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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 American Board of Neurological Surgery (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
Froedtert & the Medical College of Wisconsin
Milwaukee, Wis.

 

April 12, 2024
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Cross-Post: It’s Never Too Late to Pivot From N.F.L. Safety to Neurosurgeon

By Career, Cross PostNo 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 be of interest to our readers. Today’s post originally appeared in the New York Times on Oct. 11 as part of the “It’s Never Too Late” series. The article discusses how Myron Rolle, MD, a PGY-6 neurosurgery resident at Massachusetts General Hospital in Boston, Mass., transitioned from playing in the NFL to neurosurgery.

Dr. Rolle notes that he was inspired to become a neurosurgeon by the book “Gifted Hands” by Benjamin S. Carson, MD, FAANS (L) — a memoir that detailed how Dr. Carson went from being an inner-city youth with poor grades to the director of pediatric neurosurgery at Johns Hopkins University Hospital. Dr. Rolle’s long-term goal is to practice neurosurgery in the U.S. and spend a portion of the year in the Caribbean, developing neurosurgical services in the Bahamas and member states of CARICOM, an organization of Caribbean countries.

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 @MyronRolle and using the hashtag #Neurosurgery.

October 28, 2022
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COVID-19 and Neurosurgery: Response, Adaptation and Action on Behalf of Our Patients

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

 “Death, be not proud, though some have called thee.
Mighty and dreadful, for thou art not so.”
John Donne

The COVID-19 pandemic is a generational event. It has disrupted every aspect of modern life. Businesses are shuttered. Schools and universities are closed. Social distancing has altered our normal mores for connecting with our neighbors, friends and colleagues. Although many in medicine are dramatically affected by the pandemic as they are on the ‘front lines’ of the crisis, the pandemic has had a ripple effect through the entire health system.

Neurosurgery is no exception. The pandemic has been a significant disruption to the way neurosurgeons interact with and care for their patients. It has been remarkable how the medical community has come together and has been able to pivot on the spot to adjust the way we deliver care to our patients. There certainly is no single best approach, and there’s much to learn from each other.

Over the next several weeks, the Neurosurgery Blog will highlight some of the ways that COVID-19 has affected our practices, our lives and how many in our specialty have responded to the challenge.

We began by highlighting the experience of colleagues from the University of California, San Francisco — who proposed a way to manage neurosurgical cases in The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm. We also shared an overview of The Global Impact of COVID-19 on Neurosurgical Practice, Parts I and II, as recorded by several reports in the Journal of Neurosurgery (JNS). Both the JNS and Neurosurgery will provide weekly COVID-19-related updates from neurosurgeons from across the world.

Neurosurgeons have been personally affected by the virus with results that speak both to the tragedy of the current situation as well as the hope of recovery. Tragically, our specialty lost James T. Goodrich, MD, PhD, from New York City, who died from complications of COVID-19, and we take the opportunity to celebrate his life and achievements.

Neurosurgeons are also playing various clinical roles during this crisis. Aiming to protect patients and create surge capacity, surgeons have been asked to manage their patients and practices by abiding mandatory orders halting elective surgery. Scott A. Meyer, MD, FAANS, will share his experience in “Keeping Neurosurgical Practices Operating During COVID-19 and Beyond,” an issue that is undoubtedly vital for those who practice in solo or small group practices.

Others have been asked to assume alternate roles for their health system as demand requires, which will be discussed by S. Alan Hoffer, MD, FAANS, in “COVID-19 Answering the Call: From Neurosurgeon to Critical Care Physician.” Myron Rolle, MD, will report on “Neurosurgeons on the COVID-19 Frontlines,” based on his experience dealing with one of the epicenters of the outbreak in Boston. Shelly D. Timmons, MD, PhD, FAANS, will be tackling another very tangible aspect of this crisis — the lack of personal protective equipment (PPE) — in “SOS: Send More PPE Now!”

Neurosurgery has also responded by adapting the way we care for and interact with patients and colleagues. These last four weeks have seen an unprecedented expansion of the use of telemedicine at a rate perhaps higher than over the previous decade. Of particular practical interest may be “Telemedicine: During the COVID-19 Pandemic and in a Changing Health Care System” by John K. Ratliff, MD, FAANS, and Clemens M. Schirmer, MD, PhD, FAANS.

COVID-19 has also had a profound effect on medical education on all levels. Face-to-face interaction and departmental teaching and working conferences have been eliminated. The need to keep training going has been a driving force to explore other ways to deliver education. Ashok R. Asthagiri, MD, FAANS, and the CNS education team, will share some lessons and experiences in “Innovations in Continuing Medical Education in a COVID-19 Environment.” In addition to issues related to continuing medical education, we will hear from medical students and residents from two programs in New York — Mount Sinai and the University of Rochester — highlighting how the crisis has affected their training and what the future may hold for those medical students with ambitions to pursue our specialty.

Finally, our former Neurosurgery Blog editor, Deborah L. Benzil, MD, FAANS, also tries to look forward to the end of this crisis and moving forward through her piece “Hope and Recovery, Life After COVID-19.”

We hope to highlight some of the resolve and resilience that neurosurgeons have brought to this crisis in service to our patients. It is too early to tell whether we can simply return to normal or whether a new normal state must be found in the aftermath of the pandemic.

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.

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, P.A.

 

 

Kristopher T. Kimmell, MD, FAANS
Vice-chair, AANS/CNS Communications and Public Relations Committee
Rochester Regional Health
Rochester, N.Y.

April 21, 2020
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AANS Neurosurgeon Spotlight: Winter 2020 – The Mind of a Neurosurgeon

By AANS Spotlight, GME, Loss of Life, MedEd, Voices of Neurosurgery DepartmentsNo Comments

In The Mind of a Neurosurgeon, join authors as they discuss navigating life as a neurosurgeon. From work-life balance to processing loss, pursuing creative outlets to the responsibility of training the next generation, neurosurgeons have a unique calling that leads to a special life serving others. Browse the articles and step into the mind of a neurosurgeon for stimulating conversations about the alternate mind, retirement, mindfulness, the outsider’s perspective, music and much more.

Check back later in January and February for more on The Mind of a Neurosurgeon. Here are just a few articles out now:

Stay Current

Access the Current Table of Contents

Follow @aansneurosurg on Twitter, Instagram and like AANS Neurosurgeon on Facebook!

December 30, 2019
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Paying Tribute to Neurosurgery’s Military Veterans

By Military Faces of NeurosurgeryNo Comments

Veterans Day is an appropriate opportunity to pay tribute to the contributions of the many military neurosurgeons who have made significant contributions and sacrifices. This storied history is filled with contributions from many of our field’s current and former leaders. We thought today our Neurosurgery Blog readership might want to revisit some of the profiles of these truly amazing individuals that we previously spotlighted.

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

November 11, 2019
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