Brain surgery, science and education

As a pediatric neurosurgeon, neuroscientist, and educator, I come across many interesting bits of information and wonderful people. I will try to share some of this with you here. While the site draws heavily from my experiences as the Campagna Chair of Pediatric Neurosurgery at Oregon Health & Science University, and head of neurosurgery at Doernbecher Children's Hospital, this is a personal blog. My thanks to my wonderful OHSU colleagues, who share this exciting and rewarding work with me.

Friday, March 22, 2013

A Tradition Grows Deep Roots

The Mario and Edith Campagna Scholarship is less than a decade old, but is already growing deep roots and tradition within the soil of U.S. neurosurgical education. This week, the Campagna Scholarship Committee of the OHSU Department of Neurological Surgery met to choose the 8th Campagna Scholar. As Chair of the Committee, I can attest that we had some hard work choosing amongst many highly qualified and deserving candidates from around the country.

The new Campagna Scholar is Stephen J. Lehnert, a first year medical student at the Indiana University School of Medicine. As a Purdue undergraduate, Stephen earned a bachelor’s degree in mechanical engineering, and was a Pi Tau Sigma engineering honors student. Stephen has broad scientific interests, having worked on predictive modeling strategies in health care and served as a research engineering intern at Ingersoll Rand, Rockwell, and the U.S. Department of Agriculture.

The skills Stephen has garnered from this work will be well utilized in clinical research during his Scholarship, under the guidance of OHSU Assistant Professor of Neurological Surgery, and functional neurosurgery expert, Dr. Ahmed Raslan.

Of course, most important to the Campagna vision and legacy, Stephen is an engaging, enthusiastic and hard working future physician and surgeon, passionate about all his undertakings. He enjoys sports and the outdoors, including basketball and running, and will really benefit from the chance to get to know Oregon while he is here as a Scholar.

Former Campagna Scholar, Susan Wozniak, Campagna Professor Dr. Nathan Selden, with Dr. and Mrs. Campagna on a Scholar trip to Medford
One of the highlights of the summer (for the Scholar and for myself!) is a trip to southern Oregon to visit with Dr. Campagna. Like the Scholarship, itself, this tradition of mentorship and stewardship of future leaders in neurosurgery has grown deep roots.

Friday, March 15, 2013

OHSU Neurosurgery Residency 2013 Match

It is a true pleasure to announce the outstanding results of the OHSU 2013 Neurosurgery Residency Program Match. OHSU matched two residents this year, following our complement increase in 2012 to three and two residents on an alternating year schedule:

Dr. Carli Bullis, MD, holds undergraduate degrees in both biology and history from Indiana University in Bloomington, and is completing her medical degree at the IU School of Medicine where she is a member of the AOA honors society. As a medical student, she conducted research on the radiographic anatomy of pediatric spine surgery. At IU, she was a silver medalist at the US Figure Skating Intercollegiate National Championships.

Dr. Lauren Simpson, MD, studied neuroscience as an undergraduate at the University of Michigan, Ann Arbor, and earned a Master of Public Health degree at the University of North Carolina, Chapel Hill. She is completing her medical degree at Duke University, where she is a Dean’s Tuition Scholarship Merit Award winner. She has participated in and written about medical care capacity building in the underdeveloped world.

Our program is proud of the outstanding quality of the medical graduates who come to OHSU to train in neurological surgery. OHSU neurosurgery residents are amongst the most accomplished and capable in the country.

With this year’s match, we believe that the OHSU program now also represents the highest number (7) and highest proportion (47%) of female residents in any of the 101 accredited U.S. residency programs. This proportion is almost identical to that of women graduating from U.S. medical schools (48%), and dramatically higher than the percentage of women neurosurgery residents currently training in the U.S. (12%), or entering accredited residency programs each year (20%).

The OHSU neurological surgery residency program is fortunate to attract top applicants of either gender and of various cultural backgrounds. Increasingly, the residents we train resemble the rich and diverse population that they will care for. Each of our residents strive to meet and surpass the rigorous criteria for hard work, compassionate care, and excellence required by the personally demanding and technically challenging field of neurosurgery. Each of them defines what it takes to succeed in this terrific profession.

Carli Bullis

Lauren Simpson

Monday, March 4, 2013

Enjoying a Colleague's Success

In January, I was invited to a very special dinner celebration, to acknowledge my friend and colleague, Dr. Jeff Koh, head of pediatric anesthesiology at Doernbecher Children’s Hospital. Dr. Koh was being honored as the first holder of the Fred Fax Professorship of Pediatric Anesthesia. This important endowed position, a gift from the estate of Alice and Fred Fax, will support the important work of Jeff and his colleagues at Doernbecher now and in perpetuity.

At the dinner, listening to colleagues from near and far who were visiting to join in the celebration, I was reminded of the special talents that Jeff brings to his care of patients at Doernbecher. His calm, warm and wonderful demeanor with children changes their operative experience (and that of their parents) for the better. His focus and skill as an anesthesiologist brings an unmatched level of safety and care to their outcomes. Indeed, when one of my own children needed an anesthetic for placement of ear tubes, Jeff took care of them. This passion for quality extends to all of Jeff’s anesthesia colleagues at Doernbecher, in part because he helps to inspire it.

Jeff is also a superlative leader, who keeps a complex OR environment humming, makes sure everyone is at their best, and that everyone’s contribution is valued. Holding the Fax Professorship is emblematic of all these skills, and of what Jeff brings to Oregon’s children.

My favorite part of the dinner was to see Jeff’s wife, children, and even siblings and father, some from very far away, visiting to enjoy their family member’s success, and to better understand his contributions. That night, they too became part of our “Doernbecher family”!

My colleagues Dean Mark Richardson and Drs. Jeff Koh, Stacy Nicholson and Jeff Kirsch

Monday, February 18, 2013

Surpassing Your Elders

I had the pleasure in January of spending the day in Hillsboro at the Intel Lego Robotics Championships for the State of Oregon. I was there to watch my son’s team (Team Sigma) compete in the finals after winning runner up at their regional competition the month before.

Lego Robotics is a terrific program for junior high school students, which marries robot design, programming and competition, to team work on a major, innovative, and creative project using engineering skills, and focused on the real world. This year, the project theme focused on the health of the elderly, with the goal of proposing real solutions for elder health and safety.

My son’s team visited a local nursing home, got to know some of the residents and staff, and found about one very serious problems for the elderly: walker falls. People dependent on walkers to get around can sometimes lose control of the walker and still suffer a fall, sometimes with devastating and life altering hip or other injuries. Ryan and his friends, all on their own, looked over various walker models, learned about the most common fall mechanisms, and engineered a solution. They then went a few steps farther, drawing a CAD diagram (using fee software they found online), buying the necessary parts for a prototype, and building it!

I was privileged to be in the room with their coach in Hillsboro when they demonstrated their prototype and project design boards to a panel of engineering judges at the competition (see the photo below). Listening to them present I thought I was watching a group of young engineers, not my own 13-year old son and his friends. The judges were rapt and pushed them with tough questions. Without any ability for help from coach or parent, they confidently answered everything, using expertise (and some vocabulary) that I do not even possess. I was stunned. For the first time as a parent, I most clearly understood some of the things my son can do that I can’t, and never will be able to.

Ryan’s team also won rave reviews from teamwork judges, and robotics judges, as well as had some great runs on the robot competition tables.

Karen and I sat on our hands with anxiety, along with the parents of over 80 other teams, as the statewide awards were announced. No matter how impressed I had been, I started to give up hope after Team Sigma failed to earn first place or runner up in any of the category awards (teamwork, design, programming, etc.). As the overall 3rd place in Oregon award went by, I started to rehearse in my head a condolences and encouragement talk to have with my son. Again, it shows how little I know! In second place in Oregon – Team Sigma! I will never forget the looks on the faces of this terrific team.

Well done!

Team Sigma Accepts 2nd Place in Oregon Trophy at Intel Lego Robotics

Team Sigma Demonstrating Project to Judges

Friday, December 14, 2012

Next Generation

I am very proud of each and every resident trained in the neurosurgery residency program at Oregon Health & Science University/Doernbecher Children’s Hospital. This week, we got some news that one of them will join us in the small but important specialty of pediatric neurosurgery, caring for children with surgical disorders of the brain and spinal cord.

Dr. Eric Thompson joined the OHSU neurosurgery training program in 2005. Raised and educated in Nebraska, Eric was a young and quiet resident, who developed and interest, and great talent, caring for children and their families. He also went into the laboratory to help develop better ways of treating children with brain tumors: understanding how to stop tumor growth and reduce the impact of chemotherapy on kids.

In the meantime, Dr. Thompson also developed a leader’s voice. He took a role in teaching students and younger residents. He spoke about his research at national meetings. He represented all OHSU residents on the institutional education committee and won a socioeconomic fellowship for leadership development from our national neurosurgical societies.

It was no surprise to me that my colleagues at the world leading pediatric brain tumor clinical and research program in Toronto, Canada, selected Dr. Thompson to serve as their 2013-14 Chief Fellow. They see both the accomplishment and promise for our field that he carries with him. I am excited to see our resident succeed, but also very excited for the future of my chosen field, pediatric neurosurgery. I am also delighted that the experience of caring for children at Doernbecher Children’s Hospital is inspiring the best of our young trainees, in many fields, to dedicate their careers to carrying on and improving the tradition of pediatric medicine and surgery.

Dr. Eric Thompson

Sunday, November 11, 2012

A Stitch in Time Saves More Than Nine

One of the true challenges of neurosurgical care is that small details can have a big effect. In short, the central nervous system is one of the least tolerant organ systems in the body to irritation, injury, infection and other ill effects.

While I was training in general and then pediatric neurosurgery, I was troubled that despite careful attention, very delicate and important drains in the fluid spaces of the brain sometimes fell out. This often happened at night, required an additional procedure to replace the drain, and in the worst cases caused a temporary leak of cerebrospinal fluid (CSF) out of the drain site, resulting in infection. In some cases, with small fluid spaces, called ‘ventricles’, replacing the drain could also be tricky, and involved a small but important amount of risk.

So, throughout my career, whenever I worked with a new colleague (resident, fellow, or faculty member), I paid careful attention to details of how they liked to secure their CSF drains. I asked questions. I made notes.

When I started as the head of pediatric neurosurgery at Doernbecher Children’s Hospital, I combined what I found to be the best tricks and techniques into a very systematic way of stitching in CSF drains. I stuck with it. I taught every one of our residents how to do it, and I insisted they use my system. The method spread within our Department, but no further.

That was until 2011, when a senior and respected colleague of mine wrote me an email from Africa. He was running a neurosurgical service at a mission hospital in one of the poorest countries on earth. He had very little nursing support. His drains fell out all the time. His nurse practitioner had years before worked at Doernbecher. She mentioned to him that our drains “never fell out”. He did not believe it, but he sent me the note.

I told my friend how I do it. A month later, he sent another note. Not a single drain had fallen out. He insisted I describe the technique as an official scientific report. Moreover, he recommended that I send it to our top ranked journal. I wrote back to him complaining that this was just a curious way of securing a drain stitch. I would be a laughing stock for trying to publish a scientific paper on that. But my friend reminded me that scientific papers are there to improve patient care, and that drains falling out may not be fancy science, but are a real problem harming children literally all over the world.

So Nathaniel Whitney, one of our terrific OHSU neurosurgery residents, and I wrote the paper. With help from our world-class medical illustrator, Andy Rekito, we included detailed diagrams showing how to do it. To my surprise and delight, the Journal of Neurosurgery:Pediatrics accepted the paper immediately. Here is the link:

My friend soon sent a wonderful congratulatory note, and thanked me for following through. He deserves thanks for a suggestion that did not occur to me, and for keeping a sharp eye as he always does on the welfare of our patients and new ways to promote it.

A month later, I got another wonderful note about this project. A friend and colleague in the Midwest, another pediatric neurosurgeon whom I used to work with, saw his resident tying in a drain exactly as I do it. He asked the resident who taught him that. “I just read it in the Journal of Neurosurgery” was the answer.

Helping children in Oregon & SW Washington is Doernbecher’s primary mission. By working with our colleagues around the world, in this case from Africa to Minnesota, we also strive to advance the welfare of all children.

This may be some of the least fancy academic work I have ever done. In some ways though, I think it may turn out to be some of the most impactful.

The problem with a traditional Roman sandal tie

Friday, October 5, 2012

Standing Up For the Team

Caring for children is both a critical mission and a gift. Those of us privileged to work at OHSU-Doernbecher Children’s Hospital are stewards of systems of care that are vital to the health of our children and the sustainability of our communities. Part of that vitality and sustainability are the training of the next generation of practitioners.

Doernbecher partners with the Schools of Medicine and Nursing at OHSU to train the doctors who will care for our children and their children in the future, long after our own work is done. The presence of trainees in the hospital enriches us. We think of new and improved ways to deliver care. There are additional doctors present in the hospital at night who can respond to a sudden change more quickly than in typical care settings. There are more people available to educate families and patients about their illness and their care.

This week, I was honored for my work as the Director of the neurosurgical residency training program that is housed at both Doernbecher Children’s and OHSU Hospitals. The Palmer J. Parker Courage to Teach Award is given to 10 residency or fellowship program directors in the United States each year to recognize the value and importance of medical and surgical training and of educators. Mentorship, promotion of excellent patient care and safety, and educational innovation are core attributes for the award.

Although the honor is in my name, it is clearly a reflection of the quality and expertise of the faculty and residents at Doernbecher and OHSU with whom I work, their commitment to the highest quality education, to innovation, and to world class patient care.

I am proud of the young neurosurgeons training at OHSU-Doernbecher. Mentoring them is one of the most fulfilling aspects of my job. They contribute directly to the safety and wonderful outcomes of patients we care for. I am honored and humbled that the ACGME has recognized the work we do together.

The team at work in the operating room

Simulation based training