AANS Neurosurgeon | Volume 28, Number 4, 2019

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Training the Minds of Potential Neurosurgeons: Working with Medical Students Destined to become Neurosurgeons and Those Who are Not

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Training the next generation of neurosurgeons is essential to the success of our specialty. Their input, creativity and research will propel neurosurgery to improve and change to better meet the needs of patients. To accomplish this neurosurgeons must have early and frequent contact with medical students. If a school emphasizes primary care education, student contact with specialists is often difficult without volitional effort. Participation in medical school education by neurosurgeons is essential for encouraging, developing and selecting the brightest future neurosurgeons. This will also impact those students that will be our future colleagues in anesthesia, general surgery, neurology and general medicine. It is equally vital that all students understand the important role that neurosurgery plays in patient care and in the health care systems of the future. Therefore, neurosurgical training for medical students must instead be universal, cover broad themes and impact more than the select few who go into neurosurgery.

Neurosurgeons and Education

The special case of neurosurgery in education requires an understanding of the role neurosurgery has in today’s medical system. As neurosurgery is approximately 3% of medicine, truly a rounding error in some medical deans’ opinions, we must struggle to illustrate the importance of our neurosurgical role within the medical system. Without neurosurgery, a medical system cannot have complete trauma care, cancer care, stroke care or treatment of pain and congenital pediatric anomalies. Neurosurgeons gaining access to medical students is not only essential to the future of our small field, but also essential for a health system based on collaboration with other chosen medical fields.

Lighting a Fire

A true neurosurgical education addresses all students, because of the significant value. It is our job to see education of medical students the way W.B. Yates saw education, not as the “filling of a pail” with facts easily forgotten, but as the “lighting of a fire” in students, which will excite them with passion for their chosen profession. This greatly enriches these self-starting learners and gives practical knowledge along with science-based evaluation of symptoms, leading to the formulation of a diagnosis and the execution of a treatment plan. Furthermore, when the present state of information is inadequate, as is always the case in medicine, we must develop students who have the creativity through research to answer the questions that medicine has not yet discovered.

We gain traction in a medical school education program with quality teaching and by covering universal subjects as well as specific neurosurgical topics. My teaching philosophy takes the basic science of medical school – anatomy, histology and physiology – and adapts them to a clinical question. Over the years, such questions have ranged from, “How do I become a doctor?” to “How do you use neuroanatomy to understand the presentation, exam and treatment options of a cranial emergency?” Topics chosen illustrate a basic medical tenet, applicable whether one goes into neurosurgery or not. It may take the understanding of intracranial pressure (ICP) to hone the cranial exam in an emergency or the understanding of the anatomy of spinal long tracks and upper/lower motor neuron signs to focus and direct the neurological exam of the extremities. Similarly, when I lecture on stroke, I never ask students to name the types of stroke, but rather to understand how the anatomy, histology and physiology of the brain determines its function in health and disease and leads us naturally to risk factors, presentations and treatment options. The student learns how hypertension would cause selective damage of one vessel versus the other and how atherosclerosis would not be randomly distributed, but rather anatomically distributed, therefore, both have a very predictable but different clinical presentation and predictable treatments. All of this is an attempt to show that we must apply the science of our time to create new treatments.

Inspiring the Future

Such approaches are successful in showing students that they can learn, they can discover, they can solve diagnostic dilemmas and create new research opportunities in any field they choose. More importantly, by using neurosurgical examples to teach universal truths of medical education, we help all students understand the role of neurosurgery within the health care system, while also illustrating how to apply these advanced tools in all specialties. Through early contact with all students, one neurosurgeon may reach and “light the fire” in someone who will go on to achieve greatness in neurosurgery. Many of us knew nothing of neurosurgery when we entered medical school, but had a mentor demonstrate the possibilities of a neurosurgical career as well as the potential for achieving greatness in this field. Today’s students are brilliant. Reach them by challenging them not to memorize, but rather to understand. From that comes passion and the creativity our field needs for its future.

This is our obligation not only to neurosurgery, but also to the minds of future neurosurgeons and colleagues in other medical fields that we can impact through education.

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