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American Board of Neurological Surgery Archives - Neurosurgery Blog

Evaluating Professionalism and Self-reflection in Neurosurgery

By CareerNo Comments

As neurosurgeons, continuous improvement is essential to our growth. Self-reflection and self-improvement are core tenets instilled in us throughout training. During residency, this is built into our education, with discussions of quality, service and opportunities for improvement at the forefront.

But what about after residency? As we transition, we continue to refine what we do and how we practice, often adding new techniques to our repertoires. Residency and fellowship provide the framework to continue to grow, but the educational environment of practice may differ drastically depending on the practice setting. As of 2020, more than 50% of board-eligible candidates reported being in a non-academic practice setting.

To this end, the (ABNS) fosters excellence in patient care and supports our evolution in practice while maintaining high professional standards. The mission of the ABNS is to encourage the study, improve the practice, elevate the standards and advance the science of neurological surgery, thereby serving the cause of public health. There are three main areas where the ABNS continues to evolve to meet the needs of the field: primary examination, oral examination and continuous certification.

  1. Primary examination. The ABNS continues to work towards evolving the primary exam to a mastery exam with clinically relevant questions that reflect current basic knowledge. In 2019, the neuroanatomy “mastery” module was introduced. Residents have four attempts to master the material, which is available for advance study. In the spirit of self-evaluation, residents and program directors are being surveyed for feedback to the ABNS about this module, and the ABNS is planning to closely follow primary examination anatomy scores for impact, with the anticipation that this module will help drive learning.

As of fall 2022, there were 118 Accreditation Council for Graduate Medical Education-accredited programs and 1,629 neurosurgery residents. In March 2023, a record 887 residents took the primary exam, of whom 249 took it for credit and the remainder were for self-evaluation. Question stems are released each year to support studying. The passing score (72% in 2023) is slowly increasing, and the ABNS directors and the National Board of Medical Examiners are completing more frequent standard setting for the exam.

  1. ABNS Practice and Outcomes of Surgical Therapies (POST) and the Oral Examination. ABNS POST continues to evolve in response to current needs and feedback about the process. Current graduates now register and enter 10 cases into POST within the first six months of graduation for the ABNS to provide feedback and help track the transition to practice.

In response to the global pandemic, the oral examination changed to a virtual format for candidates. This was very well received and will continue with guest examiners traveling to pre-exam enrichment activities and conducting exams virtually. The ABNS surveys candidates and examiners for feedback about the exam process. In May 2023, 58% of candidates responded, of whom over 99% felt the application and registration process were clear and transparent, 98% felt the pre-exam session and materials were helpful, and 100% felt the exam was conducted professionally.

One candidate said, “The ABNS staff — along with the entire board certification application process — has been remarkably efficient, clear and professional. It is reassuring to see this kind of professionalism from the board, which represents our field. Overall, it was more impressive than I expected, and the level of professionalism of the staff and examiners made me proud to be in the field. Great work to the team(s) that put this together and make it possible.” Other suggestions for clarification and improvement are reviewed to help improve the oral examination process.

  1. Continuous certification. Formerly known as maintenance of certification, the ABNS uses continuous certification to help assist diplomates in lifelong learning and self-assessment by encouraging, stimulating and supporting continued education in the practice of neurosurgery. Professionalism and participation in quality improvement are also assessed. The program is designed to allow diplomates to meet requirements, comply with state and hospital regulations, and reassure patients, families, payers, funding agencies and the public that ABNS diplomates continually improve their knowledge and practice in core neurosurgery. The ABNS has strongly advocated for continued learning instead of a high-stakes exam to better support the specialty’s needs.

Neurosurgeons continue to evolve and adapt to changes in our field, health care and the needs of our patients. Continuous improvement, self-reflection and self-improvement are essential. The ABNS aims to serve the cause of public health by our mission and values and by continually improving how we serve the field and our patients.

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.

Marjorie Wang, MD, MPH, FAANS

Milwaukee, Wis.


Cross-Post: Overlapping Surgery: A Safe and Smart Way to Fix COVID-Related Backlogs

By COVID-19, Cross PostNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The American Spectator on April 1, 2021. In the op-ed, Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala. and Anthony M. DiGiorgio, DO, MHA, assistant professor of neurosurgery at the University of California San Francisco in San Francisco, Calif. highlight the opportunity for overlapping surgery to assist with the backlog of neurosurgical cases due to COVID-19.

Across the country, many non-urgent surgeries were canceled or delayed due to COVID-19. Overlapping surgery is the practice of a surgeon being responsible for more than one operating room at a time with non-critical portions of the procedure overlapping. When properly and ethically integrated, Drs. Menger and DiGiorgio use overlapping surgery in neurosurgery to better use health care resources and improve access to care.

In 2016, the American Association of Neurological Surgeons, American Board of Neurological Surgery, Congress of Neurological Surgeons and Society of Neurological Surgeons issued guidelines for the use of overlapping surgery.

Click here to read the full article in The American Spectator.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtags #Neurosurgery and #COVID19.

WINS: Celebrating Women in Neurosurgery

By Career, 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.

Alia Hdeib, MD, FAANS, FACS
Case Western Reserve University
Cleveland, Ohio



Jennifer A. Sweet, MD, FAANS, FACS
Case Western Reserve University
Cleveland, Ohio

Answering the Call: From Neurosurgeon to Critical Care Physician During COVID-19

By COVID-19, Faces of Neurosurgery, Guest Post, HealthNo Comments

With the coronavirus pandemic sweeping the nation, some regions of our country are encountering a shortage of health care providers to look after the surge of hospitalized patients. As personnel resources are strained, neurosurgeons are being asked to care for critically ill patients — including ones that do not have neurological diagnoses.

Beyond a robust foundation in neurocritical care during training and daily practice, some neurosurgeons have additional training in critical care to become full-time neurointensivists. As such, neurosurgeons of all subspecialties may be tapped to care for patients in the intensive care unit (ICU). This is not surprising because of the skills all neurosurgeons develop to monitor patients closely and act swiftly and decisively when the need arises. The complexity of neurosurgical patients demands an extensive understanding of how the body’s organ systems interact and must be treated when acute multi-organ dysfunction exists. Patients with ruptured aneurysms, traumatic brain injuries, strokes and spinal cord compression may also have respiratory failure, cardiac disease and acute kidney injury.

While learning about critical care is a part of neurosurgical training, many neurosurgeons have not been practicing critical care medicine since leaving training. One strength of organized neurosurgery is its ability to draw neurosurgeons together for a common purpose. To aid neurosurgeons in their new mission, the Joint Section on Neurotrauma & Critical Care (Trauma Section) of the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) developed A Neurosurgeon’s Guide to Pulmonary Critical Care for COVID-19, a presentation that includes:

  • A review of pulmonary physiology;
  • Protocols to promote the safety of caregivers;
  • Basics of ventilator management;
  • Recommendations from multiple professional societies for the care of COVID-19 patients; and
  • A review of techniques to optimize patient care.

This presentation is available on the COVID-19 resource hubs of the AANS, the CNS and the American Board of Neurological Surgery.

The Trauma Section has also developed additional guidance, A Neurosurgeon’s Guide to Cardiovascular and Renal Critical Care for COVID-19, which is available from the AANS and the CNS.

While our nation faces a new challenge in the COVID-19 pandemic, organized neurosurgery is rising to meet it. The educational efforts of the AANS and the CNS, along with health care policy advocacy from the AANS/CNS Washington Committee, are helping to prepare neurosurgeons in all stages in their career to answer this call.

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 hashtag #COVID19.

Alan Hoffer, MD, FAANS
Chair, Critical Care Committee of the AANS/CNS Joint Section on Neurotrauma & Critical Care
University Hospitals of Cleveland
Case Western Reserve University