A Commitment to Education
Reflecting on the goal of a medical education, William Osler, considered by many to be the father of modern medicine, said: “At the outset appreciate clearly the aims and objects each one of you should have in view — a knowledge of disease and its cure, and a knowledge of yourself. The one, special education, will make you a practitioner of medicine; the other, an inner education, may make you a truly good man, four square and without a flaw.” His appeal was for a “due proportion of each” to thereby becoming a complete physician.
Education specifically in neurosurgery was experienced by the 23 surgeons chosen who attended the first meeting of the Harvey Cushing Society in 1932. Neurosurgical education was a natural commitment that would become a core mission of the organization. It would assume an even greater role as the Cushing Society transitioned to the American Association of Neurological Surgeons in the 1960s.
With the approach of the 76th AANS Annual Meeting in April and the conclusion of my AANS presidency, it is humbling to consider that the philosophy and goals of the AANS — outlined in the letters that proposed the Harvey Cushing Society — are yet intact. The authors of those letters, Temple Fay, R. Eustace Semmes, R. Glen Spurling and William P. Van Wagenen, wished to further their knowledge of neurological surgery by meeting with their colleagues to present scientific papers and discuss problems common to their clinical practices. These great leaders recognized the need for a face-to-face dialogue on the issues of their day that would make them better physicians and improve patient care. They were intent on understanding neurological diseases and developing surgical techniques that might bring about cures. Their way had been made clear by the remarkable work of Harvey Cushing, whose approval they cherished and who himself was influenced by Osler, of whom Cushing would write a much celebrated biography.
Throughout its history the AANS has strived to meet the continuing education needs of its membership. The rapid pace of scientific discovery and technological advancement has demanded an ever-increasing investment of AANS resources and a commitment of AANS leadership to careful assessment of educational offerings.
The number of directly and jointly sponsored AANS continuing education offerings has increased exponentially over the past two decades. Much of this growth has been in response to innovations in technology that call for additional hands-on training. Unlike the AANS founders, who sought to better understand neurological disease and learn of new surgical techniques, today’s practicing neurosurgeons also must become knowledgeable in the application of a wide variety of new devices that promise to improve patient care.
Our specialty has become a technology-intensive surgical practice. Neurosurgeons must interact with industry in the development of new technologies for the benefit of their patients. The high cost of educational programs and hands-on training for these technologies must be supported through financial sponsorship from industry. Neither the practicing neurosurgeon nor the AANS can bear this expense alone.
In the past year the relationship between surgeons and the medical device industry has received a great deal of news coverage. AANS leadership has been keenly aware of the ethical and legal concerns regarding the relationship between the AANS and industry. Corporate support is desired and appropriate if it brings significant educational value and improves patient care. Governed by the AANS Guidelines for Corporate Relations, which first were released in 2005, the AANS has developed appropriate relationships with its industry partners to enhance neurosurgery’s core missions of patient care, education and research.
The complexity of today’s AANS education program demands forward-thinking leadership that will be ever vigilant against the threat of outside interests that might damage the integrity of our education program either directly or by association. We should openly welcome new technologies and ideas that advance the educational experience for our members, but we also must insist that the pathway of approval for new innovations is both scientifically rigorous and strictly overseen.
Neurosurgical education belongs to organized neurosurgery. Neurosurgeons control the content and delivery of education for AANS members. Each AANS member benefits from the commitment of our organization to our core mission of neurosurgical education.
The experience of leading this wonderful organization over the past year has led me to an even greater appreciation of the foresight evidenced by visionaries such as Osler, by the founders of the Harvey Cushing Society and by my 74 predecessors at the AANS helm. I am no less appreciative of and deeply grateful for the support and hard work of everyone in our organization who has built upon the past by contributing this year to the current and future success of the AANS. For me, it has been an honor and a privilege to serve.
Jon H. Robertson, MD, is the 2007–2008 AANS president and chair of the Department of Neurosurgery at the University of Tennessee Health and Science Center, Memphis, Tenn. The author reported no conflicts for disclosure.