Best Functional Fellowships?

[Guest]

I’d like to point out that not everything of clinical value starts out in basic science. MMA embolization was performed in a liver patient by a team in Japan in the early 2000s as a last ditch effort. That was a case report. MMA embolization is changing the world of chronic SDH management. Clinical research also moves us forward and is valuable.

[Guest]

(02-07-2022, 05:42 PM)Guest Wrote:

(02-07-2022, 05:13 PM)Guest Wrote: As one of the more cynical posters on this thread, I still have to disagree with the above poster. All the innovations Leuthard is involved with are not easily tangible but I'd argue he has had quite an impact, especially with his pioneering work around LITT. Tumor ... yes, tumor. Are we gaining more insight, yes. Does this help patients, not yet. Not really. I wouldn't dismiss their efforts, however. You won't get to a cure without years of their work.

Lastly, care to explain why the surgeon-scientist is a myth? I think no PhD will crack the code without a clinician guiding them. And whether it's a surgeon or an internist, doesn't make a difference. You either round most of your day or you cut tumors out. We need the hybrids who constantly ask questions while treating patients and hire PhDs to answer these.

100% agree. I don’t know why this website is so anti-research. There are plenty of exciting clinical trials going on literally at this moment that could push the curve by a year or more for GBM, which itself would be a triumph.

The days of synthesizing insulin and saving millions in a matter of months or publishing in Nature with one experiment are over. Real advances take whole careers and painstaking preclinical and clinical trials. Stupp is in the late stage of his career. There’s plenty of exciting work being done by early and mid-career surgeon-scientists

But how many of those clinical trials involve surgeons who designed and carried out the trial? Almost always, its a non-surgeon who actually does the research work, and the surgeon is just following the protocol. 

In my medical school, all the research-oriented students I know (from our research group) go into non-surgical fields. Surgical fields, almost by definition, take up too much time for one to do research. They also attract personalities who are aggressive, arrogant, money- and prestige-oriented--all of which are the opposite traits of a good scientist.

[Guest]

(02-07-2022, 08:18 PM)Guest Wrote: I’d like to point out that not everything of clinical value starts out in basic science. MMA embolization was performed in a liver patient by a team in Japan in the early 2000s as a last ditch effort. That was a case report. MMA embolization is changing the world of chronic SDH management. Clinical research also moves us forward and is valuable.

*discounting the materials science research that went into inventing the embolization materials

[Guest]

Chiocca and Lesniak both have ongoing clinical trials for biological they developed within their own labs with their own grant money. The same is true of many tumor surgeon-scientists.

It’s certainly easier to be a physician-scientist in a non-surgical field because you take less of a pay-cut to make time for research, but it’s important to still have surgeon-scientists. You have a fundamentally different perspective on the diseases

[Guest]

(02-07-2022, 04:22 PM)Guest Wrote: The concept of a neurosurgeon scientist is a myth.

Leuthardt, Lesniak, and Chiocca have not translated anything meaningfully to reach patients to date. Not to mention the dozens of others. Has Sampson gotten a cure to patients? Has Aghi made any impact even with all of his GBM tumor microenvironment?

The reality is that we're still operating with Stupp's protocol +/- Avastin for GBM.

Would the IpsiHand that Leuthardt helped develop not meet the criteria of meaningful transnational work?

FDA Authorizes Marketing of Device to Facilitate Muscle Rehabilitation in Stroke Patient
https://www.neurolutions.com/device (home page for the company that Leuthardt co-founded and serves as CSO)

[Guest]

Of course their are a few dozen or so surgeons doing quality research but 99% of surgeons don't do any meaningful research. You seem to be pushing the view that surgeons are leading the field, which is simply not true.

[Guest]

I don't think that was the point the above poster was making at all, simply pointing out that being a successful surgeon-scientist is a viable career plan, which it clearly is, and one I would argue is getting increasing traction in academia where hyper-subspecialization is the trend.

What I struggle to understand is why there is such active discouragement of younger trainees in pursuing this path. It is absolutely difficult, but there are also clearly successful role models and a market demand for it, both from academic programs and funding agencies, but one that will vary widely depending on your institution as it requires a chairman that is strongly supportive. It is, however, the way in which neurosurgeons can do high-impact research, which I would argue has significant value to the field.

[Guest]

How is the environment like in academia? I would guess its just like medical school and college and residency, where you are terrified to speak anything that might offend someone. And where you are controlled by radical feminist social justice warriors admins.

I would imagine that discourages a good many potential surgeon-scientists. Degrading yourself to left-wing administration for the small chance of publishing a semi-relevant paper? No thanks.

[Guest]

(02-07-2022, 08:27 PM)Guest Wrote:

(02-07-2022, 05:42 PM)Guest Wrote:

(02-07-2022, 05:13 PM)Guest Wrote: As one of the more cynical posters on this thread, I still have to disagree with the above poster. All the innovations Leuthard is involved with are not easily tangible but I'd argue he has had quite an impact, especially with his pioneering work around LITT. Tumor ... yes, tumor. Are we gaining more insight, yes. Does this help patients, not yet. Not really. I wouldn't dismiss their efforts, however. You won't get to a cure without years of their work.

Lastly, care to explain why the surgeon-scientist is a myth? I think no PhD will crack the code without a clinician guiding them. And whether it's a surgeon or an internist, doesn't make a difference. You either round most of your day or you cut tumors out. We need the hybrids who constantly ask questions while treating patients and hire PhDs to answer these.

100% agree. I don’t know why this website is so anti-research. There are plenty of exciting clinical trials going on literally at this moment that could push the curve by a year or more for GBM, which itself would be a triumph.

The days of synthesizing insulin and saving millions in a matter of months or publishing in Nature with one experiment are over. Real advances take whole careers and painstaking preclinical and clinical trials. Stupp is in the late stage of his career. There’s plenty of exciting work being done by early and mid-career surgeon-scientists

But how many of those clinical trials involve surgeons who designed and carried out the trial? Almost always, its a non-surgeon who actually does the research work, and the surgeon is just following the protocol. 

In my medical school, all the research-oriented students I know (from our research group) go into non-surgical fields. Surgical fields, almost by definition, take up too much time for one to do research. They also attract personalities who are aggressive, arrogant, money- and prestige-oriented--all of which are the opposite traits of a good scientist.

Who wants to actually be involved in the day to day of clinical trials and bench research? It's tedious, time consuming, and terribly boring. That's the best part about being a surgeon involved in these endeavors. Your role is managerial, you make the big picture decisions and investments, and the most successful neurosurgeon researchers have a team of PhDs and scientists that carry out the day to day work while they decide the overall direction and make money doing actual surgery. Then you get added to the papers as senior author and present the research around the world.

It's shocking to me that everyone is talking about how neurosurgeons don't have the time to be focusing on fucking PCRs and western blots like that's a bad thing.

[Focus]

(02-08-2022, 01:53 PM)Guest Wrote: How is the environment like in academia? I would guess its just like medical school and college and residency, where you are terrified to speak anything that might offend someone. And where you are controlled by radical feminist social justice warriors admins.

I would imagine that discourages a good many potential surgeon-scientists. Degrading yourself to left-wing administration for the small chance of publishing a semi-relevant paper? No thanks.

There's some of that to varying degrees. Often it comes more strongly from other departments. If your department has strong leadership and a program director willing to fight for residents against the endless wave of write ups, then it can be fine.

Professionalism and performance issues during neurosurgical training and job satisfaction after training: a single training center 50-year experience - PubMed (nih.gov)

There was no statistically significant difference by decade in serious PPIs. Although millennial residents had no significant increase in the reporting of serious PPIs, the increased use of electronic event reporting over the most recent 2 decades coincided with a trend of increased reporting of all levels of suspected PPIs (p < 0.05).