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The Future of Neurological Surgery: Adapting to GME Changes

By CareerNo Comments

Until the 19th century, surgical training was haphazard with no standardization. The surgical trainee learned through observation of a mentor and finished training when the mentor decided it was time. As surgery evolved from a trade to a profession, surgical training also evolved, pioneered by William S. Halsted, MD. Dr. Halsted’s principles of surgical training included the need to understand the scientific basis of disease, provide supervised care of surgical patients and gain increasing responsibility during training, leading to independent practice.

The last 25 years have been a time of dramatic change in neurosurgical education. The Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Neurological Surgery, which is responsible for determining the standards used to accredit neurosurgical residency programs, has been at the forefront of conceiving and instituting changes. During this brief period, we have established a standard of seven years of training for all neurosurgery programs, instituted duty hours restrictions, incorporated the first year of graduate medical education into the neurosurgical residency, created a standard residency curriculum working with the Society of Neurological Surgeons (SNS) and American Board of Neurological Surgery (ABNS), established case minimums for all neurosurgeons in training and increased the oversight of fellowship training through our collaboration with the SNS Committee on Advanced Subspecialty Training (CAST).

Changes in neurosurgery resident training have been driven by advancing technology, elevated patient expectations and the rapidly growing scope of neurosurgical practice. Advances in technology allow neurosurgeons today to perform a much wider range of procedures with better outcomes. At the same time, this increase has made mastering all aspects of neurosurgery untenable. So, while the scope of global neurosurgical procedures has increased, the individual neurosurgeon’s practice has become more focused. This creates a challenge for neurosurgery: how do we continue to have our trainees identify as neurosurgeons when they have widely varying practices?

A key step in assuring the public that a neurosurgeon who completes an ACGME-accredited training program and is certified by the ABNS is well trained is defining “core neurosurgery.” The ACGME Milestones 2.0 Work Group that developed our neurosurgical Milestones 2.0 concluded that core neurosurgery is defined by the cognitive and technical skills that each neurosurgeon must master to care for neurosurgical patients until a subspecialist can see them. These Milestones, along with determining the minimum number of cases that each graduating resident must perform in various neurosurgical subspecialty areas, help ensure that all neurosurgery residents have had excellent training.

Addressing the issue of neurosurgical subspecialization has required the collaboration of the ABNS, the ACGME and CAST. Along with defining core neurosurgery, the ability to obtain accredited subspecialty training during the neurosurgery residency has helped to assure that residents can not only obtain competence in all areas of core neurosurgery but excellence in those subspecialties in which they focus their practice.

Significant accomplishments in the last three years include:

  • Transition to a single GME accreditation system, whereby many of the formerly American Osteopathic Association-approved programs became ACGME-accredited;
  • Changes to case log required minimum numbers;
  • Creation of new dedicated time requirements for program leadership, program coordinators, and core faculty;
  • Design of a subspecialty-specific block diagram; and
  • Creation of a multi-disciplinary ACGME-accredited neurocritical care fellowship.

The current membership of the ACGME Review Committee remains committed to neurosurgical research. We have always expected each neurosurgeon in training to be able to form a hypothesis, test it, analyze the results and present their findings to the neurosurgical community. Every neurosurgeon should have these skills, and the ACGME Review Committee requires that neurosurgical residents be trained in these skills and that the residents and faculty demonstrate academic achievement each year.

In summary, neurosurgery has always welcomed and often led necessary change while adhering to our founding principle that we exist to take care of our patients and to participate in the research and educational efforts that assure better care for patients in the future.

Disclaimer:  Dr. Harbaugh has served as a director of the ABNS, a member of CAST, a past president of the SNS and is presently chair of the ACGME Review Committee for Neurological Surgery. The opinions in this post are his and do not represent the position of any organization.

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.

Robert E. Harbaugh, MD, FAANS, FACS, FAHA
Penn State Hershey Medical Center
Hershey, Pa.

February 26, 2024
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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.

January 18, 2024
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Brain Tumor Nonprofit StacheStrong Donates $110,000 for the Launch of the SNS Neurosurgeon-Scientist Training Program

By Brain Tumor, Career, TumorNo Comments

The Society of Neurological Surgeons (SNS) has established a Neurosurgeon-Scientist Training Program (NSTP) to increase the pool of neurosurgery residents conducting research and to enhance their success rate in becoming independent neurosurgeon-scientists. The NSTP will serve as a formal mentored research program for those neurosurgery residents who are beginning a protected research year or have already completed their protected research year.

The primary goal of this new program is to improve human health by providing participants with the skills, mentorship, education and experience needed to successfully compete for individual research funding (e.g., National Institutes of Health K awards and R01 research grants). Additional research by clinician-scientist neurosurgeons is critical to the fundamental discovery that advances new methods of care and new cures.

A donation of $110,000 by the non-profit StacheStrong provides crucial funding for brain tumor-related grants with the launch of the NSTP. StacheStrong is devoted to raising funds and awareness for brain cancer research. Defeating brain cancer and improving the quality of patients’ lives is the mission of StacheStrong.

Click here to read the 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, @SNS_Neurosurg and @StacheStrong and using the hashtag #BrainCancerResearch.

January 13, 2023
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Neurosurgery Rotation and Application Changes Due to COVID-19: A Medical Student Perspective (Part I)

By COVID-19, GME, MedEdNo Comments

The COVID-19 pandemic has resulted in many changes in the neurosurgery residency application process. Early decisions by the Society of Neurological Surgeons led to the canceling of away rotations, installation of virtual interviews, and a required eight-week home rotation in lieu of visiting rotations. Despite being disappointed that I would be unable to visit programs physically, the neurosurgical response to the challenges as a result of COVID-19 was very proactive, and it was a relief to have a definitive idea of the process early on.

Standing out during the home rotation became essential. Letters of recommendation could only come from home programs, so I used the eight weeks to form stronger relationships with key faculty members. During my rotation, I went to clinic with two of my anticipated letter writers, which proved to be an excellent opportunity to prepare and showcase history-taking, physical exam and imaging interpretation skills. Standing out in the operating room did not change much, but the added time of the rotation allowed me to see a wider variety of cases than I would have on a four-week rotation. I have become more familiar with the inner workings of my home health system. As the eight weeks progressed, I was able to take on more and more tasks associated with running the clinical service. The wider breadth of these experiences helped me learn much more about how to function as a neurosurgical resident than I would on a shorter, four-week rotation.

Many neurosurgical programs have started webinars or meet-and-greet sessions, where applicants can learn about the program directly from faculty and residents. Some programs — my home institution included — have organized lecture series, where faculty and residents give didactic sessions about various neurosurgical topics. These are great opportunities for students to get to know both the logistical aspects of the program, such as rotation schedules, research emphases and to get a feel for the all-important “fit.”As the time to submit applications approached, I reached out to friends who applied last year, current residents and faculty members to better understand the programs and compile my list. While the process has certainly been different from years past, some positive things have come from these changes, including the longer home rotation, webinars and lecture series. To say that the virtual interview dramatically affected the ability of programs and applicants to gauge “fit” may be an overstatement, and the real drawback is likely from loss of longitudinal exposure during in-person rotations. Nevertheless, this year has been exciting for both programs and applicants, and I enjoyed seeing how programs showcased themselves through virtual interviews.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtags #Match2021 and #NeurosurgeryMatch.

Sean Neifert
Medical Student
Icahn School of Medicine at Mount Sinai Hospital
New York, N.Y.

April 27, 2021
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Connecting with the Neurosurgery Community in the COVID-19 Era: Lessons Learned at the University of Miami

By COVID-19, GME, MedEdNo Comments

The COVID-19 pandemic has challenged the neurosurgery community to utilize new technologies to create and maintain connections. With social distancing guidelines in place, much attention has turned to the virtual space to accomplish this. At the University of Miami, we have trialed several virtual initiatives to connect with the neurosurgery community across the country and the world — from medical students interested in our residency training program to attending neurosurgeons interested in hearing from the world-leading experts in various neurosurgical subspecialties. We report the lessons we have learned during these unprecedented and challenging times.

Virtual Sub-Internship

Typically, sub-internships represent the culmination of medical school studies where interested final year medical students rotate in our department to gauge interest in both neurosurgery and our residency program. However, given concerns for student safety with travel, the various travel restrictions in place, and differing hospital policies on rotating medical students, the Society of Neurosurgical Surgeons opted for a unified policy for programs and students to afford all applicants the same opportunities. In 2020, away sub-internships were eliminated, and the University of Miami created a 1-day virtual sub-internship. In these, attendees were exposed to different subspecialties via attending presentations, resident life via resident presentations and applying to our program via a question and answer session with the program director, Ricardo J. Komotar, MD, FAANS, FACS. The lessons we learned are:

  • We can host more attendees than we would be able to with in-person sub-internships;
  • Compared to before, attendees of the virtual sub-internship are objectively more familiar with the residency program, faculty, residents and daily life within the program; and
  • All prospective attendees agreed that a virtual sub-internship before in-person sub-internship applications would be of great use after the pandemic.

The Resident Hour

A challenge facing medical students learning about our residency program is getting to know the current residents when they cannot rotate in the department. Given how vital inter-resident personality fit is when planning applications, we sought to increase the exposure of our residents by introducing a monthly resident-run virtual initiative called The Resident Hour. In it, we had residents present on various neurosurgery- and residency-related topics, but in a more conversational manner. The lessons we learned here are:

  • There is interest in hearing from neurosurgery residents from both within the U.S. and overseas;
  • Interactive sessions that encourage conversations greatly facilitates getting to know residents; and
  • Residents enjoy the opportunity to share with the neurosurgery community their knowledge and opinions.

Online Symposia

In the current pandemic, multiple neurosurgical conferences have been canceled. Without these, the neurosurgery community has lost exposure to experts in the field and the most up-to-date didactics. In response, our department has been able to organize our lecture series utilizing virtual symposia, nicknamed Zoomposiums. In it, we can bring in world-renowned experts virtually to discuss in real-time many pertinent and contemporary topics — including brain tumors via the Miami Global Brain Tumor Symposium organized by Michael E. Ivan, MD, FAANS, and Cerebrovascular and Skull Base Symposium organized by Jacques J. Morcos, MD, FAANS, FACS. Attendance is free and open to anyone interested, and all of the recordings (including The Resident Hour) are available on YouTube. From these symposia, we learned:

  • Virtual symposia increase the breadth of neurosurgical experts’ ability to present their work, as well as the neurosurgery community able to attend;
  • There is great interest in these symposiums across the world, with attendees from over 50 countries registering for each symposium; and
  • Being able to store these symposia online, at no cost, dramatically increases the longevity and reach of their impact.

The COVID-19 pandemic has challenged the neurosurgery community to innovate new ways to become and stay connected. Here in the Department of Neurological Surgery at the University of Miami, we have embraced virtual technology and created initiatives to increase exposure and maintain a connection to our program, our residents and our expertise. We have learned several lessons with the overarching goal of increased accessibility at the forefront of our experience. We can implement these virtual endeavors within the neurosurgery community to become more connected than ever.

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 @Neurosurgery and using the hashtags #Match2021 and #NeurosurgeryMatch.

Victor M. Lu, MD, PhD
University of Miami School of Medicine
Miami, Fla.

 

 

Ingrid Menendez
University of Miami School of Medicine
Miami, Fla.

 

 

Ricardo J. Komotar, MD, FAANS, FACS
University of Miami School of Medicine
Miami, Fla.

April 20, 2021
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Virtual Sub-internships and Remote Interviews: A Sudden Paradigm Shift in the Neurosurgical Residency Application Process Due to COVID-19

By COVID-19, GME, MedEdNo Comments

The year 2020 required constant adaptation to a rapidly changing environment in many facets of life. Few would have guessed that national travel would be severely restricted or that surgeons would be wearing face masks to the supermarket. As impactful as the COVID-19 pandemic has been on life in general, the effect on the neurosurgical practice has been similarly profound —  from shifting outpatient care towards a more remote, telehealth presence to restricting non-urgent surgical case volume. Perhaps the most significant, potentially long-lasting effect of the pandemic on the neurosurgical profession has been with the transition from medical student to resident physician.

Matching into a neurosurgical residency position in the United States has traditionally been an extensive process spanning months and costing applicants upwards of $10,000. Traditionally, students drawn to the field would rotate at a neurosurgical department associated with their medical school before embarking on sub-internship rotations in other neurosurgical departments across the country. This typically benefits the applicant by allowing him or her to observe the diverse practice of neurosurgery across different institutions. Furthermore, it allows the applicant to demonstrate his or her commitment and passion to the field to residents and faculty at these institutions. Moreover, this process is integral to generating letters of recommendation from respected members of the neurosurgical community. While applying for visiting sub-internship positions occurs in the fall to winter of the prior year, these rotations typically happen in the summer to fall of the application year. Once the Electronic Residency Application Service (ERAS) opens, usually in September, residency candidates submit applications to neurosurgery programs nationwide. Based on various selection criteria, applicants are subsequently invited for in-person interviews.

When the COVID-19 pandemic hit the U.S. in March 2020, health care providers nationwide, including neurosurgeons, began focusing all efforts and resources on treating critical patients affected by the SARS-CoV-2 virus. Furthermore, health policies were enacted in various hotspots to limit viral transmission, including stay-at-home quarantine orders, travel restrictions, and strict limitations on hospital visitors. Taken together, these had a noticeable impact on the ability of medical students to participate in visiting sub-internships.

Recognizing that these away rotations are a critical portion of a student’s application for neurosurgery residency, in late April 2020, the Society of Neurological Surgeons (SNS) released its official guidance on external medical student rotations during the COVID-19 pandemic. The SNS recommended deferring all visiting medical student rotations for the 2020 application cycle.  Instead, the SNS recommended that students rotate internally with their home institution for eight weeks. For students enrolled in medical schools without a neurosurgery program, the SNS recommended rotating at the nearest Accreditation Council for Graduate Medical Education-accredited program. Regarding students’ letters of recommendation, the SNS recommended obtaining two letters from neurosurgery faculty and one additional letter from a general surgeon faculty member. Lastly, to further discourage traveling rotations, the SNS recommended against letters from faculty at external neurosurgery programs. Overall, these recommendations served to level the playing field for applicants in regions harder hit by the pandemic (e.g., those with more significant travel restrictions) and students without a home neurosurgery residency program.

In early May 2020, a coalition comprised of the American Association of Medical Colleges, Accreditation Council for Graduate Medical Education (ACGME), American Medical Association and others released a set of recommendations for external rotations and in-person interviews during the COVID-19 pandemic. First, the group discouraged away rotations among all specialties, except for medical students without an ACGME-accredited program at their home institution. Regarding interviews, the coalition recommended that programs commit to virtual interviews and site visits for all applicants, including local students. Lastly, the standard timeline for the ERAS was delayed to account for students’ missing or delaying rotations.

Given that much of the neurosurgery residency match has traditionally depended heavily on interpersonal interaction, letters of recommendation and in-person interviews, these changes to the application process were quite unique. Anyone familiar with the neurosurgery Twitter-sphere can attest to the growing interest in virtual sub-internships and residency program information sessions. As a community, we continue to adapt to the challenges posed by the COVID-19 pandemic. In many cases, we are finding more efficient ways to educate students and promote residency programs, which may be a transition point away from the traditional — and expensive — model of rotating, applying and interviewing for residency. In this series of blog posts, we highlight the challenges in the application process experienced by neurosurgical programs, medical students and others in organized neurosurgery and showcase their innovative responses during this critical time.

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 @Neurosurgery and using the hashtags #Match2021 and #NeurosurgeryMatch.

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

 

 

 

Kurt A. Yaeger, MD
Mount Sinai Medical Center
New York, N.Y.

April 13, 2021
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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.

April 9, 2021
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Reflecting on COVID19, the Death of George Floyd and the Need for Change

By COVID-19, Equity, Social JusticeNo Comments

“I want to touch the world.”
George Perry Floyd, Jr.

We are living in trying and turbulent times in our country. A global pandemic has claimed the lives of more than 100,000 people across America and has threatened to overwhelm our health care systems in some of the worst affected areas. On top of this health crisis, we are now facing the greatest civil unrest our country has experienced in over 50 years in response to a recent series of tragic deaths of black men and women — the cataclysmic event being the deplorable death of George P. Floyd, Jr. while in police custody.

While we look to our politicians for the political answers that will heal the strife in our country, we are all struggling with our personal feelings and response to these events. It has been extremely heartening, however, to see the expression and renewed commitment to inclusion and diversity, particularly within the medical community.

As voices cry out across the world underscoring the systemic problems of racism and inequality, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have joined the chorus speaking out against all forms of discrimination and acts of violence — particularly that which is driven by intolerance and hatred. We reaffirm our commitment to inclusion and diversity. We reflect on the past and the messages of Dr. Martin Luther King, Jr. and Robert F. Kennedy. And we listen to our Black and Brown colleagues who provide a uniquely pertinent perspective on these issues, and we are thankful for their leadership and willingness to speak out.

We hope our readers will be inspired by the words of our colleagues from across the medical profession, which are reposted below in this piece. Millions around the world were horrified in disbelief at the killing of an unarmed man in police custody. As individuals and together as a society, we owe it to George Floyd and countless others to not let his death be in vain and to work to seek lasting change to stamp out racism, inequality and violence. We encourage you all to engage your patients, your colleagues and your communities in discussions as to how we can help heal our country and care for all who need us, including our most vulnerable.

In addition to the above message from the AANS and CNS, neurosurgeons and neurosurgical organizations spoke out.

A group of Black neurosurgeons who came together to publish an OpEd pointed out that as neuroscientists and surgeons, they see firsthand the effects of neurotrauma on those subjected to violence at especially alarming rates in the Black community. From the debilitating effects of blunt and penetrating trauma to the brain and spine to the “intangible neuropsychological effects stemming from fearing for one’s life on a daily basis,” there “is a slow but inevitable erosion of the state of health amongst Black people… This has culminated in a public health crisis shortening not only the lives of too many too early but diminishing the quality of life of those who remain to bear it.”

Reflecting on the shocking video depicting the death of George Floyd, neurosurgeon Fredric B. Meyer, MD, FAANS, the Juanita Kious Waugh Executive Dean for Education of the Mayo Clinic College of Medicine and Science and dean of the Mayo Clinic Alix School of Medicine, wrote to all medical students, residents and fellows. In his letter, Dr. Meyer reminded us “that although our country has made tremendous advances in civil and human rights, we all have significant work to do on so many levels to fight hatred, bigotry, and violence.” He recalled how Bobby Kennedy was one of his family’s heroes and how, as U.S. Attorney General, he was a strong advocate for civil rights. Dr. Meyer went on to note that in this time of terrible strife, anger, mistrust and hatred in our country, he is reminded of a powerful speech that Bobby Kennedy gave spontaneously on the back of a pickup truck when he learned of the assassination of Martin Luther King, Jr. He, along with his brother, President John F. Kennedy, and Dr. King, were all assassinated for the truth they spoke about human decency, civil rights, and a humane society. Dr. Meyer commends to the medical community the YouTube video of Bobby Kennedy announcing Dr. King’s death and to also listen to his speech on humanity, mindless violence and affirmation. His words are as relevant today as they were decades ago, and, as Dr. Meyer aptly stated, it is distressing that fifty years later, the same hatred that killed Dr. King continues to be pervasive in our society.

Leaders of the Society of Neurological Surgeons (SNS) — M. Sean Grady, MD, FAANS, president; Karin M. Muraszko, MD, FAANS, past-president; and Nathan R. Selden, MD, PhD, secretary — wrote to SNS members, neurosurgery department chairs and neurosurgical residency directors. In their message, they called on “educators to exemplify the highest moral and ethical standards for our trainees.” They noted that as educators and leaders in neurosurgery, we must ensure “that the American principles of fair and equal treatment for all are the bedrock of our Neurosurgical community.” Reaffirming a commitment to be “an inclusive organization reflective of the ‘higher’ principles,” they pledged “to grow and adapt and to listen to those we educate and those we serve. Although we may not have walked in their shoes, we will remain open to the knowledge and experience of every colleague and trainee and will respect and acknowledge them for their character and skills rather than for their appearance. Like our society, we believe we can continue to grow towards a more perfect union of our ideals and the reality in which we live,” and to strive together to reach higher ground.

The AANS/CNS Cerebrovascular Section, the Society of NeuroInterventional Surgery (SNIS) and the Society of Vascular & Interventional Neurology (SVIN) joined together to issue a statement acknowledging the difficult and disturbing times that the country is experiencing. These neurovascular organizations pointed out that “acts of violence and racism cause psychosocial stress that leads to poor well-being and cerebrovascular health, especially for communities of color. Given that heart disease and stroke are the leading causes of death for communities of color, our organizations are extremely disturbed by violent acts that cut to the core of the lives in our communities. We denounce the incidents of racism and all violence that continue to ravage our communities.”

Beyond the neurosurgical community, leading national medical organizations also spoke out.

The American College of Surgeons stated that it “stands in solidarity against racism, violence, and intolerance, noting that its “mission is to serve all with skill and fidelity, and that extends beyond the operating room. Racism, brutal attacks, and subsequent violence must end. We will help any injured, and we will use our voice in support of the health and safety of every person.”

Leaders from the American Medical Association (AMA) reminded us that AMA policy “recognizes that physical or verbal violence between law enforcement officers and the public, particularly among Black and Brown communities where these incidents are more prevalent and pervasive, is a critical determinant of health and supports research into the public health consequences of these violent interactions.”  The AMA continued, noting that the “disparate racial impact of police violence against Black and Brown people and their communities is insidiously viral-like in its frequency, and also deeply demoralizing… Just as the disproportionate impact of COVID-19 on communities of color has put into stark relief health inequity in the U.S.”

Finally, the Association of American Medical Colleges (AAMC) pointed out that “the coronavirus pandemic has laid bare the racial health inequities harming our Black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy.” The AAMC statement goes on to address how the brutal and shocking deaths of George Floyd, Breonna Taylor and Ahmaud Arbery “have shaken our nation to its core and once again tragically demonstrated the everyday danger of being Black in America.” Issuing a call to action, the AAMC expresses that “as healers and educators of the next generation of physicians and scientists, the people of America’s medical schools and teaching hospitals bear the responsibility to ameliorate factors that negatively affect the health of our patients and communities: poverty, education, access to transportation, healthy food, and health care.”

The AANS and CNS echo this call to action and concur that we “must move from rhetoric to action to eliminate the inequities in our care, research, and education of tomorrow’s doctors.”

Editor’s Note: Neurosurgery Blog invites you to join the conversation for social change at #WhiteCoatsforBlackLives and #ChangeTheSystem.

 

John A. Wilson, MD, FAANS
President, American Association of Neurological Surgeons
David L. and Sally Kelly Professor and Vice-Chair of the
Department of Neurosurgery, Wake Forest School of Medicine

 

 

Steven N. Kalkanis, MD, FAANS
President, Congress of Neurological Surgeons
Chief Executive Officer, Henry Ford Medical Group
Detroit, Mich.

June 10, 2020
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