.

For neurosurgery residents, your stage in training will drive who you seek out for mentorship. Most residents have performed some research before residency to be competitive enough to match. Matching in a program different from where you did medical school can feel like starting over. If undecided on a subspecialty, a similar process can be done using Pubmed and Google Scholar to identify an initial research mentor. If you have decided on a subspecialty, concentrating research efforts with mentors of that subspecialty may be more advantageous. Many programs have created protected research time within the 7-year residency, ensuring a dedicated approach to research can be pursued, especially in translational/basic science laboratories. The process of publishing includes collecting and analyzing data, manuscript writing and submission. It is vital to identify the ways to make this process more efficient. Incorporating medical students and research fellows in the various steps can allow greater productivity and the development of mentoring skills in research. Creating this track record as a resident can open doors with your mentor to apply for research grants. These grants can be funded by:

  • National Institutes of Health, such as R25 (National Institute of Neurological Disorders and Stroke), F32 and T32 training grants;
  • Society grants such as NREF; and
  • Subspecialty society grants.

Establishing your research interests and track record during residency opens doors to these various grant opportunities. As a young attending neurosurgeon, building upon the foundation established during residency can help continue the academic progression with starting your lab. If your residency wasn’t as productive in terms of publications, then utilizing mentors to help create a research laboratory will be key. Advice given to young attending neurosurgeons is to start early and ask questions that you want answered. Once you’ve identified what you want to pursue, then accessing supportive programs to help you is the next step.

Along with society grants mentioned above, other available grants include fellowship grants, early career grants (e.g., AANS Young Clinician Investigator Award), industry-sponsored grants, and foundational grants. One program that has gained interest in early career neurosurgeons is the K12 Neurosurgeon Research Career Development Program, which is intended for junior neurosurgeon faculty to mentor and facilitate advanced research career development. Utilizing institutional resources such as the grants office and collaborators can help jumpstart your academic career in research.

While this is an overview of early career development, everyone’s academic neurosurgery path may differ. All paths have one element in common: finding good mentorship. As you climb the academic ladder, you should also consider giving back to the field by mentoring the next generation.

Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.

Aladine A. Elsamadicy, MD
Yale Department of Neurosurgery
New Haven, Conn.

Building a Better Match: Efforts of the SNS Medical Student Committee

By Career, MentoringNo Comments

It has been a pleasure to serve as the chair of the Society of Neurological Surgeons (SNS) Medical Student Committee. This group of neurosurgical leaders is deeply engaged in finding better approaches to training future neurosurgeons. Our responsibilities include enhancing exposure to the field for students exploring future careers, providing a framework of mentorship for those considering a neurosurgical residency, and ensuring that The Match® is fair and efficient for both applicants and programs. It has been clear that forces are making this last goal more challenging for some time.

First, objective evaluation metrics have been eroded in U.S. medical schools. This situation began with grades but has gone on to involve eliminating the United States Medical Licensing Examination® Step 1 scores and many academic honor society chapters. Evaluating an applicant’s clinical knowledge and relative success in medical school coursework on a transcript has become much more difficult. Perhaps in response to these forces, applicants have thrown energy into research activity and increasing numbers of neurosurgery rotations in the hopes of setting themselves apart. While these activities are undoubtedly helpful, there is surely a “ceiling” beyond which more research focus or neurosurgery rotations negatively impact a student’s overall medical education and/or create excess and unnecessary financial burdens.

Finally, we have seen the median number of applications per applicant rise year after year until reaching a point where the median applicant now applies to >80% of all programs. “Application fever” compounds costs and makes holistic review even more difficult for programs to execute efficiently. The SNS Medical Student Committee has carefully reviewed these areas of concern and has produced several new strategies to promote a more efficient match system.

  1. Standardized Letters of Recommendation
    This evidence-based approach is used in other specialties to reduce implicit bias and provide more objective evaluations of a candidate’s suitability for the field. Our neurosurgery-specific template focuses on measuring key traits critical to trainee success. While “grade inflation” remains an issue, repeated use of the template has demonstrated more normalized distributions of candidate scores, especially when focusing on recommendations written by more prolific and experienced letter writers.
  2. Cap on Neurosurgery Externships
    We released guidelines advising students to spend no more than three months of their 4th year on neurosurgical externships between home and away programs. This guidance draws on the experience of many neurosurgical educators who understand the need to balance in-depth exposure to the field with other important factors. Capping these rotations helps to create a level playing field, control costs and provide students time to round out their medical education on other important subjects.
  3. Standardized Release Date for Interview Offers
    The stress of rapidly managing interview offers repeatedly became a significant concern in our surveys of neurosurgery applicants. The current system allows offers to be released on the four Fridays in October in the afternoon, with all offers held for at least 48 hours. This will enable programs flexibility about when they would like to begin offering interviews. It also means that applicants can predict when offers will arrive and can focus on their other clinical activities during the rest of the week. In line with National Resident Matching Program® rules, we have also emphasized that programs cannot offer more interview slots than they will schedule, eliminating the need for immediate responses to avoid ending up on a waitlist.
  4. Preference Signaling
    “Signaling” is the newest innovation to hit neurosurgery, and we are quickly learning how to optimize its use. In 2022-23, we participated in an optional program allowing applicants up to eight “signals” to send to programs indicating particular interest. Building from the data from that cycle, we have moved to a system of 25 signals for the 2023-24 season. Models suggest that this approach will improve the process for both applicants and programs, facilitating a holistic review of the most interested candidates and distributing interview offers evenly across the applicant pool.

The Match has undergone a remarkable evolution in the last few years alone. There are clearly ongoing challenges related to cost, stress and identifying the best candidate-program fit. I believe that the innovative efforts of the SNS Medical Student Committee reflect our commitment to ensuring that the process of applying to a neurosurgery residency remains applicant-centric, with the well-being of our applicants our top priority.

Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.

Lola B. Chambless, MD, FAANS
Vanderbilt University Medical Center
Nashville, Tenn.

Cross-Post: Medicare cuts ensure disaster to doctor-patient relationship

By Congress, Cross PostNo Comments

On the Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they may interest our readers. In case you missed it, we wanted to bring attention to a recent op-ed by Reps. Greg Murphy, MD, (R-N.C.), Brad Wenstrup, DPM, (R-Ohio) and Michael Burgess, MD, (R-Texas) in Washington Times titled, “Medicare cuts ensure disaster to doctor-patient relationship.” On Jan. 1, 2024, the Centers for Medicare & Medicaid Services cut payments to physicians by nearly 3.4% for services rendered to Medicare patients, which will cripple independent physicians and rural health care providers across the country.

Reps. Murphy, Wenstrup and Burgess, members of the GOP Doctors Caucus, are greatly troubled by another round of payment cuts to the Medicare Physician Fee Schedule, “It is our goal to navigate the ever-increasing challenges facing those who try to provide care for Medicare recipients.” In anticipation of this rule, the GOP Doctors Caucus introduced legislation seeking to reform the physician fee schedule, prevent extreme fluctuations in future reimbursement and update how costs are determined.

Efforts continue to press Congress to halt these cuts as soon as possible.

Click here to read the article.

We hope 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 #FixMedicareNow.

Ann R. Stroink, MD, FAANS Retires from Neurological Surgery

By AANS Spotlight, CareerNo Comments

Ann R. Stroink, MD, FAANS, a neurosurgeon at the forefront of advocacy efforts, retired from neurosurgery practice at Carle BroMenn Medical Center on Nov. 22, 2023. Throughout her career, Dr. Stroink has been an indefatigable force in advocating — in the halls of Congress, before the Illinois state legislature, with health plans and within organized medicine — for sound health policy to ensure patients have timely access to care. Throughout her career, she held critical leadership roles within organized neurosurgery, including president of the Illinois State Neurosurgical Society, chair of the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Council of State Neurosurgical Societies, chair of the AANS/CNS Washington Committee for Neurological Surgery and AANS president.

Following her retirement from active neurosurgical practice, Dr. Stroink has taken on another crucial role, serving as the interim CEO of the AANS. “It’s an exciting opportunity to lead the most prestigious neurosurgical organization in the world,” said Dr. Stroink. “I’m really looking forward to my stint.”

Carle Health highlights Dr. Stroink’s dedication and contributions to their organization, pointing out that her affiliation with Carle BroMenn Hospital (then Brokaw Hospital) began when her father, Hans Stroink, MD, was a pathologist. Said Dr. Stroink,

I started working in the lab and that’s where I got the buzz. I performed autopsies with my father, but the first time I saw live tissue, I knew I wasn’t going to do anything else. I’m very happy to have served patients for years.

Dr. Stroink assisted her father from seventh grade until she left for college, maintaining a connection to Carle throughout her career, given the need for neurosurgical services in her community.

She also made her mark as a female neurosurgeon. Dr. Stroink attended Southern Illinois School of Medicine, the first U.S. school to enroll 30% of women. “Having already decided to make my career in medicine, I was acutely aware of the barriers to getting into medical school as a female,” states Dr. Stroink. On the 50th anniversary of the passage of Title IX in 2022, she shared her experiences on gender equity in neurosurgery in the California Association of Neurological Surgeons newsletter.

Dr. Stroink was the first woman to enter the neurosurgical residency program at the Mayo Clinic. “I’m really grateful to the Mayo Clinic because they didn’t have to accept a woman, but they did,” said Dr. Stroink. “I was very happy to be a resident. Even though it was a new experience for them to train a female resident, it was a benefit for them and me.”

In 1985, Dr. Stroink founded the Central Illinois Neuro Health Sciences practice in Bloomington, Ill. She spearheaded the creation of a neurosurgery resident program at the hospital and considers teaching doctors essential and one of her favorite parts of her work.

We wish Dr. Stroink all the best in her retirement from practicing neurological surgery.

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 @NeurosurgeryRE and using the hashtag #Neurosurgery.

Cross-Post: Medical Student Tamia Potter Makes History

By Career, DEI, MentoringNo Comments

Our current series on Making and Maintaining a Neurosurgeon discusses how one transitions from student to resident to practicing neurosurgeon. In particular, we highlight what our field is doing to improve diversity and the importance of mentorship to those considering neurosurgery. How impactful can a mentor be? Incredibly. Especially when it comes to forging a path few before have traveled.

This cross-post highlights the impact mentorship had on one newly minted physician, Tamia Potter, MD, who just became the first black female neurosurgery resident at Vanderbilt University in Nashville, Tenn. Her story made headlines across the country, and she describes those who have inspired her along the way.

“As a child, watching my mom, a nurse, care for patients — I was always questioning why the body works the way it does,” said Dr. Potter. “I knew [then] I wanted to learn and understand how the brain and nervous system worked; I wanted to be a neurosurgeon.”

Only about 5.7% of physicians in the United States identify as Black or African American, according to recent data from the Association of American Medical Colleges. Dr. Potter stresses the importance of the many mentors who have been just as instrumental throughout medical school. She recognizes her responsibility as a mentor for future students, “I didn’t get here by myself.”

Click here to read the full article published by Case Western Reserve University.

Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.

Krystal L. Tomei, MD, MPH, FAANS, FACS, FAAP
Rainbow Babies and Children’s Hospital
Cleveland, Ohio

The Transformative Power of Mentorship: Establishing a Personal Board of Directors

By Career, MentoringNo Comments

Stepping into the inaugural American Society of Black Neurosurgeons (ASBN) dinner in 2022, surrounded by almost 30 Black neurosurgeons, residents and medical students, was an indescribable experience. In that room, I encountered past program neurosurgery department chairs and senior attendings, who welcomed me into the fold with open arms. The presence of such accomplished individuals who shared my background and experiences left an indelible impact on me.

Joining the ASBN shed light on a critical flaw in my approach to mentorship. To truly flourish and reach my full potential, I recognized the need to cultivate a diverse team of mentors around me. Effective mentorship entails a combination of peer mentors, career mentors, life mentors and sponsors. I had been burdening my primary mentor unfairly, expecting him to fulfill all these roles single-handedly. Yet, he had somehow managed to keep me afloat throughout my journey — a testament to his unwavering dedication to my success. It is somewhat humbling to admit that I failed to grasp this crucial aspect of mentorship earlier in life. My experience is not unique, particularly for individuals from underrepresented groups who may face similar challenges in finding the right support network.

With this revised approach to mentorship, I have begun to forge my own path in the field of neurosurgery. With that, I present a structured approach to finding mentors, assembling a personal board of advisors, each playing a unique role but sharing a common dedication to one’s success.

  1. Peer Mentors: These are individuals in a similar or adjacent career stage, such as co-residents, fellows, or junior faculty members. This group is the one you can reach out to bounce ideas, seek advice on resident politics, prepare for cases, avoid common residency pitfalls and become involved in research.
  2. Career Mentor: A career mentor is a seasoned faculty member who can guide and refine your professional trajectory. This mentor may be from within or outside your home institution. They assist in networking, identifying fellowship opportunities and setting and achieving mid- to long-term career goals through regular check-ins.
  3. Sponsor: A sponsor is someone who knows you well and works behind the scenes to advocate for your success. This person may not be someone you communicate with regularly, but they are individuals you meet along your journey, such as at conferences or sub-internships. Sponsors are familiar with your research work and career path. They are pivotal in advocating for you when you apply for awards, grants and advancements within neurosurgery.
  4. Life Mentor: Your life mentor ideally exists outside the confines of your direct medical community. This can be a spiritual advisor, life coach or an older family member. Their role is to help you navigate the challenges of residency and beyond while staying true to yourself. Having a life mentor reminds us that we are multifaceted human beings and to maintain balance and nurture our well-being beyond just being neurosurgeons.

By assembling a mentor team, you will have a comprehensive support system that empowers you to navigate the complexities of a career in neurosurgery while fostering personal growth and resilience. This also provides a rubric for you to engage in mentoring others, paying it forward to the next generation of neurosurgeons. Recognizing the importance of mentorship, it is crucial that, as neurosurgeons, we actively incorporate teachings on mentorship in our training programs and support mentorship organizations like the ASBN and Women in Neurosurgery so we can ensure the future success of a diverse cohort of resident trainees.

Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.

David A. Paul, MD, MS
University of Pittsburgh Medical Center
Pittsburgh, Penn.

How (Not) to Approach Mentorship: A Neurosurgeon’s Perspective

By Career, MentoringNo Comments

“I’m happy to write a letter of recommendation for you, but you should know that I will only mentor you if you decide to stay here for the summer…”

This was my introduction to mentorship as a first-year medical student. The offer was straightforward, and as a first-generation student without any external mentors, I took the opportunity and applied for a summer American Association of Neurological Surgeons Neurosurgery Research & Education Foundation grant to work with a neurosurgeon-scientist at my home institution. He denies having said that to this day, though I stand by my account. It marks the beginning of a long-standing mentorship and friendship that continues to shape my journey today.

This neurosurgeon challenged me to explore why some patients with pituitary tumors regain their vision after surgery while others do not. What began as a summer project evolved into an intensive two-year research endeavor. During this time, I became a part of the Academic Research Track program, pursued a Masters in Neurobiology and Anatomy and eventually achieved the remarkable milestone of being the first author of a paper published in Science Translational Medicine.

Despite the multidisciplinary nature of our project, much of the work was undertaken in relative isolation, without significant external guidance. At the outset, my scientific approach mirrored the nature of my mentoring relationships — I placed all my efforts into a single basket. Looking back, it seems almost unbelievable that our efforts culminated in such success — and that I matched into neurosurgery with a single prominent publication to my name.

This mentorship influenced my trajectory. Despite an emerging interest in spine surgery, I held onto the familiar mentorship I had come to rely on, applying for an enfolded external fellowship in endoscopic skull base surgery with my mentor’s encouragement. When I failed to match into that fellowship, I felt relief knowing that it was not my true passion but fear of starting over. It was a stark reminder that, once again, I had put all my efforts into one basket.

Faced with the challenge of finding new opportunities for my research year, I pursued an enfolded Society of Neurological Surgeons Committee on Advanced Sub-specialty Training accredited neurocritical care fellowship to strengthen my clinical acumen in my perceived weak clinical area. It was the first time during residency that I chose something solely for my own personal development rather than simply following the expectations of others. During the fellowship, I realized my passion for neurosurgery and neuroscience held the power to address the societal brokenness I witnessed. It became clear that my calling extended beyond the operating room; it intertwined with my commitment to advocate for social justice and equity. Neurotrauma, critical care, and spine bridge the gap between how I envision using my skill set and what I see as unmet needs in communities like mine.

As I delved deeper into my newfound passion for bringing neurosurgery to underserved communities, I connected with other neurosurgeons who shared similar experiences and challenges. These connections expanded my network beyond the boundaries of my institution, nurturing a sense of camaraderie and unwavering support. At the same time, the nation grappled with a renewed focus on diversity, equity and inclusion. In response, African-American neurosurgeons from across the country united, founding the American Society of Black Neurosurgeons (ASBN). The ASBN is a powerful platform, amplifying our voices, advocating for transformative change and fostering a nurturing community within our field.

Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.

David A. Paul, MD, MS
University of Pittsburgh Medical Center
Pittsburgh, Penn.