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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.

 

October 30, 2023
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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.

October 25, 2023
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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

October 18, 2023
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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.

October 6, 2023
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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.

September 9, 2023
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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.

September 7, 2023
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Cross-Post: A Pediatric Neurosurgeon Reflects on His Job and the Post-Roe Landscape

By Cross Post, PediatricsNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will interest our readers. Today’s post originally appeared in NPR’s Fresh Air on July 28. Dave Davies interviews pediatric neurosurgeon John “Jay” Wellons, III, MD, FAANS, about his memoir “All That Moves Us,” which reflects on his experiences operating on children facing critical illnesses and injuries.

Dr. Wellons relays the story of a 9-year-old pediatric patient in an auto accident in Alabama who had a blood clot pushing her brain. Due to the weather, medevac helicopters weren’t running. Dr. Wellons recounts he arranged for a military Blackhawk to bring her to Birmingham, Ala., for surgery. The surgery was successful, according to Dr. Wellons, “The flicker of the eyes open – that’s a miraculous feeling, Dave, you know, to see somebody wake up after something like that.”

Dr. Wellons also describes an operation on a fetus in the womb, the spine he describes as the size of three grains of rice stacked together. This was surgery to correct a condition that leads to spina bifida.

When asked what he thinks will happen in the post-Roe landscape, Dr. Wellons states, “I can’t tell you how much I think that this ruling is going to affect what it’s like for families to have these substantial — neurologic, cardiac, urologic — encephaloceles where the gut’s outside the body that is hard to be fixed sometimes. Like, we’re going to see a lot more of these now, and we’re going to have to, as a society, understand that we’re going to have to take care of these children. That’s our job. So, yes, I think it’s going to have an impact.”

Click here to access the full interview.

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

August 7, 2023
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