We cannot have a great Department of Neurosurgery at the University of Iowa without an outstanding residency program. That is because our greatest department strength is our special culture of excellence, service to others, and teamwork. Our residents are key contributors to that culture. When new trainees are emersed in this culture, and we provide them the special training they need to excel as academic neurosurgeons, they are optimally prepared to become outstanding faculty members here at the University of Iowa, and elsewhere. The public at large benefits when our graduates apply their positive attitude and exceptional skills as faculty members at leading academic medical centers across the country. Our department and the citizens of Iowa benefit when graduates are appointed to the University of Iowa faculty. Those graduates embrace and perpetuate our departmental culture, and the special approach we take to resident training. Unwavering faculty support is essential to ensure the department’s commitment to provide unusually high levels of programmatic time, attention, and valuable resources to support the residency program. 

The faculty are role models for the residents. We have internationally renowned neurosurgeons who provide the highest levels of surgical care to patients representing the full spectrum of neurosurgical disorders. Many of the clinical series published by UI neurosurgery faculty members represent the largest number of patients treated for these disorders reported in the literature. Our researchers are also world-renowned, including an unusually high number of neurosurgeon-scientists who are NIH funded. Resident trainees are immersed in these academic activities and learn from these faculty members. Program stability is critical important, and that can only be accomplished when faculty members are fully committed to the department, and the residency program “over the long haul”.  We excel in this area. Our faculty turnover rates are the lowest of any UI surgical department and among the lowest of any neurosurgery department in the nation. Faculty members embrace our special culture and elect to stay in Iowa to accomplish their professional, personal and family goals. Because of this, there are no disruptions of the clinical service or research programs that are so import to resident training. Stability and long faculty tenures also ensure that departmental leadership succession planning is smooth and the department culture, which is so important for our residents, is always preserved.

Our departmental motto is “Pleasure to Serve”, or PTS. It is simple and powerful. I had the honor, along with one of our outstanding residency program graduates (Dr. Meryl Severson, current Duke faculty member), to explain the Iowa Neurosurgery PTS motto during the University of Iowa’s 2024 White Coat Ceremony. All of our team members understand that it is a great privilege to have the special skills that enable us to provide expert neurosurgical care to patients in need. It is a great pleasure to serve the public in this way, and that must always be front of mind as we manage the inevitable stresses and disappointments that come with such a challenging and high-risk profession. That PTS mindset also applies to serving and helping teammates. This is instantiated in our unusual way of providing support for faculty. All incentives are group incentives, and no faculty member is personally disadvantaged when residents are given independent time and generous financial support for their elective educational pursuits.

Out of necessity, neurosurgery departments and residency programs are hierarchically organized. As trainees, and faculty members acquire skills and experiences they move up the hierarchy and are assigned increasing levels of responsibility and decision-making authority. It is every team member’s duty to perform and behave within this organizational structure respectfully. Clinical care delivery and research team performance is optimized when every member of the team feels that their efforts and contributions are respected and valued. Mistakes and missteps are an inevitable part of neurosurgery training and represent opportunities to learn and improve. All Iowa Neurosurgery team members, particularly team leaders (faculty and residents) interact with colleagues in a constructive, respectful manner at all times. There are no “second class citizens” on the Iowa Neurosurgery team. All interactions, within and between all ranks of the hierarchy, must be courteous and considerate.

The University of Iowa is the only academic medical center in the State of Iowa, and Iowa usually ranks as having the lowest number of neurosurgeons per capita in the U.S. Vast numbers of patients are referred to us representing every disorder in the field of neurosurgery. Our Iowa patients are also civic minded and have great affection for the University of Iowa. This is reflected, for example, in volunteer accrual rates for clinical trials and research studies that are most often the highest in the country. It is the perfect environment for building academic neurosurgery clinical practices and patient-oriented research programs. It is also the perfect environment for residents to rapidly acquire the clinical skills they will need to be independent faculty neurosurgeons.

At the University of Iowa, surgical trainees have always been fully engaged in every aspect of patients’ clinical care. Institutional leaders, and the citizens of Iowa, understand that the quality of care is enhanced when talented trainees participate in, and have a sense of real ownership in the care of their patients. To a degree that is unusual for U.S. training programs, our neurosurgery residents are given autonomy and supervised authority for providing outstand clinical care. This enables trainees to be completely confident, and competent, when they transition to becoming faculty members. The Chief Residents, for example, have operational responsibility and authority for directing the inpatient service and surgical case lists with faculty oversight.  Our team scrub caps highlight these points.

It is extremely challenging to become a top tier neurosurgeon-scientist. To successfully pursue this career path trainees must have access to skilled mentorship, protected research time, and the opportunity to train with world-class scientists. We provide all these critical elements for our residents. As soon as a new resident matches into our program, we initiate a systematic research career planning and mentorship process. I have meetings with the residents each week where trainees take turns presenting their research plans and research updates. Feedback is provided and follow-up plans are implemented (e.g., I connect a resident with a key researcher in the resident’s field of interest). Each resident, with my assistance and the help of other faculty members, creates a customized plan for their two-year protected research training experience. Residents are not “placed” in laboratories. They create a plan that optimally matches their intellectual interests, aptitude, and plans for a future career as an academic neurosurgeon. During their two years of protected research training, they have access to all of the research resources they require in order to succeed. Many trainees choose to do their research in world-class laboratories outside of the UI Department of Neurosurgery if this is their best career goal interests. These include training experiences at other top tier U.S. universities. This approach has been highly successful over the years. Multiple residents have secured NIH Individual Research Service Awards (F32) during their residency, and a large number of graduates have gone on to become NIH funded investigators as faculty members.

During a resident’s R7 “super chief” year, each trainee has a 6-month elective block. This is fully funded and supported by the department and allows residents to pursue enriching clinical training experiences anywhere in the world. Residents have made full use of this valuable opportunity to acquire advanced neurosurgical skills, and life changing culture emersion experiences in countries ranging geographically from New Zealand, Australia, and Japan in the far east, to the Neatherlands, England, France and Germany in the west. Among other advantages, those distinctive experiences give them a “special edge” when competing for coveted neurosurgery faculty positions at elite academic medical centers across the country.

Iowa City is a beautiful, vibrant college community ideally suited for residents and their families. The cost of living is low, and residents are able to purchase homes in close proximity to the hospital and college campus. Many faculty and residents ride their bikes to work. There is no traffic (except on football game day!), and citizens and neighbors are kind, thoughtful and supportive of each other. 

The U.S. academic neurosurgery community is small and tightly interconnected. Faculty members and Department Chairmen have close and trusting personal relationships with colleagues in different departments across the country. Because of those relationships there is a high level of transparency about program characteristics and how well suited a graduating resident might be for an open faculty position. Programs are maximally motivated to recruit the best resident graduates possible onto their faculty, and the key decisions are made by experienced leaders who understand what characteristics and attributes are most important in a faculty recruit. In this “open market” for academic neurosurgery talent, Iowa graduates are star performers. Our graduates have secured coveted faculty positions in leading academic neurosurgery programs across the U.S., from the west coast (e.g., Stanford, UCSF) to the east (e.g., Penn, Duke, UVA, U. Pittsburgh, Dartmouth) and every place in between (e.g., U. Minnesota, Iowa, Northwestern, UAB, Indiana U.).  The most striking case example is the outstanding neurosurgery program at Ohio State University. They have recruited four of our graduates onto their faculty! In speaking with my fellow Department Chair colleagues across the country it is clear what attributes they value the most in our graduates: they are superbly trained, they are team oriented and respectful, and they fully embrace the PTS mindset and way of life. This makes them invaluable faculty members. 

For medical students who truly aspire to become academic neurosurgeons, nothing is more important than where you match for your neurosurgery residency. Individual talent, drive and intense motivation are required in order to become an academic neurosurgeon. But those personal attributes alone are insufficient to ensure success in this intensely competitive profession. You need expert coaching, and you need to train with a great team that prioritizes and invests in you as an individual. I encourage medical students to carry out exhaustive “due diligence” in accessing residency programs. This includes connecting with experienced faculty members, including former graduates of programs to seek their advice and insights. On site rotations are very valuable but are unavoidably limited in number. Here in Iowa, we welcome inquires, visits and rotating students. Best of luck on your professional journey!