AYAM Neurosurgery Specialty Mentorship Meeting July 2023
July 17, 2023Information
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&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%.