AANS Neurosurgeon | Volume 29, Number 2, 2020

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Why Diversity Matters: Recruiting the Next Generation Part 1

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The primary goal should be, as it always has been, to attract the best and brightest candidates and leaders who are passionate about neurosurgery, regardless of their gender or any other minority status … We gain nothing as a discipline if we fail to make reasonable accommodations that will attract and nurture the best and brightest”                               

Robert F. Spetzler1

The world of neurosurgery was conceived through the active recognition of the strength inherent in diversity. Continuing this tradition is just as important today to attract the best and brightest medical students who represent an increasingly diverse patient population. Over the last decade, progress has been made; however, significant opportunity for diversification still exists, especially given the increasing diversity seen throughout medical schools. Honest, open and ongoing conversations are essential to move the needle further.

Cushing and Diversity

The importance of diversity in neurosurgery dates to its genesis. As a child, Harvey Cushing attended the Cleveland Manual Training School, which emphasized hands on experimental training and a physics-focused approach to education. The manual dexterity he developed during this time allowed him to master many different surgical techniques. He began his career as a general surgeon operating in disparate fields, such as GI, gynecology, orthopedics and plastic surgery. It was not until he began successfully treating trigeminal neuralgia via surgical techniques that he found his passion for the central nervous system.2,3

Cushing’s mentor, William Halsted, emphasized the importance of surgical pathology and physiology. After his training, Cushing partnered with Louise Eisenhardt, a neuropathologist.4 Eisenhardt would assist Cushing in the operating room, documenting tumor resections and making real-time diagnoses of tumors and tissue.5 Their work together culminated in the publication of the legendary monograph, Meningiomas.6,7

2-D Diversity and Neurosurgery

Neurosurgery has always recognized that it is the utilization of both the inherent diversity of individuals and the acquired diversity of thoughts, knowledge and experience that optimizes patient care. Harvard Business Review defines this type of diversity as 2-D, encompassing both inherent and acquired features.8

Patients report better communication, adherence to medical treatment and greater satisfaction when cared for by racially and culturally accordant physicians.9 The goal should always be to have the diversity of the nation represented within the healthcare workforce.10 Through this, physicians will be better equipped to help patients and their families with complex medical decisions that are inherent to the field of neurosurgery.

Medical schools are working to improve diversity and are currently the most diverse they have ever been. Over the past two decades, the number of matriculating students at U.S. medical schools from racial and ethnic groups underrepresented in medicine increased by 30% (from 2850 to 3713).11 There are now more women than men applying to (Women: 27,848; Men: 25,494) and matriculating from (Women: 11,461; Men: 10,402) medical school.12 Unfortunately, the diversification seen within the current cohort of medical students is not seen across all specialties.

Women neurosurgeons from around the world. Front Row from Left: Sneha Sharma (Singapore), Edie Zusman (US), Hui Ming Khoo (Japan), Helen Fernandes (England), Ellen Air (US), Sheri Dewan (US), Susan Durham (US), Sonia Eden (US), Michele Hilgart (CNS Staff), Jennifer Sweet (US) Back Row from Left: Deborah Benzil (US), Nadia Atai (US), Martina Stippler (US), Maria Manuel Santos (Portugal), Sarah Woodrow (US), Vanessa Holanda (Brazil), Ann Parr (US), Mariangela Goncalves (Brazil), Eve Tsai (Canada), Anke Höllig (Germany)

Neurosurgery ranks among the lowest of all specialties for female representation among residents, attendings and women in leadership positions. In 2008, a white paper critically evaluated gender diversity in neurosurgery and concluded that females comprised only 4.7% of the 3,545 board-certified, actively practicing neurosurgeons. The authors challenged the neurosurgical community with a call-to-action:

Attain a 20% female complement within residency programs and a 20% female faculty complement by 2020.13

This deadline is quickly approaching, and significant progress has been made. As of 2019, 18.2% of residents training are female and 8.7% of board-certified practicing neurosurgeons are female.14 Five women have achieved the position of department chairs/division chiefs, and there are currently seven women program directors. Last year, Shelly Timmons, MD, PhD, FAANS, became the first female president of the AANS and Karin Muraszko, MD, FAANS, is the current president of the Society of Neurological Surgeons. While these numbers certainly demonstrate an improvement, there is still much work to be done.

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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