AANS Neurosurgeon | Volume 29, Number 1, 2020

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Why Diversity Matters: Recruiting the Next Generation Part 2

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The Case for Diversity

Careers and employers that promote 2-D cultures, which emphasize both inherent and acquired diversity, are 45% more likely to promote innovation and growth. 15 he current numbers-driven residency selection approach may unintentionally be serving to foster a culture that restricts the acquired diversity within the residency applicant pool. The medical student perspective is:

“If you don’t have a Step 1 score near the average of neurosurgery, you might as well not apply.”

(USMLE just announced that Part 1 of the Step exam will become Pass/Fail in 2021). Many students describe preparations to apply to neurosurgery as an “arms race” due to the increasingly robust pre-residency expectations.16 The successfully matching student in 2018 had, on average,  a Step 1 score of 245, a Step 2 score of 249, 4.3 first/last author publications, 2.1 neurosurgical first/last author publications and 18.3 total research projects.17

USMLE Step 1 scores are the strongest predictor of successfully matching into neurosurgery.18 In contrast to this, performance on standardized exams is not associated with future productivity (h-index) as a faculty member or with faculty reviews as a resident.19,20 Performance on previous standardized exams predicts only future exam performance.21,22 Though a difficult task, placing more value on the individual experiences of applicants may allow residency program directors to more easily identify and recruit applicants with diverse backgrounds, with potential to diversify the field.

Perpetuating the Status Quo

These two seemingly unrelated ideas, gender diversity and pre-residency expectations, are actually closely aligned. Medical student interest in surgical fields is influenced by gender, features of surgical education and student “fit” within the culture of the specialty.23 The lack of female representation and the current numbers-driven culture may be discouraging a significant number of students from even developing an interest in the field. By reevaluating current recruitment methods, the pool of hard working, motivated and talented students interested in neurosurgery will increase.

Diversity should be sought throughout the field of neurosurgery to include people from all genders, races, sexual orientations and cultures. This can be achieved through the refinement of the resident selection process. As recruitment efforts evolve, reliance on both inherent and acquired diversity will allow the field of neurosurgery to remain at the cutting edge of medicine and patient care.  

Author’s acknowledgement:

Thank you to my mentors Susan R. Durham, MD, FAANS; Ryan P. Jewell, MD, FAANS; Deborah L. Benzil, MD, FAANS; Scott L. Zuckerman, MD, MPH, and all of the students interested in neurosurgery that I have had the opportunity to work with for their support and inspiration.

References

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1. Spetzler, R. (2011). Progress of women in neurosurgery. Asian Journal of Neurosurgery6(1), 6. doi: 10.4103/1793-5482.85627

2. Harvey Cushing: A Life in Surgery. (2006). Neurosurgery. doi: 10.1227/01.neu.0000309961.72379.d6

3. Hongbin. (2018, December 10). Harvey Cushing and the Cushing Center. Retrieved from https://library.medicine.yale.edu/cushingcenter/history

4. Changing the Face of Medicine | Louise Eisenhardt. (2015, June 3). Retrieved from https://cfmedicine.nlm.nih.gov/physicians/biography_97.html

5. Louise Eisenhardt. (2018, March 21). Retrieved from https://en.wikipedia.org/wiki/Louise_Eisenhardt

6. Harvey Cushing: A Life in Surgery. (2006). Neurosurgery. doi: 10.1227/01.neu.0000309961.72379.d6

7. Hongbin. (2018, December 10). Harvey Cushing and the Cushing Center. Retrieved from https://library.medicine.yale.edu/cushingcenter/history

8. Hewlett, S. A., Marshall, M., & Sherbin, L. (2013, December). How Diversity Can Drive Innovation. Harvard Business Review.

9. Talamantes, E., Henderson, M. C., Fancher, T. L., & Mullan, F. (2019). Closing the Gap — Making Medical School Admissions More Equitable. New England Journal of Medicine380(9), 803–805. doi: 10.1056/

10. FACTS: Applicants, Matriculants, Enrollment, Graduates, MD-PhD, and Residency Applicants Data. (n.d.). Retrieved from https://www.aamc.org/data-reports/students-residents/report/facts

11. Talamantes, E., Henderson, M. C., Fancher, T. L., & Mullan, F. (2019). Closing the Gap — Making Medical School Admissions More Equitable. New England Journal of Medicine380(9), 803–805. doi: 10.1056/

12. 2019 FACTS: Applicants and Matriculants Data. (n.d.). Retrieved from https://www.aamc.org/data-reports/students-residents/interactive-data/2019-facts-applicants-and-matriculants-data

13. Benzil, D. L., Abosch, A., Germano, I., Gilmer, H., Maraire, J. N., … Zusman, E. (2008). The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. Journal of Neurosurgery109(3), 378–386. doi: 10.3171/jns/2008/109/9/0378

14. Donaldson, K., Gelinne, A., Manigrasso, J., Everett, W., Ames, S. E., & Durham, S. R. (n.d.). Gender Diversity in US Neurosurgery Training Programs.

15. Hewlett, S. A., Marshall, M., & Sherbin, L. (2013, December). How Diversity Can Drive Innovation. Harvard Business Review.

16. Wadhwa, H., Shah, S. S., Shan, J., Cheng, J., Beniwal, A. S., Chen, J.-S., … Aghi, M. K. (2019). The neurosurgery applicant’s “arms race”: analysis of medical student publication in the Neurosurgery Residency Match. Journal of Neurosurgery, 1–9. doi: 10.3171/2019.8.jns191256

17. Wadhwa, H., Shah, S. S., Shan, J., Cheng, J., Beniwal, A. S., Chen, J.-S., … Aghi, M. K. (2019). The neurosurgery applicant’s “arms race”: analysis of medical student publication in the Neurosurgery Residency Match. Journal of Neurosurgery, 1–9. doi: 10.3171/2019.8.jns191256

18. Durham, S. R., Donaldson, K., Grady, M. S., & Benzil, D. L. (2018). Analysis of the 1990–2007 neurosurgery residency match: does applicant gender affect neurosurgery match outcome? Journal of Neurosurgery129(2), 282–289. doi: 10.3171/2017.11.jns171831

19. Gelinne, A., Zuckerman, S., Benzil, D., Grady, S., Callas, P., & Durham, S. (2018). United States Medical Licensing Exam Step I Score as a Predictor of Neurosurgical Career Beyond Residency. Neurosurgery84(5), 1028–1034. doi: 10.1093/neuros/nyy313

20. Zuckerman, S. L., Kelly, P. D., Dewan, M. C., Morone, P. J., Yengo-Kahn, A. M., Magarik, J. A., … Wellons, J. C. (2018). Predicting Resident Performance from Preresidency Factors: A Systematic Review and Applicability to Neurosurgical Training. World Neurosurgery110. doi: 10.1016/j.wneu.2017.11.078

21. Gelinne, A., Zuckerman, S., Benzil, D., Grady, S., Callas, P., & Durham, S. (2018). United States Medical Licensing Exam Step I Score as a Predictor of Neurosurgical Career Beyond Residency. Neurosurgery84(5), 1028–1034. doi: 10.1093/neuros/nyy313

22. Zuckerman, S. L., Kelly, P. D., Dewan, M. C., Morone, P. J., Yengo-Kahn, A. M., Magarik, J. A., … Wellons, J. C. (2018). Predicting Resident Performance from Preresidency Factors: A Systematic Review and Applicability to Neurosurgical Training. World Neurosurgery110. doi: 10.1016/j.wneu.2017.11.078

23. Peel, J. K., Schlachta, C. M., & Alkhamesi, N. A. (2018). A systematic review of the factors affecting choice of surgery as a career. Canadian Journal of Surgery61(1), 58–67. doi: 10.1503/cjs.008217

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