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Pathway to Neurosurgery Program: Creating the Next Generation of Neurosurgeons

By Career, MentoringNo Comments

Diversity, equity and inclusion (DEI) are vital components of strategic planning in a growing number of organizations across all sectors. The health care sector is especially relevant since DEI directly affects health outcomes. In the United States, most people are aware of the racial reckoning that has resulted in the necessary dialogue around implicit bias’s harmful effects. It has also drawn attention to the Black, indigenous, and people of color who are disproportionately impacted by long-standing systems that were not created with their whole personhood in mind. Together, we can foster equitable access to high-quality care for a wide range of people while building cultural competencies that increase a sense of belonging in spaces where people might not have been able to feel included before. Within neurosurgery, DEI initiatives that engage and educate teams have great potential.

One of the major goals of the Congress of Neurological Surgeons (CNS) DEI committee includes eliminating barriers to attract a diverse pool of future neurosurgical applicants. Concrete milestones with measures of success and failure support these goals, culminating in a groundbreaking program called Pathway to Neurosurgery. The CNS DEI committee developed the program to diversify applicants for neurosurgical residency. In honor of Timothy M. George, MD, FAANS, we presented the inaugural Pathway to Neurosurgery program at the CNS Annual Meeting in Austin in 2021.

2021 Pathway to Neurosurgery Program

Now led by the CNS Foundation, the program welcomes local high school students from backgrounds underrepresented in science, technology, engineering and mathematics (STEM) to the CNS Annual Meeting. A day-long symposium designed exclusively for them takes place near the general sessions so they spend the day surrounded by neurosurgeons and are introduced to considering a medical career, possibly even a career in neurosurgery. In 2021, 35 students from Austin joined us for an immersive experience at the convention center alongside other attendees of the annual meeting. Students who participated also applied for a one-year stipend and mentorship opportunity with a Dell Medical School neurosurgeon. We were thrilled to announce that two students were awarded a stipend for the year and a chance to spend one year with a local neurosurgeon. This tradition continues each year as longitudinal mentorship occurs with these students.

The Pathway to Neurosurgery program held its second event at the CNS Annual Meeting in San Francisco in 2022. On that day, 24 Oasis for Girls and San Francisco Achievers students, dressed in full surgical gowns and protective gear, visited multiple stations with tools and demonstrations used daily in neurosurgery. Volunteer neurosurgeons paired up with each student through the experiments, giving them feedback on holding surgical instruments and answering questions. Frank J. Bova, MD, PhD, kept a crowd of students’ interest as he described how to place an external ventricular drain shipped to San Francisco from the University of Florida just for the occasion.

2023 Pathway to Neurosurgery Program

“This is how I practice!” said an early career neurosurgeon to a wide-eyed high schooler, trying not to grip the egg too tightly as she carefully drilled through the shell. “Everyone has become involved in making this a great event for the kids,” said Maryam Rahman, MD, FAANS, one of the spearheads of the original program. Between station rotations, the students listened to speakers from various backgrounds talk about their own pathways to becoming neurosurgeons.

“I am passionate about the Pathway to Neurosurgery program because I know how meaningful it is to see someone like me in a STEM field. I spent my young life repeatedly told that I would never be a neurosurgeon. Neurosurgery must be a career option for them because we need more neurosurgeons that represent our broad spectrum of patients”, states Tiffany R. Hodges, MD, chair of the CNS Foundation’s DEI Committee.

During lunch, volunteer neurosurgeons sat at round tables with the students and casually answered their questions. Laughter and conversation bubbled throughout the day. Not only were the students enjoying themselves, but volunteer neurosurgeons also said it was one of the highlights of the CNS Annual meeting.

2023 Pathway to Neurosurgery Program

Weeks later, the CNS Foundation received feedback from many of the guests. “I never even heard of neurosurgery before I came to the event,” replied one student. “Now I’m seriously considering it for my future.” Mission accomplished.

The CNS Foundation hosted its third annual Pathway to Neurosurgery Program in Washington, D.C., during the CNS Annual Meeting in September 2023. It was a very successful event, and in recognition of this noteworthy program, the District of Columbia Mayor Muriel Bower proclaimed Sept. 7-13 as Pathway to Neurosurgery Week.

The CNS Foundation is excited to continue to expand this program.

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.

Tiffany R. Hodges, MD
Co-Chair, CNS DEI Committee
University Hospitals
Cleveland, Ohio

Training the Next Generation of Neurosurgeons: Inclusive Excellence in Neurosurgery

By Career, MentoringNo Comments

The Department of Neurosurgery at Stanford University is committed to inclusive excellence at all levels of education and training. Investing in outreach and pipeline programs exposes students to knowledge and opportunities otherwise unavailable. Our reach extends beyond Stanford and the surrounding community — we have reached students from all over the world who are interested in the neurosciences and are dedicated to learning. We are proud of the department’s work with outreach, including students locally, nationally and internationally. The future of neuroscience is bright.

Our multi-faceted initiatives aim to attract students to neurosciences throughout stages of their education, each with growing success in subsequent years. Through sharing our experience, we hope that others can create programs to assist with continuing to attract a diverse population to the neurosciences.

Stanford High School Neuroscience Forum
The forum is an opportunity for students from around the world to share a project related to the neurosciences — neurology, psychology, mental health and more. The audience is local, national and International, including Stanford community members and students from around the world. This event allows connections of shared passions. This forum’s genesis, organization and implementation came from the idea and vision of four students who organize and moderate the events each year. For the 2023 Forum, we received applications from over 10 states, eight countries and four continents.

Neuroscience JClub
Three young students initiated the Stanford Neuroscience JClub. This group intends to mentor high school students in critically analyzing a scientific paper and encourage participants to consider a career in the neurosciences. The club focuses on increasing access to the literature and the field. During the once-per-month meetings, students discuss scientific literature with expert Stanford scientists. We create a low-pressure and welcoming environment where students thrive, ask questions and learn. Since we have transitioned to a virtual setting, we have received interest from students from around the world. We had over 500 students apply to the 2023-2024 school year.

Harris Internship
The Harris Internship is a school-year-long program that pairs students with Stanford faculty and trainees with expertise in neurosciences. The mentors are committed to the year-long program. The students have the opportunity to build a relationship with their mentor and receive guidance on navigating college applications and a future career in neuroscience. Students are also asked to promote increased engagement with women and/or underrepresented minorities. For 2022-2023, there are eight Harris interns. We have received triple-digit applications for the 2023-2024 school year. Twelve interns were selected for the academic year and have been paired with mentors.

Explore and inspire
Explore & Inspire allows all college and medical students to join an intimate conversation with the Stanford Neurosurgery Department and team. The focus is on inclusive excellence. Career paths and overcoming obstacles are also discussed. We hope that students will receive guidance in navigating the neuroscience field and build a community of those interested in the neurosciences. Over 500 individuals registered for the event from approximately 36 states in the U.S. and 23 countries. We hope to continue hosting this event each year with different themes.

Summer of Neurosciences
An innovative, multi-faceted summer learning experience aimed at allowing access and exposure to neuroscience and medicine in a virtual format. The Summer of Neurosciences program is designed to provide a learning experience and expose students to the many aspects and opportunities in Neuroscience. It includes career insights, grand rounds and a weekly journal club. In the summer of 2022, we hosted 50 participants from four countries, nine states, seven universities and 37 high schools.

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.

Julia Blanchet
Stanford Department of Neurosurgery
Stanford, Calif.

 

 

 

Maria Ceja
Stanford Department of Neurosurgery
Stanford, Calif.

 

 

 

Odette Harris, MD, MPH, FAANS
Stanford Department of Neurosurgery
Stanford, Calif.

 

 

Reena P. Thomas, MD, PhD
Stanford Department of Neurosurgery
Stanford, Calif.

 

Cross-post: Fix the broken Medicare physician payment system that threatens patient access  

By Access to Care, Cross Post, MedicareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items published elsewhere that we believe will interest our readers. Today’s post originally appeared in The Hill on Oct. 17. In the op-ed, Reps. Larry Bucshon, MD, (R-Ind.), Ami Bera, MD, (D-Calif.), Raul Ruiz, MD, (D-Calif.), and Mariannette Miller-Meeks, MD, (R-Iowa) state that the Medicare payment system fails to reimburse physicians adequately for the critical services they provide. Unlike other providers, the Medicare Physician Fee Schedule (MPFS) does not have an automatic inflationary update and physician payments declined by 26 percent from 2001 to 2023 when adjusted for inflation.

To address this flaw, Reps. Bucshon, Bera, Ruiz and Miller-Meeks introduced the Strengthening Medicare for Patients and Providers Act (H.R. 2474) to modernize the Medicare physician payment system while protecting patients’ timely access to care. This bill would apply a permanent, inflation-based update to the MPFS.

Click here to read the full op-ed and here to contact Congress and urge your representatives to co-sponsor H.R. 2474. Additional information and resources are available at the American Medical Association’s (AMA) Fix Medicare Now website.

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) endorse H.R. 2474. The AANS and the CNS also joined several coalition letters endorsing the bill, including the AMA, Alliance of Specialty Medicine and a coalition of more than one million physician and allied health professional groups.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

Making and Maintaining a Neurosurgeon

By Career, MentoringNo Comments

“You need to see a neurosurgeon.” Those words would likely make any person pause. Unlike the quip, it is brain surgery. Neurosurgery is a critical medical specialty — treating everything from tumors to strokes, Parkinson’s to cerebral palsy, aneurysms to spine fractures. The average neurosurgeon has spent at least 15 years in school and training after graduating high school — four years in college, four years in medical school and seven years in a neurosurgical residency. And that is the bare minimum, not including extra years of schooling to get a second degree — such as a master’s or doctorate — and subspecialty fellowship training after residency.

So, what exactly is the process of becoming a neurosurgeon? How do we “make” a neurosurgeon? Once a neurosurgeon is done with training, how do we ensure they continue practicing lifelong learning to stay at the top of their field? Our field is committed to ensuring that patients who need neurosurgical treatment are cared for by competent, empathetic and qualified neurosurgeons, implementing initiatives throughout medical education to ensure these goals are achieved.

Through this series, we will discuss how we “make and maintain” a neurosurgeon. How do we recruit a qualified and diverse workforce? How do we break down barriers for residency applicants to ensure that students match into programs where they will succeed? How do we adapt our training programs to changes in science and technology and adapt to ever-changing regulations? How do we learn from mistakes and teach future generations always to ask how we can be better? What are we doing to verify the quality of subspecialty fellowships for those who want additional training in a neurosurgical subspecialty? Once a neurosurgeon finishes training, how do we assess them? Our first several blogs in this series will highlight the work across the country in these many avenues.

Neurosurgery is dedicated to the practice of lifelong learning. So even when the formal education is completed, we continue to grow in our practices and careers. The second half of this series will follow neurosurgeons who can share their experiences. This includes self-reflection and assessment and a focus on continuous lifelong learning, considerations of adding new procedures with innovations in the field, moving beyond neurosurgery into other roles in medicine and a continuous reflection on our profession. Hence, we continue to evolve and evaluate the needs within our specialty and recruitment and maintenance of diversity in neurosurgery.

Just as science evolves, so must our field to ensure that we continue to provide the best neurosurgical care to our patients, founded on a solid educational background and with a mindset for continuous improvement.

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

Cross-Post: ‘No other industry would tolerate this’: The problem with prior authorization in spine surgery

By Cross Post, Prior Authorization, Spine CareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items from other places that we believe will interest our readers. Today’s post originally appeared in Becker’s Spine Review on Sept. 25. Neurosurgeons Anthony M. DiGiorgio, DO, MHA, FAANS; Praveen V. Mummaneni, MD, FAANS and Luis M. Tumialán, MD, FAANS discuss prior authorization and the significant problems physicians face when it comes to receiving fair payments for services offered.

Denial of payment after prior authorization has become a grim reality in American health care. Insurance companies authorize procedures, and surgeons perform them as approved. Then, the insurance company denies payment. The authors state, “No other industry would tolerate this system. Yet, in healthcare, physicians, bound by their oaths to care for patients, endure a system that withholds payment.”

Ultimately, patients bear the brunt of this charade. The authors conclude the article by stating that patients deserve insurance companies that fulfill their contractual obligations.

Click here to read the full 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 #FixPriorAuth.

Bridging the Gap: A Pathway to Neurosurgery for Underrepresented Students

By CNS Spotlight, DEI, EquityNo Comments

Dedicated to alleviating health care disparities, the Pathway to Neurosurgery program encourages high school students from underrepresented groups and/or disadvantaged backgrounds to pursue a career in neurosurgery. On Monday, Sept. 11, the Congress of Neurological Surgeons (CNS) Foundation will host the program at the 2023 Annual Meeting in Washington, DC.

Forty high school students from the E.L. Haynes Public Charter School will participate in a hands-on activity lab to give them insight into a day in a neurosurgeon’s life. Students will also attend lectures from leading neurosurgeons and hear from plenary talk guest speakers.

In recognition of this noteworthy program, the District of Columbia Mayor Muriel Bowser proclaimed Sept. 7-13 as Pathway to Neurosurgery Week. “The CNS is thrilled that Mayor Bowser has recognized the Pathway to Neurosurgery program. As CNS president, it has been a privilege to witness the growth and development of this critical mission-centric project, offering exposure to the wonders of neuroscience to these exceptional students,” states Elad I. Levy, MD, MBA, FAHA, FACS, FAANS, CNS president and professor and chair of neurosurgery at the State University of New York at Buffalo.

“African Americans, Hispanic Americans and women are significantly underrepresented in neurosurgery, and the CNS Pathway to Neurosurgery program aims to address this problem by promoting diversity, equity and inclusion in neurosurgery. Our goal is to inspire students to consider neurosurgery as a career option to foster innovations in patient care that can improve outcomes and reduce minority health disparities,” said Tiffany R. Hodges, MD, co-chair of the CNS Diversity, Equity, and Inclusion Committee and associate professor of neurosurgery at Case Western Reserve School of Medicine. Only 4% of practicing neurosurgeons in the U.S. are Black, 5% are Hispanic and 8% are women. In contrast, approximately 14% of the U.S. population are Black, 19% are Hispanic and 50% are women.

Click here to read Neurosurgery’s press release.

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 @CNS_Update and using the hashtag #PathwaytoNeurosurgery.

Cross-Post: Improving Health Care Quality Measurement to Combat Clinician Burnout

By Burnout, Cross PostNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items from other places that we believe will interest our readers. Today’s post originally appeared in Journal of the American Medical Association (JAMA) on Sept. 1. Neurosurgeon Anthony M. DiGiorgio, DO, MHA, FAANS, Jesse M. Ehrenfeld, MD, MPH and Brian J. Miller, MD, MBA, MPH discuss the impacts and causes of burnout, which affects up to two thirds of physicians.

Although the causes are multifactorial, the authors state that one of the key causes for clinician frustration is quality metrics. Administrative burdens from poorly designed systems and ineffective regulatory policies are central to clinician frustration. Improving these metrics could reduce clinician burnout, with studies indicating that physicians spend less than 15% of their day in direct patient contact. “A living system of quality metrics with a ceiling on their quantity, as well as a metric life cycle with continuous assessment and improvement, would significantly reduce burdens on clinicians and administrators alike” according to DiGiorgio et al.

Click here to read the full article in JAMA.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.