AYAM Neurosurgery Specialty Mentorship Meeting July 2023

July 17, 2023

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Career-planning webinars organized by the Association of Yale Alumni in Medicine (AYAM) connecting Yale medical students with alumni in specialties across medicine and surgery.

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00:00The AYIM specialty mentorship panel
00:03series and we have we elected to start
00:07with neurosurgery and so we are,
00:10we are feeling incredibly grateful that we
00:12have a a group of neurosurgeons here with us.
00:16We're going to get started in just a minute.
00:17I just want to just want to let you
00:19know we're going to start in one or two
00:21minutes and so some additional people are
00:23are coming on to the onto the zoom now.
00:26So we'll get started real short.
01:20Okay, fantastic. So hopefully,
01:23as everybody has successfully
01:25joined up onto the Zoom panel,
01:28like I mentioned just a minute or two ago,
01:31my name is Paul Liang.
01:33I'm the Vice President of the Association
01:36for Yale Alumni and Medicine.
01:38And and this is something we've
01:40been planning for quite some time.
01:42We think that there's a great opportunity to.
01:46Connect alumni of the medical school
01:50who chose to go into certain areas.
01:53I'd like to actually thank one of
01:55the medical students, Brett Gu.
01:56He was actually one of the critical
01:59sparks in in initiating this effort.
02:02The idea is that Yale medical students.
02:06Are bright and innovative and and thoughtful.
02:09But you know,
02:10one of their big points of interest,
02:12you could say anxiety, is selecting
02:13an area that they wish to train in.
02:15We all pass through this process
02:17and then educating themselves on,
02:19you know, what's?
02:20How should I be thinking about
02:22a certain specialty?
02:23And then once you commit to going into it,
02:25what's the best way to learn about it and
02:27navigate your way into that profession?
02:29And so we recruited from amongst.
02:33All of the Yale Medical School
02:35graduates who went into neurosurgery,
02:377 fantastic neurosurgeons.
02:38I've spoken to every one of them in
02:41person and they're going to each tell
02:43us a little bit about their lives.
02:44They're going to keep it relatively brief,
02:465 or 6 minutes,
02:47where they're going to tell us about
02:48their route out of Yale Medical
02:50School into their profession,
02:52what they're experiencing nowadays.
02:53I think every each one of them
02:56has a unique vantage point and
02:58and interesting things to say.
03:00After that,
03:00we're going to open it up
03:01to questions and answers.
03:02We very much want to hear
03:05all the questions you have.
03:06And then our panelists will
03:08be answering that okay.
03:09So I'm going to briefly let you
03:11know that there's a, there's a,
03:13there's a group of doctors,
03:15I'll let them introduce their
03:16own professional credentials,
03:17but there's Doctor Linda B,
03:20who I think is being called
03:21away to an emergency,
03:22but I still see her at this instant.
03:24So maybe she can get a word in if
03:26she's more than welcome to go up
03:28first and then Doctor Brian Nahan.
03:30They're both in Boston.
03:31Doctor Howard Center,
03:33who's in a Pittsburgh PA as I am.
03:36I'm not a neurosurgeon.
03:37I'm a facial plastic surgeon In in
03:39Pittsburgh, PA we also have Doctor Howard,
03:42excuse me, Heather McRae,
03:44Doctor Joseph King, Doctor James Yoon,
03:47who has just started a residency here at
03:50UPMC in Pittsburgh and a good friend of mine,
03:53Doctor and Duka Aman Kilar.
03:54And so those are the panel members.
03:56Let me go ahead and initiate
03:58immediately with Linda.
03:59I see you're still there.
04:00So if you,
04:01if you want to before you
04:02run to your duty calls,
04:04you've got a major situation there.
04:05But please begin.
04:07Thank you so much.
04:09What a pleasure and a privilege
04:11to join this group for Yale
04:13and especially with so many
04:15friends who've influenced me over
04:17the years also on the group.
04:19I'm sure everybody will have a different
04:21path of how they got to neurosurgery,
04:23and I will say that this is mostly
04:25for all the students and trainees
04:27and however you guys would like to
04:29guide in what questions you want.
04:31We're we're happy to address,
04:33but in brief, I am a graduate of the
04:37LMDPHD program I joined in 2010 I think.
04:412010, No, 2000.
04:42We graduated in 2010.
04:44We started in 2002.
04:45I see how they're giving me a quizzical look.
04:48So we started in 2002 and
04:52I have to say I was close minded from
04:54the moment that I started Med school,
04:56so I wanted to do neurosurgery ever since.
04:59I was in elementary school and despite
05:01being Nancy Engoff at the time,
05:03asking me every year for seven years
05:05why I didn't think about neurology to
05:08to balance with the PhD and all that,
05:10I simply had no answer for
05:12her except for that.
05:13I thought I liked the brain in a
05:15surgical kind of way until I read.
05:18The French Laundry, you know,
05:20all of my friends know that I don't
05:22cook or have any life skills,
05:23but I do like reading cookbooks.
05:25And The French Laundry is is by a chef
05:28named Thomas Keller where he says in
05:31the preface that something to the.
05:34Effective, You know,
05:34if you accept that there's
05:36no such thing as perfection,
05:37and you spent your life in pursuit of
05:40happiness and and and giving happiness.
05:42And for him the mundane tasks of
05:44cooking was what made him happy.
05:46And that struck me that there
05:48was something about every other
05:50profession that was glorious,
05:51but many other things that I
05:53did not appeal to me like.
05:55Urine or interpreting EKG's or you know,
05:57so on and so on,
05:59but there's really no part of
06:00neurosurgery that I found unappealing.
06:02And so that settled it finally in our our
06:067 1/2 year conversation about neurosurgery,
06:08but.
06:09Doing the the program at Yale,
06:12I think I was just incredibly lucky,
06:14even though I had some inkling
06:16that I was interested in this.
06:17But it's really the mentors and
06:19the environment which I at that
06:21time thought was just normal.
06:23And only when I,
06:23you know,
06:24grew up and and left Yale did I realize
06:26that it was a very special environment
06:28from the week before my first.
06:31Day of medical school I I showed
06:32up in the neurosurgery department,
06:34introduced myself and asked how I
06:36could get involved and everybody and
06:38you know gave me an opportunity.
06:40Their kitchen supplied me with free
06:42lunch for a solid number of years
06:44and Thanksgiving dinner at Doctor
06:46Duncan's house and all the above
06:48maybe really feel like neurosurgery
06:50was like a warm and cuddly family.
06:52And I still feel that way but but
06:54I guess it's not necessarily
06:56universal but but most mostly so.
06:59Doing a PhD there with in brain
07:02Tumor biology with Joe Pete Meyer
07:03as one of my mentors really also
07:05led me down the path of interest
07:08and and brain tumors which I share
07:10with a number of other folks here
07:12including Doctor Nahead and Dr.
07:13Amankola and it it's just a fun field
07:17but really I'm so centered upon
07:19kind of the brain it's intricacies
07:21and there were just so many moments
07:24during the my education at Yale that.
07:27To shape my future career in a
07:29formative way that I couldn't have predicted.
07:31For example,
07:32you know my first teaching conference
07:34as a pre first year medical student.
07:37At that point in time the former chair
07:40of neurosurgery was a name man named
07:43Doctor Collins and Doctor Collins.
07:46There was a third or fourth year medical
07:48student giving sub intern a ship.
07:51Talk on trigeminal neuralgia,
07:52which is condition of facial pain.
07:54And Doctor Collins asked him a question of,
07:58you know, where the exit the framma through
08:00which the trigeminal nerve leaves the
08:03skull and if you guys have been in the
08:05neurosurgery department or what was then
08:06a nurse surgeon trying the conference room,
08:07Is this, you know,
08:08rectangular room like some potted plants?
08:10I was basically sitting behind Doctor
08:12Collins behind the potted plant.
08:14There's no way he could have
08:16seen me scoping the room.
08:17But when the medical student
08:18said that he didn't know,
08:19somehow he turned 180 degrees.
08:21Looked at me in the eye behind the potted
08:23plant and asked me for the answer and as
08:26I stuttered saying that I didn't know,
08:28he said nothing.
08:28Looked at the medical student and said you
08:31should take responsibility for not knowing.
08:34During 180 degrees looked at me again
08:35behind the potted plant and said you should
08:38also take responsibility for not knowing.
08:40And that was a moment that it
08:42impressed on me that I got to know
08:44some stuff to go into neurosurgery.
08:46And it was,
08:46I have to tell you the greatest blessing
08:49of the beginning of medical school,
08:51to inspire me to learn your anatomy
08:53and and to realize that there is
08:55substance and that there is a sense
08:58of responsibility towards this field
08:59and the patient that we treat.
09:01I did my PhD as I mentioned in your.
09:04Biology,
09:04studying brain tumors and that
09:06then led me in my residency,
09:08which I pursued at Brigham and Women's
09:10Hospital in Boston Children's and
09:12Boston to continue my postdoctoral
09:14research in in the neuro oncology field.
09:16I continue in this day.
09:19I'm now an Associate professor of
09:21Neurosurgery and Associate Program
09:22Director at the Brigham and run a
09:24last focus on skullbased tumors and
09:27the intersection of of how we can
09:30apply biology and biological tools.
09:32To translating kind of better prognosis
09:35and treatments for these patients.
09:37So I have to say I've been incredibly
09:40lucky with mentors you know the
09:42entire path and in neurosurgery
09:44starting from the first day of
09:47before medical school at Yale and
09:49and everybody has a different path.
09:51But I would say if there is any
09:52one thing that it conveyed to me,
09:54it's just like having an enthusiastic
09:57invested interest in the field the more that.
10:01You give it,
10:02the more it gives you.
10:04So that's that's my path.
10:10Fantastic. Thank you so much.
10:11Doctor B. So Doctor Nahan, can you
10:14tell us, tell us about yourself.
10:17Hi everyone. My name is Brian Nahan.
10:20I am a graduate of the class of
10:222005 and like Linda know just
10:27about everyone on this panel and.
10:29One of the things that's amazing about
10:32our field is that it's not only small,
10:34but that there's a significant number
10:36of Yale medicines who have gone into
10:38neurosurgery almost disproportionately so.
10:40And all of us are are not only close
10:42friends but close colleagues and and
10:44and many years later it's been awesome.
10:47My path to neurosurgery started it.
10:50I felt a little bit like Forrest
10:52Gump where I was in a research lab
10:55as a high school student and it
10:57happened to be a neuro trauma lab.
10:59Focusing on brain injury and concussion
11:01and I got my first with that.
11:03I thought the brain was something
11:06pretty interesting and I I I'd love
11:08the idea that so much was unknown
11:10and there's such a huge potential
11:12to make an impact where I found
11:13other parts of medicine interesting.
11:15But you know the story was a little bit
11:18written and you know I went through
11:20college with an amazing mentor who
11:23largely sent me on this path and.
11:26Like many of you,
11:26I got to Yale and just blown away.
11:28It was just the best five years of of
11:32any educational part of my my training
11:35and my closest friends are from that time.
11:38And I I it was a combination
11:42of the Yale system,
11:43the opportunity to work so closely with
11:45folks in a collegial way and then frankly
11:47just to explore different aspects.
11:49And so I actually tried every
11:51specialty with an honest approach and.
11:53Kept coming back to neurosurgery and
11:55I was super lucky at the time and
11:57Duka was in the class above me and
11:59he and I were friends and we both
12:03worked with Marat Canal who's still
12:06there and met Mike De Luna and Max
12:09Lawrence who are a year above that
12:10and Graham Gould and a lot of Yale
12:12students were were working down
12:13that path and and and it just became
12:16not only an an obvious path to me
12:20that I really liked but a really
12:22interesting one and.
12:23Initially I was not planning on taking
12:25a year off and it was really the
12:27opportunity to learn more about the
12:29field and ROT was just so supportive
12:32to to kick off a project that at
12:35the time was pretty ambitious and
12:36it was sort of a all in opportunity.
12:39And also I got to learn and meet many
12:42of the folks in the department and
12:43I want to echo what Linda said, I I.
12:45I could not think of a better
12:47situation for Med students to be
12:49in to be exposed between living in
12:52Harkness or you know Crown towers
12:53or some version of that and having
12:55accessibility to the residents and
12:57the attendings and then the Deans.
12:58And it's something even at MGH and
13:01Harvard we try to replicate and
13:03and it is very hard to do and
13:05it's something so, so special.
13:06That's part of it.
13:07But I felt like I was joining a community
13:11and love the surgery and love the.
13:14You know, the Unknown and Rot was
13:16an amazing mentor and I was lucky
13:19to look at my elder classmen,
13:20even though and Duka looks younger than
13:23me with with wisdom and and seeing
13:24that the path was actually attainable.
13:27And like many of you who are interested
13:29in it, it just seemed like such a
13:31huge jump to go from Med school,
13:33particularly one without grades.
13:35At the time to a residency and lo and behold,
13:39by some luck I got into MGH and
13:42I did my residency there.
13:44Afterwards I stayed on.
13:47I'm a brain tumor surgeon and
13:49I'm our program director.
13:52I'm a largely clinical,
13:53although I do run a a lab that's
13:56trying to develop the first
13:57blood test for brain tumors.
13:59So liquid biopsy and I do a lot of
14:02sort of innovation stuff outside of.
14:05Neurosurgery.
14:06Looking back,
14:07I will say this is the greatest
14:10field hands down.
14:12With all due respect to Paul and
14:15others who might not go into nursery,
14:16it's an amazing field And looking
14:18back I would do it again and
14:20Yale puts you in such a great
14:21position to choose things rather
14:23than being this rat race.
14:24And many,
14:26many years later my closest
14:27friends are are neurosurgeons.
14:29And some of the happiest people I know.
14:31And so you know,
14:32anything we can do on this
14:33panel to help any of you as
14:34you guys look at this career,
14:36particularly as you look at other
14:38programs outside of Yale and even at Yale,
14:41just we welcome you to this community.
14:46Thank you so much From Brian.
14:47That was absolutely fantastic.
14:49So Doctor Howard Center,
14:50please tell us your perspectives.
14:52Hi, my name is Howard Center.
14:54I sort of stumbled into neurosurgery
14:56not knowing what I wanted when
14:58I entered medical school,
15:00and at the end of my third
15:02year I decided on neurosurgery.
15:04It was based on the fact that I
15:06love the neuroscience course in
15:08medical school and I liked surgery,
15:10but I wasn't really crazy about
15:12operating on the GI tract.
15:14So I took a rotation in neurosurgery
15:16and my mentor, Doctor Bennett Stein,
15:18who's chief of neurosurgery
15:20at Columbia Presbyterian,
15:21became my mentor.
15:22And he said why don't you do some
15:25neurology before neurosurgery?
15:27So I did neurology at NYU and then
15:29entered the Yale Neurosurgical Residency,
15:32which I completed.
15:33My professor was Doctor Collins,
15:35who's already been referred to,
15:36who is Harvey Cushing,
15:38Professor of Neurosurgery,
15:39and he was a great mentor.
15:40And I was coresidence with Joe,
15:42Pete Meyer and Charlie
15:44Duncan when I was at Yale,
15:46so I knew a lot of the faculty
15:48who have been referred to.
15:51Looking back my career,
15:52I stayed at Yale for one year after
15:55completing my residency and then
15:57decided that although I loved Yale,
15:59I wasn't crazy about New Haven
16:01and I moved to Pittsburgh.
16:02There was a need of vascular neurosurgery
16:05and that was sort of my subspecialty,
16:07doing intracranial to extracranial bypasses,
16:10aneurysms,
16:11and a VM's.
16:13And over the next 15 years I
16:15went from a three Man Group to
16:17A5 Man Group to A10 Man Group.
16:19And finally in my last 15 years I
16:21joined an academic institution where
16:23we had residents, did teaching,
16:26and did research.
16:27So I've sort of been on both
16:29sides of the coin.
16:30I can certainly recommend a large
16:33group or an academic position with
16:36a residency program as a way to
16:39keep you from working yourself
16:40to death and being on call.
16:42Every other night or every third
16:44night for trauma as an attending
16:47can be very stressful.
16:49Looking at neurosurgery,
16:50I chose it because, one,
16:52it's an incredible puzzle, Two,
16:54it's very challenging.
16:563 it gives you a.
16:58Tremendous ability to directly impact
17:00patients lives and I would always
17:03tell my friends and residents that
17:05what I like best about neurosurgery
17:08was not the operating room.
17:10What I like best in neurosurgery was
17:12the clinic where the patient returned
17:14three to four weeks after surgery.
17:16Having been relieved of their pain
17:18or treated for their brain tumor
17:20or had their aneurysm clipped and
17:21they said thank you doctor center,
17:23I feel so much better.
17:25And to anybody who's had any
17:27medical problem and they've
17:29gone to an orthopedist or an ENT
17:31surgeon or any other specialty
17:33and been relieved of that problem.
17:36I think that that gives you some
17:38insight into what I felt is the the
17:41best part of neurosurgery which is
17:44the ability to directly for a positive.
17:47Have sense impact patient lives.
17:53Thank you. Thank you very much.
17:54Doctor Center. So we're over
17:56to Doctor Heather McRae now.
17:58Please let us know about your own path.
18:02Hi everyone. So I entered not knowing
18:06that I was interested in neurosurgery.
18:10I actually, I thought I might want
18:12to do some sort of pediatric.
18:14Specialty, but actually thought I did
18:17not want to do something in surgery
18:20and change my mind based on mentorship.
18:23So that I think has been a theme of everyone.
18:26And I forgot to introduce where I am now.
18:28I'm an assistant professor of
18:30neurosurgery at the University of Miami
18:32going out for associate this year.
18:34And I'm director of Pediatric
18:35Neurosurgery at Holt's Children's,
18:37which is the Children's Hospital
18:38of the Jackson Health System,
18:39the County Health Network down in Miami.
18:43So I'm based out in Miami.
18:45So when I entered Med school,
18:46I asked one of my small group section
18:49leaders for a pediatric oncologist,
18:51pulmonologist and neurologist to shadow.
18:54The pulmonologist didn't respond,
18:55but I subsequently matter and she was great.
18:58The oncologist didn't really know
18:59what to do with the Med student and
19:01the neurologist was Laura Meant,
19:03who was amazing and adopted me and by
19:06the end of my first year had me set on
19:09becoming a pediatric neurologist And then.
19:12At the end of my second year of Med school,
19:13I asked if I might be able to
19:14go to the OR with her husband,
19:16who was Charles Duncan, who's been
19:18mentioned already as well and was like,
19:21wow, this is really amazing.
19:23I really enjoy being in the OR,
19:26and then I debated a bit what
19:27to do some of the people.
19:30That Brian mentioned,
19:31we're all there.
19:33When I was there,
19:34Brian was a Med student as well
19:36and Duka was there too.
19:37And a number of the residents impacted
19:40my decision to go into neurosurgery
19:42because they started letting us as medical
19:44students do more and more in the OR.
19:46And we're very encouraging and they're,
19:48I would say that the triad of
19:51faculty members of Charles Duncan,
19:53Joe Pete Meyer and Dennis Spencer
19:56sort of took I think both Linda
19:58and I under their wing.
19:59In the operating room.
20:01So Duncan was my main mentor, Joe.
20:03Pete Meyer was Linda's main mentor,
20:05but the three of them were
20:07incredible to both of us.
20:09Linda,
20:09I think,
20:09news since she was five that she
20:11was going to be a neurosurgeon,
20:12but I took longer.
20:14I was MDPHD and I didn't fully
20:16decide until part way through my
20:18PhD when I'd had a really rough day.
20:21I went to the Ora with Duncan and at
20:23the end of the day I came out going,
20:24wow, this was an amazing day.
20:27And I was like,
20:27if this has the power to transform
20:29from it being kind of a crappy
20:31day to a really wonderful day,
20:33this is the right fit.
20:34And Mike Deluna, who has mentioned,
20:37had actually said if you can imagine
20:39yourself going into any other field,
20:40you should do that.
20:42It's probably an easier path,
20:43but if you get to the point that you can't.
20:45Think of anything other than neurosurgery.
20:47You should do neurosurgery.
20:48And I thought that was a
20:50really good bit of advice.
20:51I actually give that advice to
20:54medical students that I teach now.
20:56So by the end of my MDPHD,
20:59which I did my PhD in Peter de Camille's lab,
21:02I had really decided on pediatric
21:04neurosurgery based on that.
21:05That was one of the reasons that
21:07led me to choose Cornell and
21:09Sloan Kettering for residency,
21:10because I could do Peeds throughout my time,
21:13as opposed to some residencies
21:15where you can only do Peeds as a
21:17set rotation during a specific year.
21:19And then after Cornell,
21:20I went to Boston Children's for my
21:22pediatric neurosurgery fellowship and
21:23then came down to Miami and I think.
21:27I would argue unlike all the tumor
21:29surgeons that Peeds is the best
21:30because we have the most diverse
21:32array of cases and kids bounce
21:34back like adults could never.
21:35But I think there there's really
21:37neat aspects of neurosurgery,
21:39whatever some special to you go
21:41into and if you it's good to keep an
21:46open mind as you start residency.
21:48I somewhat did but mostly was set on Peeds.
21:52But I think it's a fabulous field
21:54where you really have a huge ability
21:56to make an impact on a patient who can
21:58be super sick when you meet them and
22:01then they recover and do fantastic.
22:05So for instance,
22:06on Monday we had a kid who came
22:08in with an epidural.
22:09They're basically on death's doorstep.
22:11You take that out and she's walking around
22:13the unit and doing great postoperatively,
22:15and that's really amazing to
22:17be able to do that.
22:20The other thing I will add in
22:21terms of how supportive Yale was.
22:23I think we do have a tremendous
22:25number of people who go into
22:27neurosurgery from Yale Med.
22:28In the starting class
22:29that Linda and I were in,
22:30we ended up finishing in different classes.
22:33There were eight women from our
22:35class who went into neurosurgery
22:37and graduated different times.
22:39And I remain very close friends
22:42with several of them.
22:43And I think that's pretty unique to have
22:45those friendships maintained 20 years later.
22:47So happy to take any questions
22:50later that people have.
22:56Thank you so much, Doctor McRae.
22:57So Doctor Joseph King, please.
23:00You are situated on the Yale faculty now,
23:03so give us your perspective.
23:06Thank. Thank you very much.
23:07My Internet connection is telling
23:09me it's unstable sometimes.
23:10So hopefully we'll be able to get
23:13through this without too many glitches.
23:15I'm closer to some of the other panelists
23:17here who decided on neurosurgery early.
23:20I always like to fix things growing up,
23:22whether it was my bicycle or doing
23:24repair work around the house.
23:25And my dad actually kind of turned
23:27over the house maintenance to me
23:28when I was about 12 or 13 because
23:30I was better at it than he was.
23:32And then I was also very interested
23:34in science and the brain.
23:35And then sometime in high school I
23:38read something, I think it was a New
23:40York Times Magazine article about.
23:42You know,
23:42a week in the life of a neurosurgeon.
23:44And I said, yeah, that's for me,
23:45I want to learn to be able to fix the
23:47brain because it works with my fits,
23:49with my interest in science and the brain
23:51and and my mechanical proclivities.
23:53And that persisted through college.
23:56You know,
23:56I did a I did biology and psychology
23:58study in college because I thought
23:59that would be a Boston College.
24:01I thought that would be a a good preparation.
24:03And I also got my first introduction
24:05to research and then came to
24:07Yale and had a mark,
24:08same marvel experience
24:09that other people have.
24:11Similar exposures to, you know,
24:13the more senior faculty.
24:16Dennis Spencer, Charles Duncan,
24:18Joe Pete Meyer.
24:19Doctor Collins was here also when I was here.
24:21I I graduated in 1988 and I also
24:26met a classmate my first year,
24:29Amy Justice.
24:29And we got married during our fifth
24:32year of medical school and went
24:34off to Penn for our residencies.
24:36Where I had a wonderful neurosurgical
24:38training experience there and became
24:40very interested in vascular surgery
24:42and thought when I came out that I
24:44wanted to be a vascular surgeon.
24:46But the other important thing that
24:47I did is that during my lab time
24:49while I had done basic science
24:51research while at Yale, I.
24:52Went and got a master's degree in
24:55clinical epidemiology and Biostatistics
24:56because I was more inclined towards
24:59statistical analysis and using,
25:00you know, large databases and doing
25:02kind of early big data and modeling.
25:04You know that I was, you know,
25:06doing basic science research.
25:07And so that kind of set me off in
25:10a different research direction.
25:12And then once we,
25:14once I finished my training,
25:16my wife and I relocated to.
25:19Pace Western,
25:20where I worked for three years
25:22and I started out as a vascular
25:25neurosurgeon and then that didn't
25:26work out and so we moved to PIT
25:28and at Pitt there were four or
25:30five other vascular neurosurgeons
25:32already and I found it to be perhaps
25:34a bit more stressful than I had
25:36wanted to have that lifestyle.
25:37Everybody who has a vascular problem
25:39seems to have their hemorrhage
25:41at night or on weekends or both.
25:43It's very disruptive to your
25:44your personal life and and
25:46so I switched to a general neurosurgical
25:48role and that's why I also took on a
25:50lot of responsibility of taking care
25:52of veterans at at the VA hospital
25:54for some of the students who may
25:56not be aware the US government runs
25:58a healthcare system for veterans
26:00of our of our armed forces and.
26:04So ever since early in my career,
26:06I've actually spent a substantial
26:08amount of my time at the VA hospital.
26:11And then about five years later
26:13in 2000 and two, 2003, I,
26:15my wife and I were invited to
26:17come back to Yale, you know,
26:18kind of go full circle to come back
26:20and teach where we were taught.
26:21And so currently I'm an associate
26:23professor of neurosurgery and I'm
26:25also the Associate Program Director.
26:27So I have, you know,
26:27the honor of of working with Mike de Lune,
26:29our program Director to train the
26:32next generation of neurosurgeons.
26:33And on my clinical work is full time
26:35at the VA you know so I'm chief of
26:37neurosurgery at the VA and then I also
26:39have some other you know local and
26:41national administrative responsibility
26:43for the VA healthcare system.
26:45I've been the the head of the National
26:47Neurosurgery Board for the VA.
26:49So I've kind of invested my clinical
26:50career in helping taking care of of the
26:52men and women who have served our country,
26:55our nation's veterans,
26:55you know a chance to to give
26:58back to our country and.
27:00Also,
27:00the VA has given me a lot of flexibility
27:03for research experiences and so you know,
27:05I've been able to pursue research
27:09opportunities with VA&amp;NIH funding,
27:12you know, so that my career has,
27:14you know, enabled me to take part,
27:17you know,
27:18similar to to doctor center of of
27:20a variety of of aspects of teaching
27:23of doing some administrative work.
27:26Of taking care of patients and
27:28doing research.
27:29So I I found that my career
27:31in neurosurgery could be quite
27:32varied and and very fulfilling.
27:37Thank you, Doctor King.
27:39So now James Yoon, are you there?
27:42Now James is a first year
27:44neurosurgical resident at UPMC,
27:46the University of Pittsburgh Medical Center.
27:47So James, are you there?
27:50I my God, I got the word that maybe he
27:53was not going to be able to make because.
27:56You're a first year resident.
27:57You're not really in control of your life.
27:59Doctor Long. He's he's actually
28:00just graduated to 2nd year,
28:02but unfortunately he's on the
28:04trauma service right now.
28:05So who knows what he's in
28:06the middle of right now?
28:07He's got his up to his elbows
28:09in something intense perhaps.
28:10So listen, let's go ahead and move on.
28:14My good friend and Duka Amoncular.
28:16Please tell us. Tell us your perspectives.
28:20Absolutely. Well, first of all
28:22it's it's a real pleasure to be
28:24here and to see all these people I
28:27haven't seen in a very long time.
28:29You know, I think that I,
28:31I can say that basically I was cheated
28:35into neurosurgery by by the Yale
28:37school and medical school and medicine
28:39because you know Yale just made
28:42neurosurgery seem so damn normal and.
28:44And that's the that's that's that's
28:47you know obviously I'm joking but but
28:50that there is something about you know
28:53yell Med school that that you know
28:56forces people who would otherwise
28:57go into different fields to go into
29:00neurosurgery and and you know I can
29:02say that I've always been interested
29:04in neuroscience you know neurosurgery
29:06was something that I'd I'd thought
29:08about but and and you know but I I
29:10knew I wanted to be a surgeon or.
29:12To do you know international medicine
29:16you know and and go through maybe the
29:18the the Ed path and and eventually I
29:22just met this incredible array of of
29:25people that you know many here have
29:29mentioned and we became incredibly
29:31close friends and and and you know I
29:35actually saved my nursery rotation.
29:38For the very last rotation,
29:40because I didn't want to do it
29:41because it's like something I really
29:42didn't want to do.
29:43And so you know because I knew how
29:45long it would take and and and I
29:46wasn't sure that I that I want to
29:48do it And then and you know I'm not
29:50an incredibly religious guy but I
29:52I can say that the first time that
29:55I was in the OR seeing an aneurysm
29:58clipped you know by Doctor Ganell.
30:02I just at that moment where you'd realize.
30:05That you can't do anything else.
30:07You know that that that's when that
30:09happened to me and and that was it
30:12I was I was hooked and there was no
30:15other field to go into And then I I
30:19actually then spent a year like doctor
30:23nee head in doctor Grinnell's lab you
30:27know studying cabinet malformations
30:28and and really you know understanding
30:30first of all that the that nurse surgery.
30:33You know,
30:34what's remarkable about neurosurgery and,
30:36you know,
30:36all of you guys at Yale, you know,
30:38are really in a special position to see this.
30:41What's remarkable about neurosurgery
30:43is that there's so much medicine in
30:46neurosurgery and there's so much,
30:48you know, it's not just there's medicine,
30:50there's neurology, There is,
30:52there's there, there's surgery.
30:54And Yale exposes you to all of that.
30:57I remember.
30:58Being a medical student and sitting
31:01in front of, you know,
31:02both Bill Collins and Dennis
31:05Spencer and they both,
31:06they had different styles
31:07as as Linda alluded to,
31:10you know,
31:11Doctor Collins once started yelling at
31:12me at the top of his lungs because I
31:15ordered my differential diagnosis wrong,
31:17you know.
31:18So it's like he was like really
31:19you would you put, you would put,
31:21you know, epidural first, you know.
31:23And I was like,
31:24no Sir, no, Sir, I'm sorry,
31:25I'm sorry, you know.
31:26And and and Dennis Spencer would
31:29just kind of ask you a question and
31:31then just like stare at you and just
31:34wait until you started stuttering
31:36like an idiot and and and you know
31:39somehow after this entire experience,
31:41I decided that this was what I
31:43wanted to do because A the people
31:47I liked the most were doing it
31:50BI. There was there there was no aspect of
31:53medicine that combined everything I loved.
31:56About medicine so much and and and
31:59and and see if it was just like it
32:02was this yell was a very made it seem
32:04very normal in spite of you know
32:06those those two examples I just gave.
32:09I mean it was a it was very normal.
32:10I mean so you knew neurosurgery could
32:12be a very intense specialty but
32:14you also knew how how how beautiful
32:17and elegant and elaborate it was.
32:19So ultimately I.
32:24I I then decided to go into neurosurgery
32:25after working at Doctor Granell's lab.
32:27I tried to run away.
32:29Doctor Granell would not let me.
32:30So I stayed at I stayed at Yale for
32:33another seven years where I had an
32:36incredible seven years first thinking
32:38that I was going to be a vascular
32:41surgeon and then really being drawn
32:44by neuroncology and and that's really
32:46been my love and passion since.
32:49You know I think that there are a
32:51number of people here like Ney Head and.
32:53Who've who've copied me but you know
32:56that's no but no we we you know we we
32:58just we came up through this together.
33:01I think that's that's that that's
33:02the that the camaraderie that you
33:04see on this panel.
33:05I mean we came up through this together
33:07and and after finishing I did my
33:10fellowship at at Sloan Kettering and
33:13I also did a research 2 research years
33:15at Sloan Kettering where I shuttled
33:17back from between back and forth between.
33:21Yale and and and MSK and and I think
33:25Doctor King still probably thinks that
33:27I owe him a couple of VA op notes from
33:30the from my time you know going back
33:32and forth Anyways I think that in the
33:35end what I got was this incredible
33:38experience where I had you know the the,
33:41the thing that I was the most passionate
33:44about which is doing tumor surgery
33:47a a real sort of appreciation of.
33:49The academic aspects of neurosurgery,
33:52and I think that that's something
33:54that you know,
33:55every one of these palaces explained
33:57to you in a different way how you
33:59can be academic.
34:00You can be academic by teaching residents.
34:02You can be academic by,
34:05you know, working on innovation.
34:06You can be academic by doing big data.
34:10And in my case,
34:11what I decided was that I was going
34:13to be academic by running a a
34:16translational science lab that's.
34:18That is you know NIH funded and I and I work,
34:23I work on a mutation called IDH
34:25that affects that that is president
34:27low grade gliomas and and and and
34:30I essentially just had this package
34:32I started out at at University of
34:34Pittsburgh which also seems to be kind
34:36of a common theme here And I was at
34:39at Pitt for about 8 years and then
34:42I was called away to the University
34:44of Pennsylvania where I'm now the.
34:48The presidential professor
34:50of neurosurgery at
34:52at Penn and and the the the head of the
34:57brain tumor center and also the division
34:59chief of of nurseurchical oncology
35:01and run a major lab and also more
35:08importantly you know I think give try to
35:12give joy to to to patients try to give.
35:16Hope to patients where you know there
35:18might there may otherwise you know be
35:21you know real real sort of dark time
35:24in their lives and you know that's
35:26what you know people have alluded to
35:28that but that you know neurosurgery is
35:30not a you know it's not a light field.
35:32You know you don't go into neurosurgery
35:33and it's like you know like we're
35:35just doing really like things you
35:37you deal with real disasters and and
35:40you meet people at the lowest point
35:42point in their lives and somehow.
35:46You have the skill and capacity to
35:48to to to to to reverse that and that
35:52becomes very powerful and and then and
35:55then at the same time you're learning
35:57about how to make your you know what you
36:01how to make your interventions better
36:03because we're all exceptionally driven.
36:06Every single person on this panel in
36:09in different ways is driven to do
36:11something you know better and so.
36:13I don't think there's any other field
36:16like nursery that combines you know
36:18all the elements of of of medicine
36:20and and that tries to you know really
36:24create the like both the best technical,
36:29you know the best technicians people
36:31were able to operate and also you know
36:34the the most academically minded people.
36:38So you know we.
36:40We can you know you guys feel free to
36:43ask questions later but but but it's
36:46just an incredible field and I think
36:48that if you are already thinking about
36:50it now you probably have a hard time
36:52you know to stop thinking about it.
36:54So you you're probably already done
36:55you know is what I would say if you're
36:58if you're if you're already down
37:00that road it's probably over for you.
37:02So welcome to the club.
37:06That's fantastic.
37:07Thank you so much Induco.
37:09Thank you very much.
37:11So that is the sort of that is the
37:14introduction or presentation of
37:15each of our neurosurgical panelists.
37:18And So what I would like to do
37:21now is welcome the students,
37:23the medical students.
37:24We have Yale medical students here with us,
37:27but we also have some Yale
37:29undergraduates who are perhaps
37:31thinking about medical school and
37:33are already contemplating perhaps
37:35they're looking over the rainbow and
37:37and what they made the decisions
37:38they may need to make down the road.
37:40So I'd encourage all of you to
37:43either use the the question and
37:45answer session section where you
37:47can raise your hand with zoom and
37:49and and pose your question and
37:51then we'd be happy to answer them.
37:54We did have some questions submitted
37:58previously when people registered for this.
38:00So let me pose those questions and
38:02again let me remind the panelists.
38:04I may pick one or two people to you
38:06know okay well how about you start
38:08with this Howard or Doctor King or
38:10what have but but feel free to jump in.
38:13You can unmute yourself and jump
38:15in if you feel you know you've
38:17got a burning comment to make.
38:18So a number of you let me
38:20start with one question.
38:22A number of you have alluded to the
38:25fact that neurosurgery is, you know,
38:27not something you go in to lightly.
38:30It's an intense field.
38:32I for one,
38:33I trained in otolaryngology at the
38:35University of Pittsburgh and we did
38:37have some fairly close interaction
38:39with the neurosurgical group in
38:42the skull based practice that that
38:45a couple of my attendings, Dr.
38:46Snyder and Doctor Rakows or Corrals
38:49that have worked very closely with
38:51the department and I can remember
38:53my attendings commenting that the
38:55neurosurgery group here is fantastic.
38:58And the sensation was that they were
39:00and all our fields, we know this,
39:02right,
39:03all the fields are culturally a little
39:05bit different and the neurosurgeons
39:07are different from us as a oncologist.
39:09And and maybe in a good way that
39:11maybe not just in a different way.
39:13And and one of the observations
39:15we made was that,
39:16you know in otolaryngology sometimes
39:18we do things that are very intense.
39:20You're dissecting right on the
39:21facial nerve or you're you're
39:23taking out a big head neck tumor.
39:24But there's other components
39:26of our practice that are more,
39:28you know,
39:29all the chips are not down all the time.
39:31But I think I remember Doctor Corral
39:34complimenting the neurosurgery feel back.
39:36You know,
39:36those guys need to be,
39:37they need to be of a special sort
39:39because the great majority of
39:41the time when they're in action,
39:43the chips are down.
39:44And so here's my question to you.
39:45We had a number of questions submitted about,
39:48you know, work, life balance and you know,
39:50I think related questions about,
39:51you know, what is the right personality.
39:54That that is,
39:55you know,
39:56say imagine yourself a first or
39:58second year medical student.
39:59You're like, wow, cognitively these,
40:01you know, the brain, my goodness.
40:03And the concepts of
40:04neurosurgery are so attractive.
40:06But but there's also invariably
40:08like characteristics to your
40:10field partially governed by the
40:12pathology that you that you manage.
40:14It's very serious business
40:16almost all the time.
40:17How does how does one of our Yale
40:19medical students figure, oh geez,
40:21I'm very intellectually interested in this.
40:23But especially given at the Yale Medical
40:25School we all talk about the fact
40:26that it's a humane environment right?
40:28People are typically not beating each
40:30other up ranking in grades and and
40:32and even when we go on to the clinical
40:35rotations things have a more humane feel.
40:37How does the Yale medical student
40:39determine not only in my intellectually
40:40interest is but whether it's work life
40:42balance is one of our explicit questions.
40:44And do I have the personality characteristics
40:47that are going to carry me through
40:49a multi decade career neurosurgery?
40:51So let me just ask Doctor Nahat,
40:53can you can you stop start with that
40:55and give give some comments on that
40:57and anybody else can speak as well.
40:59Of course,
41:07Brian, if you could unmute,
41:12you know one of the keys to my work life
41:14balance is to remain on mute all the time.
41:16So I love this question because it's
41:20probably one of the biggest misperceptions
41:22about a field in neurosurgery and.
41:25My wife said in intensive care and
41:27does a lot of global health work and I
41:30would argue she works harder than I do.
41:31And I think anybody and everybody
41:34in your field, if you love it,
41:37you're going to do it and
41:38it doesn't seem like work.
41:40I would say there are places and
41:41and people who are a little more
41:43intense than probably they should
41:45be or or frankly aren't as balanced
41:47as one would hope they would be.
41:49But it's a personal choice I
41:51would say for me.
41:52Personally, my biggest mentors
41:54have always had a decent balance,
41:58have kids,
41:58you know have are part of a family
42:01that they love and have a spouse
42:03that's working very hard and successful
42:05and neurosurgery is part of that.
42:08But you know, like you said, Paul,
42:10it it it requires significant training.
42:13But I think the more you do it,
42:15the more you love it,
42:16the easier it feels and the easier it is.
42:19But it's not to be mistaken as
42:21we take any of this lightly.
42:23So you know for our residency and
42:26frankly even within our faculty,
42:27the things we encourage are that people
42:29have a very healthy work life balance.
42:31You work really hard when you're in
42:33the hospital and I always tell our
42:35residents the moment you're done
42:36like get out and go enjoy bus and
42:37or your families or whatever your
42:39hobbies are And it's important that
42:41you do that because you bring that.
42:44Innovation and and ingenuity and
42:46frankly rest back to the workplace.
42:50I feel like that's almost in
42:51every single specialty nowadays,
42:52whether it's a medical one or a surgical one.
42:55I do think the intensities,
42:57the highs are highs and the lows
42:58are lows in nerve surgery.
42:59I'm a brain tumor surgeon.
43:01They're largely elective operations,
43:04but they can be long sometimes
43:06and most times they're short.
43:08But it I do have a healthy balance
43:11of both clinical research and other
43:13interests and and for me family is a
43:16pretty significant part of my life.
43:20I'm happy to different I'm happy
43:23to answer that question too.
43:26So I think that the the point
43:28about the highs are high and the
43:30lows are lows is really important.
43:31I don't think there's any.
43:33One type, you know,
43:34there's the stereotypical neurosurgeon.
43:35I think one of the reason that, you know,
43:38as in Duca said we're all cheated into
43:39neurosurgery is there wasn't a lot of
43:42the stereotypic neurosurgeon at Yale.
43:43It was a great group of people who are
43:45really welcoming and tried to convince
43:47Med students to go into neurosurgery.
43:50But I do think the point about
43:51the highs being high and the
43:52lowest being lows are important.
43:53I remember when I was a bed student,
43:55because I was there longer since I was MDPHD.
43:58Some of the younger Med students who were
43:59thinking about neurosurgery would call me.
44:01And I remember there was one woman
44:02who came in thinking she was
44:04definitely going to do neurosurgery.
44:06And then she got to her subeye and she
44:09just saw a string of really sick patients,
44:12bad aneurysmal ruptured patients and
44:15patients that weren't doing well.
44:17And she called and she was really upset.
44:19And she was like, I just,
44:20I'm not sure I can do this.
44:22And I was like, well, you don't have to.
44:23If this is not the right fit for you,
44:25that's okay and I don't think
44:28those of us who handle it.
44:31Aren't upset about those lows.
44:34I think we very much vote for most of us.
44:36We do internalize those lows.
44:38It's just how you deal with that.
44:41So for me in pediatric neurosurgery,
44:44you know two of the lows that I deal
44:46with are gun trauma to the head.
44:48Miami has more than its fair share.
44:52I've handled that by now.
44:53That's one of the things that
44:55I am doing research on and.
44:57We're trying to work on as
44:59a pediatric section.
44:59Is there something we could do to try
45:02to prevent the fact that this is the
45:04leading cause of death in children?
45:06The other low that affects me though
45:09I'm not an adult tumor surgeon.
45:11Most pediatric neurosurgeons do
45:13like brain tumor operations.
45:15And so we have the highs.
45:17A kid who has a benign,
45:18there's a particular benign type of
45:20tumor we can take out in the back of
45:22the head and that kid is cured and
45:23goes on and lives a happy healthy life.
45:25That's a juvenile polycytic astrocytoma.
45:27But we also have something called
45:30diffuse intrinsic pontine glioma or DIPG
45:32now it's called the diffuse midline glioma.
45:35And there's a specific mutation
45:37that causes that glioma.
45:39And those kids,
45:40we meet them,
45:41they have not usually huge symptoms and
45:44we know that they're probably going to be
45:46dead in a year and that's devastating.
45:48I just saw a new case of that last week.
45:51So the way.
45:52I personally handle that is wanting
45:53to see is there anything I can
45:55do on the research front to move
45:57this forward and help.
45:58So when I was a resident at Cornell,
46:00I got interested in this and I started
46:03a clinical trial giving interarterial
46:05drug delivery for these patients.
46:08Certainly not a care but I think it's given
46:10them some improvement in their symptoms and.
46:13Quality of life working on trying
46:15to bring that child in Miami,
46:17but we did treat one patient with
46:18a compassionate use exemption and
46:20it bought her a little bit more
46:21time and a little bit more quality.
46:23And so I think that most of us have
46:26fairly intense personality types.
46:28I do think we tend to work hard,
46:30play hard and you do have to have
46:33balance outside of the hospital that
46:35helps you to sort of decompress and
46:38offset your time in the hospital for me.
46:42It used to be horseback riding.
46:44Now lately I haven't had as
46:45much time for that,
46:46but family is important for me.
46:49I probably partly due to neurosurgery,
46:52met my husband late,
46:53met him right when I became a faculty member,
46:56and I now have 3 1/2 year old twins.
46:58I think you saw one of them jumping
46:59in the screen a little while ago.
47:01So I think it is important to
47:03have a balance outside.
47:05I do think that probably particularly.
47:09As a woman is a little bit harder in
47:12neurosurgery than in some other fields.
47:14And I know a lot of,
47:15you know,
47:16Med students and residents I
47:17talked to are concerned about sort
47:19of when they would have a kid
47:21if they wanted to have a kid.
47:23I was extremely lucky.
47:24I worked,
47:25I was on call through my 36th week of
47:28pregnancy with twins and delivered at 37.
47:31But it is true that amongst surgical
47:35faculty and residents there are.
47:38More complications in terms of infertility
47:40and early deliveries and things like that.
47:43Hopefully the field is changing
47:45to have better accommodations,
47:47so that's less of an issue for people.
47:49But I don't think that's something
47:51that should discourage someone
47:52from going into the field,
47:53because I know plenty of neurosurgeons,
47:55both men and women,
47:56who spend a lot of time with
47:58their families and have kids
47:59and make that a priority.
48:02Thank you so much.
48:03You know, and I'd like to I think
48:04this is a very important question.
48:05We'll certainly get on to other questions,
48:07but I'd like to ask Doctor King to sort
48:10of to give a little commentary himself.
48:13I I remember chatting with Doctor
48:15King it must have been 3-4 months
48:16ago when people were planning this.
48:18It's taken a while to sort
48:20of birth this thing and and.
48:22And he mentioned that, you know,
48:24a couple of Yale medical students,
48:26of course Doctor King has responsibility
48:28for mentoring students at Yale right now.
48:30So he's got a great vantage point on this.
48:32Couple of medical students decided to
48:34go into neurosurgery and had done sub
48:36eyes and enjoyed themselves at Yale.
48:38But then I recall,
48:39correct me if I'm wrong, Doctor King,
48:40that you know, they had selected,
48:43they'd chosen one or two places
48:45to go off and do sub internships
48:47elsewhere and what they had found.
48:50You know outside of the the warm
48:52bosom of Yale Medical School and the
48:55neurosurgical department of Yale was a
48:58little bit of a wake up call in terms
49:00of their experience there and and what
49:02would you the feedback they received,
49:04you know at the end of their at the end of
49:07their month visiting such and such programs.
49:10And so I'm just trying to put myself
49:12in the shoes of a second year medical
49:14student or something like that.
49:15And they're listening to this great
49:17enthusiasm about neurosurgery.
49:18They've also heard a little bit of
49:19this and that about how, you know,
49:21there's a certain intensity in it.
49:22And I think your comments,
49:23all of your comments are very
49:25reassuring that you know, like listen,
49:27it can be done and there's a lot of normal
49:29people and you're joining the community.
49:31But I I guess I'd just like
49:32to post to Doctor King,
49:34have you and your in your
49:36mentorship of medical students.
49:37Do you sometimes find that hey listen,
49:40you know this person's whip
49:41smart and and what have you,
49:43but with your own knowledge of
49:45neurosurgery in New Haven and
49:47Pittsburgh and Cleveland that you
49:49know you you you want to be thinking
49:51about this with your eyes wide open.
49:53Is is Yale sort of a walled garden
49:55and in some sense relative to the
49:57whiter culture or is that is that,
49:59is that not the case?
50:01I think I
50:02think Yale may be a little bit different.
50:04I think our residents are very close.
50:06Our residents,
50:07not only are they spending 80 hours a
50:09week with one another during residency,
50:11you know, while they're on the job,
50:13but they're also socializing with one
50:15another on their off hours, you know.
50:17And our residents who are talking
50:20with their colleagues,
50:21their classmates who are at other
50:23programs or under the impression that,
50:25you know, our our residency may get
50:27along a little better than and and
50:30maybe a little bit more collegial.
50:32But I think that all neurosurgery
50:34residency programs are demanding
50:35and well I think that people
50:36talk about worth like balance,
50:38but you're signing up for
50:39a 7 year residency program,
50:41You're signing up for a program
50:42that's going to push the limits of
50:44the 80 hour work week realistically.
50:46So it's going to be longer than
50:48most other training.
50:48And then a lot of other people
50:49you've heard from a bunch of our
50:51panelists go on to do an additional
50:53year or even several years of
50:55training like Doctor Mancalor did,
50:56whether it's in clinical or or research.
50:59So I I think that there is an
51:01intensity level and a willingness
51:02to commit years and and that you're
51:04in your early to mid 30s and
51:06and some of our NDPHD panelists,
51:07you know perhaps are even further
51:09along than that by the time they
51:11finished their training and really
51:12got into their their first jobs
51:14and started building their careers.
51:16And then I think you know there
51:18are a lot of job options out there.
51:21And if you want to go into the fast
51:23track and get into an academic
51:24program and be clinically busy
51:26and build your research program.
51:28You know,
51:28that takes time and you're not going
51:30to do that at 40 or 50 hours a week.
51:32And and so I think that they're
51:34just practical considerations on,
51:35you know,
51:36what you're going to do and how
51:37you're going to spend your time.
51:38Frankly,
51:38one of the reasons that I went to
51:40the VA is because I'm basically
51:42on service every other week and
51:45so the alternate weeks.
51:47You know, I have time to do research.
51:49I have time to get my other
51:50administrative stuff done.
51:51And I made sure,
51:52you know,
51:53since I was in charge of the call schedule
51:54cuz I was the chief of the service that,
51:56you know,
51:56I would look at my kids lacrosse
51:58game schedule over the season
51:59and make sure that I was not in
52:01clinic on Wednesday afternoon when
52:02my son was playing lacrosse.
52:04Or when my daughter was doing a swim meet,
52:06you know,
52:07so I was there for my kids and and
52:09and my wife is a you know an MDPHD,
52:12you know full time academic And
52:14so we had shared responsibilities.
52:16But I part of it was I took a position
52:19that gave me that flexibility in
52:21order to be able to prioritize those
52:24things so that I'm only working
52:26A50 or 60 hour week.
52:27You know some of my colleagues
52:29are are doing more than that.
52:31But I think some of my
52:32colleagues are are workaholics.
52:34So some of it is figuring
52:36out what's important to you.
52:37I I think how you spend your time
52:39says what you know is really
52:41important to what you value.
52:42And so you can say you're a family person.
52:45But if you're spending 112 hours
52:46a week at work and and only you
52:48know and don't get home till
52:50your kids are asleep, you know,
52:52I'm not sure what that means.
52:54But some people,
52:55they want to spend that much time
52:57at work and there there are some
52:59incredibly driven hard working
53:00long hour neurosurgeons, you know,
53:02but there are other people who do
53:03a really good job of figuring out
53:05the balance and that's part of the challenge.
53:07I think if you want it,
53:09you can do it.
53:10But you know I had to jump twice.
53:12You know, I'm at my third job where
53:14I finally got the work life balance correct.
53:17But you know you've you've got
53:19to look around and.
53:21Understand what you're getting
53:22yourself into and and figure out
53:24what your priorities are and
53:25how you want to spend your time.
53:30Brian, I believe you had wanted to follow on.
53:32Yeah, I mean I think that's
53:34not intrinsic to neurosurgery.
53:35I think there is cardiologists who are there
53:37in the hospital every hour of the day.
53:39And and I agree with Joe, it's you know it.
53:44Neurosurgery actually I did not understand
53:45this when I was a Med student but the
53:49different specialties have such come
53:51dramatically different lifestyles and
53:52but also within it there's a huge range.
53:55And you know one of the things we do with
53:58our residents is really walk them through
54:00what it being an academic neurosurgeon
54:03is being a a practice based one being
54:05a one that's largely A researcher who
54:09also operates and and you know.
54:12The risks and and and benefits of each.
54:15But I I I agree with you.
54:16I just think it's you know in nowadays
54:19unless you're doing a completely shift
54:21based work it that's probably true for
54:23all of them and the the difference
54:25honestly between academic and what used
54:27to be called private practice and now
54:29is practice based is not that different
54:31anymore in terms of the number of hours
54:33and frankly the hospital based practices.
54:36So it it's such a interesting aspect of it,
54:39none of which you kind of know
54:41as a Med student.
54:42But the field itself has just,
54:44you know more questions than answers and
54:46the opportunities are pretty amazing.
54:48And you know if you find the
54:50right place that jump from Yale,
54:53which is,
54:54you know admittedly an amazing
54:56environment to your residency is
54:58hopefully not a big jump but rather,
55:01you know I went from there to.
55:04MGH.
55:04And the thing that was impressive
55:06wasn't the difference in the way the
55:08attendings and the residents were,
55:09but rather just the volume of
55:11a bigger center.
55:12But there are places in any field
55:14where you go to a place that's
55:15a little more toxic or not.
55:17And that's part of how you know,
55:19you rely on your mentors at at the
55:21school and the Deans who can give you
55:23the heads up on you know where to go.
55:26I would just.
55:29Sorry, Heather, I was going to,
55:31I mean I think that you know,
55:35the reality is that that there's no,
55:38there's no one field that has
55:39the same type of person, right.
55:41I mean you know,
55:42I think you know Paul can talk
55:44about you know, ENT and they're,
55:46you know with with ENT there
55:49are you know Skullbased surgeons
55:52and head and neck surgeons and
55:54then there are you know.
55:56People who basically do,
55:58you know, just
56:04rhinology and and so on,
56:07it's a it's a huge variety and
56:09I think neurosurgery, you know,
56:11while overall it's more intense,
56:13I think there are two things that
56:15are that that that we have to kind
56:17of acknowledge #1 is that there's a
56:20reason why the residency is you know.
56:23You know, seven years and and
56:25that it's not just to prepare
56:27you to to learn how to operate,
56:30but it's also to prepare you to learn
56:32how to manage the lifestyle, right.
56:34And so within those seven years,
56:36like, you're going to find
56:37exactly where your sweet spot is.
56:39And so you know,
56:42Joe's right that there's that
56:43there's a huge variety of people.
56:45And you know, I mean,
56:47I definitely work more than 60 hours a week,
56:50but.
56:50I consider myself to have an incredible
56:53work life balance because I also you
56:56know get to my kids soccer games on
57:00weekends and you know I just made
57:02my kids highlight real for like you
57:04know because college recruitment
57:06I sat there like editing you know
57:08every piece of of of of of you know
57:11highlight that he that he that he
57:13you know done as a soccer player.
57:14So I mean it is it's it's it's.
57:18It's there's just, it's so variable right.
57:21I mean it's as variable as we
57:23are all are as people,
57:24right.
57:24And so I think that the thing that
57:27you have to ask yourself in terms of
57:30work work life balance is you know
57:32it's really just that you know number one,
57:35can I I think what Heather said in
57:37in the beginning was is critical
57:39like and I'm curious to kind
57:41of hear other panels opinion,
57:42opinions on this you know can I handle those.
57:46Lows because I mean the lows
57:48aren't just like when you have a,
57:52you know, a perfectly, you know,
57:54a perfect case where you know,
57:55you're just like okay.
57:56This is going to be a great outcome
57:58sometimes when like a perfect case
57:59supposed to be a great outcome.
58:01You know, every once in a while it's not.
58:02And and so you, you know,
58:05and you're working on the brain and so,
58:07you know, people are left,
58:09you know,
58:10with significant deficits and and
58:12I think that one thing I have,
58:14one thing I'll say is that what
58:16makes neurosurgery.
58:17You know what what what makes a good
58:19neurosurgeon and and and makes a surgeon who
58:22has a capacity for good work life balance?
58:25Is it the ability to 1st sort
58:27of be able to accept blame,
58:29right.
58:29To be able to look at themselves and say,
58:31hey you know this was a bad
58:34outcome but like here are the two,
58:38three things that I could have
58:39done differently because then the
58:41next time you do it better, right.
58:42And that and over the long haul.
58:44As Brian says said it gets easier and
58:48easier and easier and then the the the,
58:51the feeling of doing something really,
58:53really complex becomes, you know much
58:56more routine and that gives you a,
58:58you know it's it's more the mental
59:00space that you spend dealing with
59:02the intensity of neurosurgery
59:04that makes it really hard.
59:05But but yeah the the seven years
59:08of training and the the the sort of
59:11postlude where you're trying to find.
59:13Your exact fit.
59:15You know ultimately you know most of
59:17us do you know what I mean I think
59:19if you look at the satisfaction
59:20rates and you know among in medicine
59:23I mean these things are published.
59:25You know neurosurgery is not the
59:27worst you know so but it's you
59:29know it might be viewed as the
59:31most intense and the most you know
59:33the most you know the most rabid
59:37or whatever you want to call it.
59:39But like it is not it's it's by no
59:41means the worst and that's because.
59:43You have a lot of different personalities.
59:44You have a lot of different aspects of
59:47the field and you can always find your fit,
59:50you know.
59:50And so I think you know the question
59:53is like do you do you want to you
59:56know engage in those seven years of
59:58residency and and and everything
59:59that comes after it.
01:00:00But but it's I would say it's very,
01:00:03very work life balance is absolutely even.
01:00:06It's just necessary neurosurgery.
01:00:08You just can't do this.
01:00:10All the time and have nothing outside,
01:00:12you know, because you will,
01:00:15you know you'll,
01:00:16you'll burn out and so you know that
01:00:18that's that's an important factor.
01:00:23I think when
01:00:23applying for a neurosurgical residency,
01:00:26which is something that the medical students
01:00:28in the audience are interested in, that
01:00:30that what was just mentioned is critical.
01:00:33When I was interviewing applicants for our
01:00:36residency at the Allegheny Health Network,
01:00:39one of the things we looked for is to be
01:00:42intense for something outside of medicine.
01:00:44Were you a great writer?
01:00:46Are you into sports?
01:00:48Are you into a certain aspect of music?
01:00:50Is there something you really,
01:00:52really feel intensely and do
01:00:55intensely about outside of medicine?
01:00:57I know there was another
01:00:59question about research,
01:01:00and if that was your thing that you
01:01:03really felt intense about research,
01:01:05that's fine.
01:01:05But a lot of the research that you
01:01:08think may enhance your application
01:01:10is what we'll call bubble gum
01:01:12Research is research that you were
01:01:14not really producing anything that
01:01:16didn't show a lot of innovation.
01:01:18That was something you just did
01:01:20in order to make your CV better.
01:01:22And if that's what you really want to do,
01:01:25that's fine.
01:01:25But that's not the kind of research that.
01:01:28That is productive in the
01:01:30field of neurosurgery.
01:01:31The research that's productive in
01:01:33the field of neurosurgery is seeing
01:01:34some aspect of the puzzle that you
01:01:37think can be solved in a better way.
01:01:40And whether that's clinical
01:01:41research or laboratory research
01:01:43or a combination of the two.
01:01:46That's what's important in terms
01:01:48of the application for residency
01:01:50is to show that you're really into
01:01:52something other than medicine.
01:01:55Thank you very much. That's fantastic.
01:01:58As you perhaps alluded to,
01:01:59there was a question just
01:02:01submitted by Tyrone Dispenza.
01:02:03I'll read that question to you
01:02:05and you can reflect on it.
01:02:07I want to extend it on it a little bit.
01:02:09The question is what advice do you have for
01:02:12launching a research program with Neurosur,
01:02:14with a neurosurgical practice from Tyrone?
01:02:16And I want to, there was a number of
01:02:18questions that were submitted beforehand.
01:02:20One of them was what do
01:02:21you make of the arms race?
01:02:23In in neurosurgically related
01:02:26research as it applies to students
01:02:29applying into neurosurgery.
01:02:33My some remote insight into this.
01:02:37My my wife is the smart one.
01:02:39She's the one of the assistant Deans at
01:02:41the medical school at the University of
01:02:43Pittsburgh and she comments on the fact
01:02:45that since step one was made pass fail.
01:02:48They've seen a palpable increase,
01:02:51and she administers one of the research
01:02:54programs where they can accept a certain
01:02:56number of people into funded research
01:02:58positions at the University of Pittsburgh.
01:02:59While they're medical students,
01:03:01and especially areas like
01:03:02plastic surgery near a surgery,
01:03:04a few others where medical students
01:03:07perceive like, well, hold on.
01:03:08Step one's now pass fail.
01:03:10Say I'm at a medical school like Yale or PET.
01:03:13That's largely pass fail or not graded.
01:03:16Holy cow. By the time I'm I'm,
01:03:18I'm going to be deep into
01:03:20that application process.
01:03:21How do you, how do you,
01:03:22how are these faculty going to
01:03:24distinguish somebody who's just
01:03:26enthusiastic and bright and who,
01:03:28as as Howard says, may have,
01:03:30you know,
01:03:30an intense interest in something
01:03:32outside the field?
01:03:33And so there's there's,
01:03:34I think students feel quite compelled.
01:03:37To I mean literally in the first
01:03:38month of medical school they're
01:03:40approaching my wife's program.
01:03:41Like I want to get very serious.
01:03:43I want to hook up with a with a credible
01:03:45minch when I want to move forward.
01:03:47What would you say to the medical students,
01:03:48a second or third year medical
01:03:50student at Yale and his sort of you
01:03:52know taking the time to figure out
01:03:54what they want to do and perhaps
01:03:56if not they've done other things
01:03:58but they've not been applied into
01:04:00neurosurgical research or any research.
01:04:03Is this is,
01:04:03is there an arms race in the application
01:04:05process so any of you who are
01:04:07interested can can respond to that.
01:04:11Yeah, on a national,
01:04:12this is a great question and it's applies
01:04:15to every field as you mentioned Paul,
01:04:16I think on a national level we've looked
01:04:19at this and and tried to you've even
01:04:21seen some of this in social media recently.
01:04:24Defuse the arms race.
01:04:25And to get a little bit about what
01:04:27Howard was saying, it's, you know,
01:04:28it's quality, not quantity.
01:04:30Although, you know, it's very,
01:04:31very obvious if a student has just
01:04:33put their name on a bunch of case
01:04:36reports that don't move the needle.
01:04:38We at MGA chat, we we haven't been
01:04:40looking at board scores for a while.
01:04:42I've never believed that it means anything.
01:04:44And that's probably the Yale system in me.
01:04:47So I I'm not totally at a
01:04:48loss for not having it.
01:04:50We look at the whole application.
01:04:51We actually really do read all of them.
01:04:53The things we actually look for are people
01:04:57excelling at whatever their own passion is,
01:04:59an interest as opposed to some random thing
01:05:01that they're doing for an application.
01:05:03And and it's it's the, you know,
01:05:06it's like a plan at Yale.
01:05:07It's very,
01:05:07very obvious who's gaming
01:05:09the system and who's not.
01:05:11And that can sometimes be research.
01:05:14That can often be.
01:05:15The question is usually not
01:05:16should I do research,
01:05:17It's usually should I do a year
01:05:20off because I'm not an MDPHD
01:05:22or whatever the circumstances.
01:05:24But if you look at our resident applicants,
01:05:27only half have some type
01:05:29of legitimate extra time,
01:05:31either as a fifth year or as a PhD.
01:05:33So there are people who go straight through.
01:05:35We often just want somebody to to
01:05:38excel at the things they really
01:05:40love and it's very obvious And yes,
01:05:42I I can't remember who said
01:05:43this on the panel,
01:05:44but often the people who are the
01:05:47strongest residents are the ones who
01:05:49have a healthy bounce of something else
01:05:51outside of neurosurgery or being a a
01:05:54Med student who loves neurosurgery.
01:05:56And that brings that wealth of
01:05:58experience on the other hand.
01:06:00It's not a secret, right?
01:06:01Every field wants to know how.
01:06:03And you came about thinking
01:06:05to go into that field.
01:06:06It shouldn't just be like I thought
01:06:08it was cool or the surgeries
01:06:10are tough or whatever it is.
01:06:12And so that,
01:06:14you know,
01:06:15demonstrating that you not only
01:06:17understand that fields but frankly
01:06:19are trying to do something for
01:06:20that field both for yourself
01:06:22and for others will help you no
01:06:24matter what specialty you go into.
01:06:25And that's often what we look for.
01:06:28Yeah, I mean I I think to follow
01:06:30up on what Brian just said,
01:06:31I think that that's the critical thing.
01:06:33I remember interviewing a a resident
01:06:38applicant at Pitt who had like
01:06:438080 something publications as a resident,
01:06:46as a as a medical student.
01:06:47And you know, I just kind of flipped
01:06:49through the middle to the middle page
01:06:51and I said tell me about this article.
01:06:53You know, what was it?
01:06:55What was the point of it?
01:06:56And he just kind of started stuttering,
01:06:58right. And so, you know,
01:07:00suddenly those 80, you know,
01:07:04publications meant nothing compared to
01:07:06someone who had three legitimate applications
01:07:08in an area they were really interested in.
01:07:11And so I think you know what,
01:07:12what you're really looking for.
01:07:14I mean, I think the arms race is overblown.
01:07:17I think that it's, you know,
01:07:18it's it's the kind of thing where you know,
01:07:20people, you know,
01:07:22it's it's created within.
01:07:24You know by often by,
01:07:27you know there's a culture where people
01:07:30are just like oh you have to do this,
01:07:31you have to do more,
01:07:32you have to do more and then it just kind
01:07:33of it's you know so it's like being pre Med.
01:07:35You have to like get in in Orgo and then
01:07:37you have to do this and you have to do,
01:07:39you know it's like just like it's
01:07:41it's it's totally overblown and what
01:07:43you really want is someone who has a
01:07:46genuine passion about neurosurgery.
01:07:48I mean because there are people who.
01:07:51You know aren't in nursery just because
01:07:53they think it's cool right and and
01:07:55and I think that's what we don't
01:07:56want in nursery like we want people
01:07:58who you know really love the idea of
01:08:01the brain of operating on the brain
01:08:03who find the nervous system to be
01:08:06compelling and and I I I mean I think
01:08:09I can I can tell those people when I
01:08:11when I talk to them I mean you know
01:08:14they they they exude a certain amount of.
01:08:18You know passion.
01:08:19Some of them are,
01:08:20you know, you know,
01:08:22it's sometimes passion is like, you know,
01:08:26intense and sometimes it's a quiet,
01:08:28sort of confident passion.
01:08:30But but you see it.
01:08:31You see the fact that they really
01:08:34want to do this and they've
01:08:36spent time thinking about this.
01:08:38And, you know,
01:08:39I think just being on this panel says a lot,
01:08:42right? Like it says that you are.
01:08:44Invested.
01:08:44You want to learn about,
01:08:46you know the the the the field itself.
01:08:48So I think yeah I think the arms
01:08:51race is is overblown and I think
01:08:54that you find a a variety of of of
01:08:58of applicant types at every single
01:09:02institution and and and and and
01:09:05and really you know one just needs
01:09:07to concentrate on themselves and.
01:09:08I think about what what makes you
01:09:10interested in neurosurgery and
01:09:12and what you're good at within
01:09:13neurosurgery and what you're interested
01:09:14in it could be gun violence.
01:09:16You know,
01:09:17that's taking you know a huge center
01:09:19stage and and because we deal with
01:09:22with with gun trauma it could be you
01:09:25know studying molecular mechanisms
01:09:28of you know carcinogenesis or
01:09:31you know spinal cord you know,
01:09:33you know injury and and repair.
01:09:35I mean there's a,
01:09:36there's there's a ton of stuff so.
01:09:38You know, I think my advice would be
01:09:41find a thing that you are interested in,
01:09:44focus on that and make that something
01:09:47that you can talk about during the
01:09:50application process and then and
01:09:52then and then get involved with the
01:09:54rest of the department and and and
01:09:57see if you can help out with other
01:09:59publications where people or other
01:10:01people might be primary authors.
01:10:02But don't spend your entire, you know?
01:10:07Medical school career trying to get
01:10:08your name on every single paper cuz
01:10:10that's like that you can you see right
01:10:12through that especially the at the
01:10:15at the you know high end programs.
01:10:17So that would be my my advice about that.
01:10:21Heather did you have a comment
01:10:22or was that a hand? Yeah
01:10:25I completely agree with the
01:10:26comments are made on social media.
01:10:28There was actually an interesting
01:10:29post I think it was by Lola
01:10:32Chambliss who's the Vanderbilt
01:10:34program director about how the.
01:10:35Number of publications is skewed
01:10:37and so the mean is super high,
01:10:40but if you looked at the median,
01:10:41it's much lower.
01:10:42So there's there's certain candidates
01:10:43that have tons and tons and tons like
01:10:45some of the ones that Duke is talking
01:10:47about where you're not even sure how
01:10:48much they did on any of these papers
01:10:50that sort of skewed the average number.
01:10:52So I I think for a student who's
01:10:54interested in neurosurgery,
01:10:56it's really important to spend time with
01:10:58the residents and not just going to the OR,
01:11:01but also like.
01:11:02Taking call with them and seeing what it
01:11:05is like to be a neurosurgery resident.
01:11:07The the sort of work life
01:11:08balance we've talked about.
01:11:09I'll admit it's a lot easier once
01:11:11you're a faculty and you're trying
01:11:12to figure out what job you want
01:11:13and how you want to balance your
01:11:14life than it is in residency.
01:11:16The seven years of residency are
01:11:18pretty long and are intense and you're
01:11:20working really long hours and don't
01:11:22always have control over things,
01:11:24but you can still try to have a balance,
01:11:27but it's not as easy.
01:11:30But I think that in turn, you know,
01:11:32when I look at an application,
01:11:34I similarly don't really care
01:11:36about board scores,
01:11:37but the but places use that as a
01:11:39cut off of who they'll interview.
01:11:42And I don't necessarily look at
01:11:43the total number of publications,
01:11:45but I want to know that someone really
01:11:48seems to understand what neurosurgery
01:11:50entails and seems like they would
01:11:53have a true love for neurosurgery
01:11:55and be willing to put up with.
01:11:56You know,
01:11:57the time commitment that it
01:11:58is and how intense it can be.
01:12:00And then I want to see in terms
01:12:01of research that they really are
01:12:03passionate about it and did it
01:12:05themselves that they can talk about it,
01:12:07that it's not just they were an author.
01:12:09So it's similar,
01:12:12fabulous, fabulous.
01:12:13So listen, I think I would
01:12:15summarize all of your responses.
01:12:17There's a sort of a similar theme
01:12:20that it's authenticity, you know?
01:12:22There's a lot of hoop jumping
01:12:24that goes into, you know,
01:12:26a lot of the route that we've taken,
01:12:28young people, you know,
01:12:29my son just applied to university.
01:12:31There's a perception that there's a
01:12:33lack of authenticity in the process
01:12:34because there's such a amped up
01:12:36sort of pressure chamber about it.
01:12:38But I think that's what all of you
01:12:39are looking for authenticity in,
01:12:40in your efforts and your interests.
01:12:43Brett Gu, medical student at Yale,
01:12:46just submitted a question.
01:12:47All our fields are changing all the time.
01:12:50This question is.
01:12:51Where do you see the future of
01:12:53neurosurgery going and how can
01:12:55trainees prepare for these changes?
01:12:57Are there,
01:12:58are there are there new things on the
01:13:01horizon that are going to fundamentally
01:13:03change neurosurgery in in the practice?
01:13:07In odolaryngology,
01:13:08head and neck cancer surgeons
01:13:10for instance used to muse about.
01:13:16Advanced molecular
01:13:17treatments or chemoradiation,
01:13:19advancements in chemoradiation,
01:13:21more stereotactic radiation,
01:13:23would it, You could say maybe
01:13:25that's a defensive psychology but
01:13:26would it invalidate some of the
01:13:28surgical approaches that you know,
01:13:30you spent many years honing.
01:13:32I'm not sure if that's exactly
01:13:33what Brett was getting at at all.
01:13:34But I'm just are there new things
01:13:36coming in your surgery that if you
01:13:37were a young and and you're like,
01:13:39listen I'm on my way out but if I
01:13:41were a young and what kind of what
01:13:42kind of things might they want
01:13:44to be aware of things that may.
01:13:46You know, significantly change the
01:13:47practice in the coming decades.
01:13:55Anyone else want to take that?
01:13:56I mean I I would say that, you know,
01:13:59surgery is very interesting because
01:14:01there's a lot of what we do that
01:14:04can't be studied in an in an in
01:14:06a purely evidence based fashion.
01:14:08And and you know, you know,
01:14:14Doctor King can speak a little bit.
01:14:16More eloquently about this,
01:14:17but but one of the things that I,
01:14:19I really think is important is
01:14:22you know being able to you know
01:14:26understand that what you are doing
01:14:28in any field this applies to any
01:14:30any field is really adding value.
01:14:32But especially to surgery because
01:14:34you know we're not practicing based
01:14:36on you know a million randomized
01:14:39controlled trials and you know
01:14:40and and a lot of the randomized
01:14:43controlled trials are are flawed.
01:14:46You know in one way or another but
01:14:48but I think that I do think that one
01:14:51area that is really compelling and
01:14:53it's it really it kind of goes across
01:14:56all of the nursery school specialties
01:14:59and all of the research areas is the
01:15:03use and management of of of big data.
01:15:07You know so you don't want to just
01:15:09like you know the the the case report.
01:15:11Unless you're reporting on something
01:15:14that is incredibly novel, you know,
01:15:17it doesn't really add much to the field.
01:15:18But when you can gather, you know,
01:15:21a substantial amount of data, I mean,
01:15:23I remember Brian as a resident,
01:15:25I mean as a medical student running around,
01:15:27you know,
01:15:28that finding like aneurysm samples and,
01:15:31you know,
01:15:31collecting as many of this as
01:15:33possible and now that's like that
01:15:34was like the start of it.
01:15:35You know,
01:15:36like you don't want to just you don't
01:15:38want to publish on, you know, one.
01:15:40One patient you know you want to
01:15:43find 1000 patients somehow and and
01:15:46and understand what the outcome
01:15:48of those patients are or what the
01:15:51molecular alterations are and that's
01:15:53what guides you know there's always
01:15:55going to be you know that there's
01:15:57going to be more minimally invasive
01:15:59more you know they mean novel
01:16:01procedures robotic surgery and.
01:16:05You know you know within the last
01:16:0815 years you know vascular surgery
01:16:11has gone from being largely open
01:16:13you know vascular to endovascular.
01:16:15But the same surgeons that were doing
01:16:19you know open vascular you know
01:16:21surgery are now doing endovascular surgery.
01:16:24So they've adapted.
01:16:26So things will change.
01:16:29But I I I think that the, the,
01:16:30the the most important thing is
01:16:32just to you know.
01:16:34Answer the question,
01:16:36you know what is what I'm studying going
01:16:38to add value and I would say that the,
01:16:41the,
01:16:41the,
01:16:42the most critical way to to answer
01:16:44that question is just to really be
01:16:46as expansive in the in in your end in
01:16:49your sample size no matter what you
01:16:52do and and and that's something that
01:16:53gets taken for granted all the time.
01:16:55You know people will publish
01:16:57like you know 5 mutations that
01:17:00they found in a given
01:17:01you know tumor type but.
01:17:03But then we don't know
01:17:04what that actually means,
01:17:05you know so but but but that I
01:17:07think that's going to become
01:17:09more and more important both for
01:17:11validating the procedures that we
01:17:13do do and for comparing different
01:17:15types of procedures to each other.
01:17:21All right. Thank you very much.
01:17:23So we, we received a question.
01:17:29Again previous to this event
01:17:31asking about international I MG's
01:17:35international medical graduates.
01:17:37You know we have Yale undergraduates here.
01:17:39Perhaps we have somebody who's
01:17:41entertaining going to medical
01:17:42school elsewhere McGill or Europe
01:17:44or Latin America or what have you.
01:17:46Is there is there a role is it is
01:17:49there is it is it a tough road to
01:17:51hoe to come into New York surgery as
01:17:53an international medical graduate.
01:17:57And and and if so would you any
01:18:00specific advice One caveat I'll I'll
01:18:02mention here is that when I was at
01:18:05Yale medical School I I did some
01:18:07research in in a PhD researchers lab.
01:18:10Her name was Joan Stites and she
01:18:12was she was in some sort of a a
01:18:15joint sort of physical lab set up
01:18:18with them with a guy by the name
01:18:20of Rick Lifton and I think you're
01:18:22doctor Canal of of of fame at.
01:18:24You know medical school,
01:18:25I mean maybe I'm answering the question
01:18:27at a time but best as I understand he's
01:18:29a graduate of a fine medical school in
01:18:30Turkey and I don't think it's held him back.
01:18:32Now at some respects he may be also
01:18:35quite a remarkable individual.
01:18:36But any any thoughts about international
01:18:39medical graduates who aspire to be
01:18:41neurosurgeons at US training programs
01:18:43any any any thoughts of wisdom.
01:18:47I
01:18:52think that the the numbers
01:18:53clearly show you know that
01:18:55non-us medical graduates,
01:18:57you know have a much.
01:18:59More difficult time to getting
01:19:00acceptance to a neuro, you know getting
01:19:02a neurosurgical residency placement.
01:19:04You know you can't look at the
01:19:05numbers and and and deny that.
01:19:06I think that the the people
01:19:08that are are successful,
01:19:10that someone like Doctor Canal who's
01:19:11our chair now you know had already
01:19:13done you know had really excelled in
01:19:16Turkey in medical school and then he
01:19:19made a connection with Dennis Spencer.
01:19:22Who was our chair at the time and
01:19:24you know came over and started doing
01:19:26research work and ended up with a with
01:19:29a residency position here so that,
01:19:31you know, he showed initiative,
01:19:34he showed drive.
01:19:35He had worked very hard in his country
01:19:39of origin to establish a strong
01:19:41academic track record and then he was.
01:19:44You know fearless and reaching
01:19:45out to you know to US programs
01:19:48and including you know Yale where
01:19:50Doctor Spencer took a chance on
01:19:52him and it was an amazing payoff.
01:19:53You know Doctor Ganell has had
01:19:55a has had an incredible career.
01:19:57He's one of the leaders in you know
01:19:59in genetic research and neurosurgery
01:20:01particularly dealing with the
01:20:03you know vascular malformations
01:20:04and and and brain tumors.
01:20:05And in part doing a collaborative
01:20:07work with Rick Lifton.
01:20:08So I I think that it,
01:20:10I think that it can be done of it.
01:20:11I think that realistically though it can be,
01:20:13it can be a tough Rd.
01:20:16Thank you so much for that.
01:20:17Doctor King I very briefly
01:20:20because James Ewan,
01:20:21who's the resident has just signed on.
01:20:23It's a quick followup question,
01:20:24which I think is important,
01:20:25just sent in from Amy Manch.
01:20:27Thank you so much for your question.
01:20:30To follow up on the IMG question,
01:20:31do programs make a
01:20:33distinction between US grads,
01:20:35graduates of US medical schools that are U.S.
01:20:37citizens versus citizens US
01:20:39grads that are noncitizens?
01:20:41Is that a factor US citizenship
01:20:43Appoint to my solution.
01:20:47I can answer that. Do you have an answer?
01:20:49Yeah, I don't. I don't think
01:20:50it has to do with citizenship.
01:20:52And nationally if you look at it,
01:20:54there are folks that are
01:20:55citizens from others.
01:20:56I think it's just familiarity with the,
01:20:58you know, as Doctor King was
01:21:00mentioning familiarity with the
01:21:01individual and the institution and
01:21:03frankly the ability to do a sub I.
01:21:06One of the hardest things as a foreign
01:21:08medical graduate is sometimes you
01:21:10if you don't have a medical school
01:21:13that will have a relationship to
01:21:14let you do a sub I in the States.
01:21:17Because it has to be from Med
01:21:18school to Med school,
01:21:19that can be a limitation.
01:21:20So there's a number of different hurdles.
01:21:22It certainly is more challenging,
01:21:24particularly because it's such a
01:21:26competitive specialty and and still
01:21:28one of the few specialties where
01:21:29a number of people go unmatched
01:21:31who are US trained.
01:21:32So nothing's impossible as
01:21:35as Joe had mentioned.
01:21:38Marat is like the a great example
01:21:40of incredible hard work but also you
01:21:42know a lot of dedication to do it.
01:21:44So hopefully that and it has nothing
01:21:48to do with Citizen at least on our end.
01:21:50It's just kind of where you're coming
01:21:52from and and your ability to to
01:21:54showcase that to the to the program.
01:21:57Same thing with us and we have
01:21:59had non-us citizens in our program
01:22:01within the last five years.
01:22:02You know usually the visa status
01:22:04can be worked out with a lot of
01:22:06paperwork and and some legal inputs.
01:22:08And hospitals, you know,
01:22:09that run the residency programs usually
01:22:11have a lot of experience of helping
01:22:14foreign medical students and non citizens,
01:22:16you know work through the visa issues so they
01:22:18can come and train at their institutions.
01:22:20But sometimes people are applying
01:22:22from schools in other countries that
01:22:24you've literally never heard of
01:22:25before and it's really difficult.
01:22:27To evaluate them.
01:22:28And so I think as as Brian said,
01:22:30I think that especially for foreign medical
01:22:32graduates or international students,
01:22:34you know, the sub I is really important.
01:22:35I think it's also crucial for
01:22:37domestic students too.
01:22:38You know that you have to go and
01:22:40see what other programs are like,
01:22:41but you're also being evaluated, you know.
01:22:43And so when you're going to do that sub I,
01:22:45whether you're an international student
01:22:47or a domestic student, you know,
01:22:48you got to go and you got to go work 110%.
01:22:51You got to really make an impression
01:22:52on people because you know,
01:22:53we do pay a lot of attention to
01:22:56sub I letters.
01:22:57You know,
01:22:57as other people have said,
01:22:59you know,
01:22:59we don't pay much attention to board scores,
01:23:01but those sub by letters I think are crucial.
01:23:04All right. Thank you very much.
01:23:05So James Yoon has untangled himself
01:23:08from the trauma service there
01:23:10in the Presby trauma bank where
01:23:11I spent a lot of time myself.
01:23:13So. So listen, the
01:23:15resident room, James,
01:23:19there you go. So James,
01:23:21you're coming a bit late but that
01:23:23your your your perspective is vital
01:23:24you're you're just one teeny step
01:23:26ahead of these medical students
01:23:27that are that are listening to us.
01:23:29Can you give us some and
01:23:31I do apologize it's 758.
01:23:32We said we'd wrap this up
01:23:35at 8:00 o'clock but but,
01:23:36but but let's give James a little time
01:23:38to talk and and give us his thoughts.
01:23:41Well, thank you so much and
01:23:43sorry I'm joining so late.
01:23:44I had a bunch of consults that
01:23:46I had to see and then just
01:23:48signed out to my night team but.
01:23:50It's really great to be here and I'm
01:23:52obviously happy to take questions offline.
01:23:55I graduated medical school in
01:23:5622 and I'm now at P GY2 starting
01:23:58on our trauma junior rotation.
01:24:00So I'm responsible for our
01:24:02trauma neurosurgery list,
01:24:03which ranges anywhere from 25 to 40 in
01:24:07patients including ICU's and floors.
01:24:09On top of seeing consoles, local,
01:24:10entire hospital between 7:00 AM to 4:00 PM.
01:24:13So I'd agree anywhere from,
01:24:15I don't know, 15 to,
01:24:16I don't know 10 to 15 consoles a
01:24:19day for I think I had 12 today.
01:24:22Around the same number yesterday,
01:24:25half of which were probably operative.
01:24:26So it's a very busy rotation and I think,
01:24:30you know,
01:24:30it's a lot of responsibility
01:24:31that you get gradually since you
01:24:33graduate from medical school.
01:24:35But it's just crazy to think that,
01:24:36you know,
01:24:37I have new interns now and seeing how
01:24:39far I've just even come in one year or
01:24:42even just a couple years from that school.
01:24:45I was born and raised in South Korea
01:24:47and I came to the States in high school.
01:24:50I went to Brown from undergrad and that's
01:24:53kind of where I found neurosurgery.
01:24:56I had really great mentors in
01:24:58Med school like Doctor King here.
01:25:02You know,
01:25:02we met in my first year of medical
01:25:04school and he's mentored me all
01:25:06throughout Med school and just,
01:25:07you know,
01:25:08fantastic to have this like yell
01:25:09community of neurosurgeons.
01:25:12Because it's a small field
01:25:14and everyone knows everyone,
01:25:16but I'm happy to take questions about
01:25:20what Residency's like, you know,
01:25:23or about applying or if you have
01:25:25any questions about anything.
01:25:27I'm happy to chat anytime.
01:25:29I just want to make one quick comment for
01:25:31the for the for the people in the audience.
01:25:33You know, just notice that Doctor
01:25:35Yoon is just like finish a shift.
01:25:38And he still somehow has a smile on his face,
01:25:41you know, and that is something that that's
01:25:43that just tells you about neurosurgery.
01:25:46I mean like he,
01:25:46he should be crying right now, right?
01:25:48You know by by every other measure
01:25:50you know he should be crying.
01:25:52But he has a smile on his face and that
01:25:54and and that speaks to the you know,
01:25:56the passion and the interest
01:25:58and the fact that.
01:25:59You know he loves what he's doing
01:26:01and and that's that's that's that's
01:26:03basically what you are going to
01:26:04see I mean he's on the I mean I've
01:26:07you know I was in attending a pit I
01:26:08mean I I I know what it's what it's
01:26:10what it's like and the fact that he
01:26:12can you know finish that that long
01:26:15shift and still be here and still be
01:26:18smiling is I think basically speaks
01:26:20that's it speaks 1000 words so.
01:26:23And to echo what and Duca said,
01:26:25there's actually a paper that was
01:26:27published many years ago that shows the
01:26:30burnout rate of faculty based on number
01:26:33of hours and special subspecialty.
01:26:35And on the graph it's really jarring
01:26:38like neurosurgeons tend to work,
01:26:40you know, more hours than other
01:26:41specialties and the burnout is some
01:26:43of the lowest in across specialties,
01:26:45not even like not that bad,
01:26:46it's very, very low,
01:26:48whereas fields like ER and
01:26:50radiology and others.
01:26:51That might have more shift base that
01:26:53the burnout tends to be a lot higher.
01:26:54And so James,
01:26:56you just proved our point
01:26:57and and we appreciate that.
01:27:02Yeah, Brian, Brian, I wanted to sort
01:27:05of start to close with a few things.
01:27:08Brian made a comment to me.
01:27:09He and I were talking on the phone.
01:27:10It must have been six weeks
01:27:11ago or something like that.
01:27:12And he made a we all are.
01:27:14I think most of us who are, you know,
01:27:17medical school graduates are sort of
01:27:18boosters for the school and boosters for
01:27:20the culture of the place that launched us.
01:27:22And Brian,
01:27:23I think I said it better than I could he,
01:27:25he mentioned that in his work at MGH,
01:27:28you know, he's he's encountered colleagues
01:27:31perhaps in neurosurgery or in other areas.
01:27:33That you know they're in mid career and
01:27:35maybe they're starting to, you know,
01:27:37they're starting to get winded,
01:27:38they're starting to get a struggle a bit.
01:27:39There's a bit of burnout here and there,
01:27:42not again not necessarily
01:27:43as neurosurgery colleagues,
01:27:44but you know maybe he can expand on this
01:27:46and he commented that he felt certain
01:27:48and I started to reflect on it as well.
01:27:51He felt certain that those formative early
01:27:53years at Yale your your introduction to
01:27:56medicine in a non hostile environment,
01:27:58in a non competitive environment.
01:28:01I'm not saying there was no competition,
01:28:02but not this acidic sort of Crucible type
01:28:05thing that we often hear about elsewhere.
01:28:08Actually wasn't just,
01:28:09you know,
01:28:09pleasurable while he was in New
01:28:11Haven but actually had a durable
01:28:13positive effect on if I'm I'm I'm.
01:28:16Tell me if I'm misinterpreting what you said,
01:28:18Brian.
01:28:18A durable positive effect on his
01:28:20psychological sort of frame of mind
01:28:23as he approached his career and and
01:28:25perhaps my sense of it has insulated him.
01:28:28From from from some of these hazards
01:28:30of burnout and and getting winded
01:28:32and I thought about myself and
01:28:33I I think it was the same.
01:28:35I think if you start in a place
01:28:38that kind of slaps you around real
01:28:40good you know that's you know we're
01:28:41all it's like it's like going to
01:28:43the Marine Corps or something like
01:28:44that you just figure well this is
01:28:46it it's supposed to be abrasive and
01:28:48I think that's not generally what
01:28:50we experienced and so and so I, I,
01:28:53I I was appreciative of Brian comments.
01:28:56I'd like to say one thing to James
01:28:57before we close out or if anybody
01:28:59else has any comments.
01:29:00While all those things are highly
01:29:02laudable about Yale Medical School,
01:29:03I can remember when I went to
01:29:05residency program,
01:29:05I had a few other people from.
01:29:07Yale who were in the residency programs,
01:29:09various surgical areas at the University
01:29:11of Pittsburgh at UPMC and there was
01:29:13some commentary sometimes that wow,
01:29:15we we learned to be thoughtful
01:29:16about medicine and we learned to be
01:29:18asked questions and what have you.
01:29:20But there is something, as much as I,
01:29:22I've just wanted what I've just said,
01:29:23there's something to be said for
01:29:25that harsh environment because
01:29:27it's sort of toughens you up.
01:29:28And you know I remember some Yale
01:29:30medical School graduates sort of
01:29:32saying it was a bit of an abrupt
01:29:33shift when you go to the real world.
01:29:36James, you know you you had
01:29:37a great time at Yale. You,
01:29:38you know you you placed into a great place.
01:29:41Do you feel you were well prepared?
01:29:43You know, I think over the
01:29:44whole arc of your career,
01:29:45the consensus on this panel is it's a
01:29:47fabulous place to launch your career
01:29:49for people who are now you're speaking
01:29:51to medical students back in New Haven.
01:29:53Do you feel like is there, is there,
01:29:55is there any observations you make
01:29:57after Yale Medical Education and now
01:29:59you're off doing something very intense?
01:30:01Are are you feeling good with where
01:30:02you're at in terms of your preparation?
01:30:06I really do, and I do.
01:30:08People tell people a lot that I'm
01:30:09really grateful for my Yale medical
01:30:11education because I think, you know,
01:30:12I think a lot of my attendings
01:30:14will tell me that, you know,
01:30:15you can teach a monkey how to do surgery and,
01:30:18you know, you can teach people
01:30:19how to operate in those things.
01:30:21But what Yale really taught
01:30:21me was how to talk to people,
01:30:23like how to talk to my patients and how
01:30:25to communicate with other services.
01:30:27I mean, I make hundreds of
01:30:29phone calls each day.
01:30:30My pager goes off nonstop
01:30:32between 7:00 and 4:00.
01:30:33So it's really how to communicate
01:30:35with other teams and, you know,
01:30:37and take really good care of patients.
01:30:39I think that's one of the changes
01:30:41that was really hard for me because
01:30:42as a medical student you feel you
01:30:44can't feel responsible for patients.
01:30:46But as a resident,
01:30:47it's like at the end of the day,
01:30:48you were the responsible person
01:30:51taking care of this person.
01:30:53So you don't leave until the job's done.
01:30:55You know, you don't take shortcuts.
01:30:57And you know that transition of
01:31:01responsibility, but also, you know,
01:31:02getting the work done is hard.
01:31:04But I think Yale overall just
01:31:07creates an environment where,
01:31:09you know,
01:31:10you realize at the end of the day that
01:31:12this is a person and you're treating
01:31:14them as a whole instead of just a disease.
01:31:16And I don't know,
01:31:17I think it's just a whole mindset and I think
01:31:20you're well prepared being a Yale grad and.
01:31:23You know,
01:31:23you'll see when you go on the
01:31:25trail that everyone loves Yograds.
01:31:26And I think there's a reason for that.
01:31:30Just fabulous.
01:31:31I do want to fit in one last question
01:31:33that's just been put forward.
01:31:35Great question. This is from,
01:31:38I apologize if I don't pronounce
01:31:40the name of Nana Adenu Minsha.
01:31:44She says I have a public health
01:31:47background and I'm curious about and
01:31:49I'm curious about the experiences.
01:31:51What your experiences have been in
01:31:53global neurosurgery considering the
01:31:55high technological advances in the US
01:31:57compared to the rest of the world.
01:31:58Do any of you have experiences
01:32:01internationally in global neurosurgery
01:32:02if you've done mission trips,
01:32:04what kind of what kind of outreach
01:32:06beyond the the the borders of the
01:32:08United States have you been involved in?
01:32:13Yeah. I mean I I,
01:32:15you know I can say that that you
01:32:18know that that's something that.
01:32:20Is for for me personally very welcomed
01:32:25in in neurosurgery and I actually
01:32:27don't think there's enough of it.
01:32:29I think that, you know,
01:32:31we talked about the divide between, you know,
01:32:34the haves and have Nots and you know,
01:32:37as a brain tumor surgeon, you know,
01:32:40trying to get that technology out to
01:32:43communities and countries that don't have it.
01:32:45Is really difficult but you can
01:32:47you know you can start to do that.
01:32:49Remember when we were at Yale you know
01:32:51Marat and I you know would you know
01:32:54donate the the donate our operative
01:32:57microscopes that we were no longer
01:32:59using but they were functional through
01:33:02the the foundation for International
01:33:05Education and Neurosurgery.
01:33:07You know to to to to to to to different
01:33:10countries and I remember carrying a.
01:33:13You know a bag full of you know kerosenes
01:33:16and and you know Lexel ronjours and
01:33:20and you know other instruments on a
01:33:22trip to Nigeria where my parents are
01:33:25from and I I and and being stopped
01:33:28at like customs and they were like
01:33:30they like open the bag like what
01:33:32what what what is it what are you
01:33:33doing with all this you know like
01:33:35you know but but you know we can all
01:33:37contribute in different ways and.
01:33:39And I think you can make a career out of it.
01:33:41You know those,
01:33:43you know Brian can speak about you
01:33:45know the folks at Boston Children's
01:33:47and you know who who really kind of
01:33:51revolutionized the, the ability to to,
01:33:55to to to to you know treat patients
01:33:59with hydrocephalus in a sustained
01:34:03and successful way.
01:34:05And I and I think that neurosurgery
01:34:07you know that that is.
01:34:08That is an area that that is is
01:34:12developing and and I would say that
01:34:14that's one of the forefronts of
01:34:15neurosurgery is like how do you you know,
01:34:17but you have to be truly dedicated
01:34:19to that you know to the art,
01:34:20you know to the to the idea that
01:34:22you're going to you know bridge
01:34:23that gap And it can't just be in you
01:34:27know trauma surgery but you know
01:34:29find different ways to to to do it.
01:34:31But yeah I mean public health perspective
01:34:34is absolutely something that is not only.
01:34:37Tolerated but absolutely
01:34:39welcomed in neurosurgery.
01:34:41Yeah just to follow that we there's a
01:34:44huge huge and growing need for the global
01:34:47neurosurgery off the heels steps of
01:34:50The Lancet Commission by John Muir and
01:34:53and folks at at at Harvard and Key Park
01:34:58is a neurosurgeon who's dedicated his
01:35:00career to this also based out of there.
01:35:03Within our efforts like in Duke has
01:35:05said as a resident I spent some time
01:35:08in Uganda also bringing a drill and
01:35:10and we have one of now two or three
01:35:13of our residents at this point,
01:35:14one most recently who's now a chief my role,
01:35:18who started his own initiative both
01:35:21doing work in Subsaharan Africa and
01:35:23then also now doing and launching a
01:35:25whole global effort in the Caribbean
01:35:28through initiative he calls Caracom.
01:35:31And then there's like Ben Wharf,
01:35:33who's at Boston Children's,
01:35:34who like in Duke was mentioning,
01:35:36there's Mike Hagglin.
01:35:37There's just just a lot of
01:35:40neurosurgeons each doing work.
01:35:42And I would bet that this is it,
01:35:44not only a growing field,
01:35:46but a needed field.
01:35:47And frankly, we have a huge,
01:35:49huge impact because neurosurgical trauma
01:35:51globally is such a huge burden of disease.
01:35:55So I I yes,
01:35:56your interests are are definitely
01:35:58part of where the field's going
01:36:00and we're always looking for folks
01:36:02who have an expertise in it just on
01:36:04the global nursery side and then
01:36:06obviously on the public health side,
01:36:08you know on the for all of us so much
01:36:10of what we do has such an impact on on
01:36:13public health and it's always helpful
01:36:15to have somebody with that background.
01:36:19There's a lot of work going on in
01:36:21pediatric neurosurgery for global health.
01:36:23Ben Wharf is one of the key examples,
01:36:25but there are other individuals as well.
01:36:26One of my good friends just got
01:36:28back from a mission trip to the
01:36:31Ukraine with some of her mentors.
01:36:33She's a pediatric neurosurgery attending,
01:36:35but it was orchestrated by
01:36:37the Toronto group. So
01:36:38what I would say is that as a medical,
01:36:41I don't know what year you are Nana,
01:36:43but you know. Like like we like we
01:36:47all mentioned related to the to
01:36:48the idea of research in the field.
01:36:51You know the key is really going to be to
01:36:54attach yourself with someone who's very
01:36:56serious about about global neurosurgery.
01:36:59So that when you you know,
01:37:02I mean I I have to admit I was a,
01:37:04I was a you know molecular biologist and
01:37:06now like a cancer immunologist and and
01:37:09you know I can't claim to have this vast
01:37:12knowledge of global neurosurgery but.
01:37:15But you know,
01:37:16if that's going to be your shtick,
01:37:19you know, you have to be able to like you
01:37:21know attach yourself to someone who's
01:37:23who's going to mentor you and who's going to,
01:37:25you know, make sure that you come
01:37:27out of medical school.
01:37:28You know,
01:37:29having had an impact and having and having
01:37:32a unique understanding that you know,
01:37:34I don't have or you know any of
01:37:36the people who don't do global
01:37:38nursery or or or or or focused on,
01:37:41you know, public health evaluation of.
01:37:44Nurse surgical you know you know
01:37:48operations or you know practices
01:37:51you know that I think that's that's
01:37:53something that is that that you
01:37:55know you you know doing a public
01:37:57health degree having a public health
01:37:59degree is probably not enough but
01:38:00you just but showing that interest
01:38:03through your research will will make
01:38:06you stand out you know remarkably
01:38:11wonderful. So it's 813.
01:38:13So we're a little bit over time,
01:38:16but I think I really appreciate
01:38:17those last comments.
01:38:18I think they were very valuable.
01:38:20So I would like to just tremendously
01:38:23thank all of the students,
01:38:25the medical students and the
01:38:26undergraduates who attended this
01:38:27and thank you for your questions.
01:38:29I'd also very much like to
01:38:30thank all of the panelists,
01:38:32the the AY AM, the Association
01:38:35of the Yale Alumni in Medicine,
01:38:36We do all kinds of things to try to.
01:38:39Tap the tremendous reservoir of
01:38:41knowledge and talent that is the alumni
01:38:44base of the medical school residency
01:38:46programs here at Yale New Haven Hospital.
01:38:48And so this is just the first,
01:38:50this is the launching program.
01:38:52We intend to every two years rotate
01:38:55through every clinical area that
01:38:57that medical students would match
01:38:59into and provide them this,
01:39:00this video is going to be recorded,
01:39:03it's being recorded and it's
01:39:04going to be archived and so.
01:39:06We want this to be a resource
01:39:08and so we'll circle back.
01:39:09In two years.
01:39:10You had some of your neurosurgery
01:39:11colleagues wanted to be on this panel,
01:39:13but we had to limit it.
01:39:14So in two years we'll do
01:39:15this again with neurosurgery.
01:39:16We want it to be a continuous
01:39:19conversation because of the medical
01:39:20students have all of these questions.
01:39:22They have all of these desires to to
01:39:24learn about the field they're going
01:39:26into because it's of such import.
01:39:27You know,
01:39:28this is you're choosing the path
01:39:30that's going to take you down the
01:39:32rest of your life professionally.
01:39:33So are there any last comments
01:39:35from any of the panelists,
01:39:36if not
01:39:37I just want to say thank you Paul for
01:39:40tolerating a bunch of neurosurgeons
01:39:41as a non neurosurgeon I think that's
01:39:44that's that's meaningful and that
01:39:46shows your love of Yale and you
01:39:49know you know and we we we really
01:39:51appreciate it and you and thanks
01:39:54for excellent moderating. Well
01:39:56thank you. I live to tell the tale.
01:39:58So listen, I think you guys are
01:39:59just a bunch of big pussycats.
01:40:01I think everything they
01:40:02tell you is not tricks.
01:40:03So anyway, no, I really enjoyed it.
01:40:06I spoke to almost every one of you
01:40:08individually and and and really enjoyed it.
01:40:10It's it's it's been very fulfilling for
01:40:12me to to launch this in this way so.
01:40:15Shaylen, who's sort of behind the scenes,
01:40:18the guru of this is going to put
01:40:20a slide up and it's just going to
01:40:22have each of your names and and ways
01:40:24in which medical students are or
01:40:26undergraduates could reach out to
01:40:27you if they have followup questions.
01:40:30And so thank you so much and have
01:40:32have an incredible evening all of you.
01:40:35Thank you.
01:40:36Thanks everyone. Thanks everyone.
01:40:38Great seeing everyone.
01:40:40Thank you for the invitation, 100%.