Seventy-five years of neurosurgery residency training at The Mount Sinai Hospital

Matthew T. Carr Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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Jeffrey H. Zimering Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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Jillian M. Beroza Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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Alyssa Melillo Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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Christopher P. Kellner Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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J Mocco Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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Kalmon D. Post Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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Joshua B. Bederson Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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Raj K. Shrivastava Department of Neurosurgery, The Mount Sinai Hospital, New York, New York

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The Department of Neurosurgery’s residency program at The Mount Sinai Hospital was founded in 1946. The department has its origins in 1914 as a division of general surgery, with Charles Elsberg at the helm. Neurosurgery then became a separate department in 1932 under the leadership of Ira Cohen. Dr. Cohen oversaw the creation of the neurosurgery residency training program 75 years ago. Since its inception, the residency program has graduated 120 residents. For more than 100 years, The Mount Sinai Hospital has been a site of clinical excellence, groundbreaking research, and technological innovation in neurosurgery. Currently, the Department of Neurosurgery has 39 clinical faculty members, performs more than 5300 surgeries and endovascular procedures annually, and is in the top 25 neurosurgical departments for NIH funding.

ABBREVIATIONS

ACGME = Accreditation Council for Graduate Medical Education; APP = advanced practice provider; NEMAT = Neuroemergencies Management and Transfers; PRF = preresidency fellow; UCSF = University of California, San Francisco.

The Department of Neurosurgery’s residency program at The Mount Sinai Hospital was founded in 1946. The department has its origins in 1914 as a division of general surgery, with Charles Elsberg at the helm. Neurosurgery then became a separate department in 1932 under the leadership of Ira Cohen. Dr. Cohen oversaw the creation of the neurosurgery residency training program 75 years ago. Since its inception, the residency program has graduated 120 residents. For more than 100 years, The Mount Sinai Hospital has been a site of clinical excellence, groundbreaking research, and technological innovation in neurosurgery. Currently, the Department of Neurosurgery has 39 clinical faculty members, performs more than 5300 surgeries and endovascular procedures annually, and is in the top 25 neurosurgical departments for NIH funding.

In Brief

This paper highlights the history of the Department of Neurosurgery and the residency training program at The Mount Sinai Hospital. The evolution of the department and residency program over time is described, as well as key figures who shaped neurosurgery at The Mount Sinai Hospital and as a field. There is much to celebrate and learn from the department's storied history.

Neurosurgery at The Mount Sinai Hospital has a long history, predating the establishment of neurosurgery as a distinct subspecialty. Neurosurgery residency at The Mount Sinai Hospital started in 1946, marking 2021 as the 75th anniversary of the residency training program. The program has graduated 120 residents, many of whom have gone on to be leaders in the field of neurosurgery. The objective of this article was to highlight the history of the Department of Neurosurgery at The Mount Sinai Hospital, particularly with regard to the residency program, and to outline the current state of neurosurgery training at The Mount Sinai Hospital.

Early Years of Neurosurgery at The Mount Sinai Hospital

The Mount Sinai Hospital was incorporated on January 15, 1852, as "The Jews’ Hospital in New York" to serve the rapidly growing Jewish population in New York City. The name was subsequently changed to The Mount Sinai Hospital in 1866 to reflect the nonsectarian policy of patient care.1 On May 22, 1901, the cornerstone of a new hospital building was laid at the present address on 100th Street between Madison and Fifth Avenues.1

The beginnings of the neurosurgery service at The Mount Sinai Hospital can be traced to Dr. Charles A. Elsberg. Born in New York City in 1871, he graduated from the College of the City of New York in 1890 and from Columbia University College of Physicians and Surgeons in 1893. He completed his internship at The Mount Sinai Hospital, training alongside Dr. Ernest Sachs under Dr. Arpad Gerster. Dr. Gerster was a general surgeon with an interest in neurosurgery and was a pioneer in epilepsy surgery.1 Dr. Elsberg was promoted to attending surgeon in 1914.1,2

Also in 1914, the hospital’s board of directors designated ward beds for four surgical subspecialty services, one of which was neurosurgery to be led by Dr. Elsberg.1 The Mount Sinai Hospital was thus one of the first hospitals with a dedicated neurosurgical service.1 Dr. Elsberg would go on to be a founding member of the Society of Neurological Surgeons in 1920 alongside Dr. Cushing and Dr. Sachs. He served as the society’s third president from 1923 to 1925.3

Dr. Elsberg was one of the founders of the Neurological Institute of New York in 1909. In 1929, when the new building for the Neurological Institute was completed, Dr. Elsberg retired as head of neurosurgery at Mount Sinai to focus his efforts on the Neurological Institute, where he served as the first chairman of the Department of Neurosurgery until 1937.4,5

Dr. Harold Neuhof took charge of the neurosurgical service in 1929. He graduated with his medical degree from Columbia University in 1905 and completed his internship at The Mount Sinai Hospital. After World War I he returned to The Mount Sinai Hospital as an associate surgeon of Dr. Elsberg.6,7 His interests quickly turned to thoracic surgery, however. He became head of that division after the retirement of Dr. Howard Lilienthal, and would go on to pioneer in that field.6,8 In 1932 he passed on responsibility for neurosurgery to Dr. Ira Cohen.

Dr. Cohen (Fig. 1) then led as chief of the neurosurgical service. He lobbied for the establishment of a new Department of Neurosurgery, and served as its first chairman in 1932.9 A descendant of the original founders of the hospital, Dr. Cohen was born in Long Branch, New Jersey.1,2 He completed his undergraduate studies and medical school at Columbia University in 1909 and 1911, respectively. Dr. Cohen interned at The Mount Sinai Hospital from 1911 to 1914, and became an adjunct surgeon at the hospital in 1920.2

FIG. 1.
FIG. 1.

Dr. Ira Cohen, first chairman of the Department of Neurosurgery from 1932 to 1950. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY.

Creation of the Neurosurgery Residency Training Program

Dr. Cohen oversaw the beginning of the neurosurgical residency training program in 1946. The first neurosurgical resident was Dr. Aaron Beller, who became chairman of the Department of Neurosurgery at Hadassah Hospital in Israel shortly afterward.10 The second resident trained was Dr. Leonard Malis. Dr. Cohen would step down as chair in 1950, having trained the first two residents in the program’s history. He would be followed, briefly, by Dr. Sidney Gross as acting chairman, until Dr. Leo Davidoff become the new chairman in 1951.

Dr. Leo M. Davidoff was born in Latvia in 1898 and emigrated to Massachusetts as a child. He studied at Harvard Medical School, graduating in 1922. Dr. Davidoff completed his neurosurgical residency at the Peter Bent Brigham Hospital under Dr. Cushing in 1926, as the only Jewish neurosurgeon directly trained by Dr. Cushing.2,11 He served as president of the Society for Neurological Surgery from 1951 to 1952. In February of that same year, he was appointed chairman at The Mount Sinai Hospital. His stint at Mount Sinai was brief, and in 1955 he left to help found the Albert Einstein College of Medicine.

Dr. Sidney W. Gross (Fig. 2) was born in Cleveland in 1904. He received his medical degree from Case Western Reserve University in 1928 and completed neurosurgical residency at the Neurological Institute of New York from 1929 to 1931 under Dr. Elsberg. He also completed a fellowship at Washington University under Dr. Sachs.12,13 He started as an adjunct neurosurgeon at The Mount Sinai Hospital in 1938.

FIG. 2.
FIG. 2.

Dr. Sidney W. Gross, chairman from 1956 to 1970. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY.

After Dr. Davidoff left The Mount Sinai Hospital, Dr. Gross was appointed as chairman of the Department of Neurosurgery in 1956. That year saw the American Medical Association approve a 3-year neurosurgery residency training program, and in 1958 the program was expanded to 4 years. Neurosurgery residency typically followed a 3-year general surgery residency. The hospital neurosurgeons at that time were in private practice, with a small clinic for neurosurgery service patients. Starting in 1964, The Mount Sinai Hospital began an affiliation with Elmhurst Hospital in Queens. This rotation has remained a staple of the program. Neurosurgery residents rotating at Elmhurst are exposed to a high volume of neurotrauma and a diverse patient population different than that seen at The Mount Sinai Hospital. The neurosurgery residents also covered the neurosurgery service at the Veterans Affairs Hospital in the Bronx at that time. In 1968, the Mount Sinai School of Medicine enrolled its first class, bolstering the academic prowess of the institution. Dr. Gross would step down in 1970, making way for the appointment of Dr. Malis.9

Residency Training Under Leonard Malis, 1970–1991

Dr. Leonard I. Malis (Fig. 3) was born in Philadelphia in 1919. He was a graduate of the University of Virginia for college and medical school, graduating in 1943.13 He first completed residency training in neurology at The Mount Sinai Hospital under Dr. Israel Wechsler, before becoming the second neurosurgical resident under Dr. Cohen.2,14 Dr. Malis pursued a research fellowship in neurophysiology at Yale with Dr. John Fulton, before returning to Mount Sinai Hospital as an assistant attending in 1951 and establishing an electrophysiology research laboratory in the Department of Physics.14

FIG. 3.
FIG. 3.

Dr. Kalmon D. Post (left) and Dr. Leonard I. Malis (right). Dr. Malis served as chairman from 1970 to 1991. Dr. Post served as chairman from 1991 to 2008 and is current chairman emeritus. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

Dr. Malis was a surgical innovator and inventor, with some of his key developments being an automatic cassette changer for cerebral angiography and a bipolar coagulator (which was distinct from the invention of bipolar coagulating forceps by Dr. Greenwood in Houston).14,15 Perhaps most famously, he was a pioneer of microsurgery, using the first intraoperative microscope in a neurosurgical operation at The Mount Sinai Hospital in 1965 for a craniopharyngioma. This prompted him to shift his academic focus to the development of microneurosurgery (Fig. 4). He taught courses in microneurosurgery at The Mount Sinai Hospital from 1968 to 1975, the earliest of which were taught alongside Drs. Donaghy and Yasargil.2,16 He also served as editor of the journal Microsurgery.

FIG. 4.
FIG. 4.

Upper: Dr. Malis and his initial microscope. Lower: Dr. Bederson’s current microscope setup with augmented-reality overlay. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

Dr. Malis remained in private practice even as the hospital became more academic. He served as the program director, which was customary at the time (Table 1); a less formal educational structure existed in the program. Much of junior residency was spent watching the attending and senior residents operate, with a focus on observational learning.

TABLE 1.

List of program directors and assistant program directors in the Department of Neurosurgery at Mount Sinai

Years ActiveProgram DirectorAssistant Program Director
1970–1991Leonard Malis, MD
1992–2002Kalmon Post, MD
2002–2009Joshua Bederson, MD
2009–2014Aman Patel, MD
2014–2015Kalmon Post, MD
2015–2020J Mocco, MD, MSRaj Shrivastava, MD
2020–presentRaj Shrivastava, MDChristopher Kellner, MD

Prior to the formal residency match, Dr. Malis offered residency spots after candidate interviews. The focus on hiring was less on academic background and more on personal relationships. One early and persistent challenge in the department had been increasing diversity. Dr. Malis hired women and foreign medical graduates as residents at a time when the field was less diverse. This commitment to diversity continues in the program, and can be seen in the program’s alumni and faculty.

There was a focus on neuroradiology within the program, with morning conferences with neuroradiologist Dr. Yun Peng Huang to review angiograms, myelograms, and pneumoencephalograms. This focus on neuroradiology teaching and collaboration continues, with Dr. Thomas Naidich leading a biweekly neuroradiology conference.

The resident cohort remained two residents per year, and during Dr. Malis’s tenure the duration shifted from a 4-year training period to 7 years (including 1 year of general surgery internship). The residency had no ancillary help with advanced practice providers (APPs), and thus all tasks fell to the residents. There were no duty-hour restrictions, and hours often exceeded 80 per week. The smaller program with fewer neurosurgeons and patients led to a familial and collegial environment in the department.

Dr. Malis retired as chairman in July 1991. During his tenure, the Department of Neurosurgery experienced substantial growth. One neurosurgical operating room expanded to two, and the number of laboratories grew from one to eight.14 He authored more than 105 articles and book chapters throughout his illustrious career.16 The chairmanship of the Department of Neurosurgery is named in his honor.

The Modern Era of Residency Training

Dr. Kalmon D. Post (Fig. 3) was born in Brooklyn in 1942. He graduated from Columbia College and went on to complete his medical degree and residency training in neurosurgery under Dr. Joseph Ransohoff at New York University in 1975. His academic career began at Tufts University School of Medicine, before he headed to Columbia University in 1981 to serve as associate professor of neurosurgery and eventually to be promoted to professor and vice chair. In 1991, he was recruited to The Mount Sinai Hospital to serve as professor and chairman of the Department of Neurosurgery.9

Dr. Post expanded upon the legacy of excellence in skull base and microneurosurgery that started with Dr. Malis. He is best known for his surgical management and academic study of pituitary tumors, starting during his time at Tufts when he published a textbook titled The Pituitary Adenoma.17 He is also a professor in the Department of Medicine, earning an award for Endocrinologist of the Year from the Division of Endocrinology at Mount Sinai. He is president-elect of The Pituitary Society for 2022–2023. Dr. Post continues to serve on the review boards of Neurosurgery, Pituitary, World Neurosurgery, and Surgical Neurology International. He is an active researcher with 130 publications and more than 80 book chapters.

Dr. Post oversaw further expansion of the department in clinical workload and research productivity. The department performed approximately 500 operations in 1990 just prior to his arrival; that number swelled to more than 1300 annually by 2002. He was also responsible for developing subspecialization and recruiting faculty who would bolster the international reputation of the department across the breadth of neurosurgery, including Dr. Isabelle Germano, Dr. Joshua Bederson, Dr. Tanvir Choudhri, and Dr. Nirit Weiss. Dr. Bederson established the first basic science laboratory within the department, studying models of stroke and subarachnoid hemorrhage, and was the first faculty member to receive an NIH-R01 grant.

Dr. Post transitioned from chairman in 2008 but remains as professor and co-director of the Pituitary Center. Dr. Post oversaw the training of 70 neurosurgical residents while chairman and chairman emeritus. He served as the program director in 2014 prior to Dr. J Mocco’s tenure. He heralded an increased academic focus with a greater emphasis on resident research, and instituted a publication requirement for residents. He bolstered research productivity, and initially funded research laboratories from clinical practice until grants and industry funding became the primary source of revenue.

Dr. Joshua B. Bederson (Fig. 5) was promoted to chairman in 2008, becoming the sixth and current chair. He was born in The Mount Sinai Hospital in 1957 and grew up in the suburbs of New York City. He earned his undergraduate degree from Cornell University, where he was on the gymnastics team and was Ivy League all-around champion. He attended medical school at the University of California, San Francisco (UCSF). He took a year off from his medical studies to pursue his other passion, sculpture, and held a gallery show of his artwork in New York City before returning to UCSF to graduate in 1984. Dr. Bederson completed his neurosurgical residency training at UCSF under Dr. Charlie Wilson, and then a cerebrovascular fellowship at the Barrow Neurological Institute under Dr. Robert Spetzler. He received additional skull base and microsurgical training under Dr. Yasargil and Dr. Vinko Dolenc.

FIG. 5.
FIG. 5.

Dr. Joshua B. Bederson, present chairman since 2008. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

Dr. Bederson joined the department in 1992 as director of the cerebrovascular program. In 2001 he was promoted to vice chairman of the department, and in 2002 he began serving as residency program director, a position he would hold until 2009. Under Dr. Bederson the department has seen a boom in operative volume, research funding, and technological innovation (Table 2).

TABLE 2.

Operating room case volume, endovascular case volume, faculty publications, and US News & World Report ranking in the Department of Neurosurgery at Mount Sinai over the past 13 years

YearOR VolEndovascular VolUSNWR RankingFaculty Publications
200815821611
20091582168
201015152416
201115722225
201228202613
201328596662220
2014310110531565
20153262125214119
20163486153812146
20173233164016176
20183198189717238
20193356202514235
20202606181712315

OR = operating room; USNWR = US News & World Report.

Mount Sinai as an institution has grown tremendously over the past decade after the merger with Continuum Health Partners in 2013 to form the Mount Sinai Health System, now the largest in New York City.18 The footprint for the department now extends well beyond the Upper East Side. The department currently consists of 39 academic and clinical faculty, 14 neurosurgery residents, and 8 fellows in endovascular neurosurgery and neurocritical care. The department performed 3356 open neurosurgical cases in 2019, and an additional 2025 endovascular cases. The Mount Sinai Health System has steadily held 19% of the neurosurgery inpatient market share in New York City since 2016 according to the Department of Health Statewide Planning and Research Cooperative System. Residents cover The Mount Sinai Hospital, Mount Sinai West, and Elmhurst Hospital.

A steady increase in research funding and productivity has been a trend throughout the existence of the Icahn School of Medicine at Mount Sinai. In 2020, the Icahn School of Medicine ranked 15th in total NIH funding among US medical schools, and second in neurosciences funding. The Department of Neurosurgery is fortunate to have the globally recognized Friedman Brain Institute and a world-class Department of Neurology within the Icahn School of Medicine, with whom close clinical and research collaborations exist. A 2014 study found that the department at Mount Sinai was ranked 18th in cumulative h-index among US academic neurosurgery departments.19 In 2020 the Department of Neurosurgery ranked 24th in NIH funding, with $1.9 million.20 This is due to the work of clinicians and researchers such as Dr. Helen Mayberg, Dr. Hongyan Zou, Dr. Dolores Hambardzumyan, Dr. Hadjipanayis, and others.

Dr. Bederson has recruited world leaders in the field who are pushing the envelope of neurosurgery. The aforementioned Dr. Mayberg, the leading expert in deep brain stimulation for neuropsychiatric illness, is a professor of neurosurgery and works closely with Dr. Brian Kopell’s Center for Neuromodulation. Dr. Alejandro Berenstein, professor of neurosurgery and director of the pediatric cerebrovascular program, has advanced the field of interventional neuroradiology, and has been editor of the textbook Surgical Neuroangiography. Dr. J Mocco, director of the cerebrovascular center, currently serves as president of the Society of NeuroInterventional Surgery.

Neurosurgery, as a field, has seen tremendous advancements that have changed how we operate and the context in which we research. Surgical and technological innovation has remained a focus of the department since the days of Dr. Malis. In 2014, Dr. Bederson founded the Neurosurgery Simulation Core, now called Sinai Biodesign, to develop groundbreaking surgical technology. Dr. Bederson was the first neurosurgeon in the country to use an augmented-reality overlay of critical neurovascular structures during microsurgery.21 A current setup of Dr. Bederson’s operative microscope is shown in Fig. 4. Clinical instructor, endovascular fellowship graduate, and Director of Innovation Dr. Thomas Oxley has developed and implanted the first endovascular device allowing restoration of communication in paralyzed patients.22 A strong interest in artificial intelligence, fueled by residency graduate Dr. Eric Oermann, has led to advances in artificial intelligence applications for neurosurgery.23

The Department of Neurosurgery includes the division of Neurocritical Care. This allows for greater collaboration between neurocritical care physicians and neurosurgeons and is exemplified by the Neuroemergencies Management and Transfers (NEMAT) program. NEMAT permits rapid triage of neuroemergencies from within and outside the Mount Sinai Health System. Mount Sinai has seen great success with NEMAT, particularly for patients with intracerebral hemorrhage.24 The health system has designated centers of excellence for different pathologies to prioritize transfer and management. The department also boasts a fellowship in neurocritical care under the leadership of Dr. Alexandra Reynolds.

Other interdepartmental ties exist with the orthopedics, otolaryngology, neurology, and pediatrics departments, including faculty joint appointments. There are collaborations through initiatives such as the Pituitary Center and the Tisch Cancer Center, a National Cancer Institute–designated cancer center. The department also benefits from dedicated neurosurgical nursing, and The Mount Sinai Hospital has been awarded American Nursing Credentialing Center Magnet recognition multiple times.

The landscape of healthcare and neurosurgery in New York City and across the country has changed drastically over the past 20 years.25 A challenge within the department has been adapting to this changing healthcare environment and staying competitive in the ultracompetitive New York City market, which the department has achieved by persistently demonstrating clinical excellence and academic prowess. There exists great collegiality among the departments and residency programs in the metropolitan area, with the New York Society for Neurosurgery hosting annual resident research day, stump the professor night, and the Charles Elsberg Lecture. Mount Sinai has been intimately involved with the society, with Dr. Bederson serving as president in 2015–2016. Within the complex healthcare backdrop of the largest city in the US, Mount Sinai and its Department of Neurosurgery have demonstrated how to adapt and thrive in the increasing centralization of tertiary neurosurgical care. The department has instituted a hub-and-spoke model for neurosurgery. Much of the attitude in the department driving the culture of success stems from the broader desire within the field of neurosurgery to produce higher-impact research and patient-driven outcomes.26

Residency Program in Present Day

One constant for the department over the past 75 years has been the residency training program (Fig. 6). The training curriculum has evolved to adapt to Accreditation Council for Graduate Medical Education (ACGME) guidelines and embrace current surgical residency pedagogy. The learning model has switched from observational to intentional and purposeful learning under the ACGME core competencies and educational milestones.27 This switch in learning models is reflected in surgical cadaver labs and simulation sessions. Perhaps more drastically, the resident enrichment year has seen unique applications that have expanded the program’s footprint. Dr. Oermann spent 2 years with Verily, the life sciences division of Google. Dr. Ernest Barthélemy earned a master’s of public health at Harvard University as a Paul Farmer Global Surgery Fellow.

FIG. 6.
FIG. 6.

Residents and faculty at the 2019 Annual Neurosurgery Charity Softball Tournament. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

Among the more innovative changes in the residency program is the use of preresidency fellows (PRFs). PRFs are physicians interested in neurosurgery residency who gain operative, call, and academic neurosurgery experience while building their resumes and applying for residency. Many are foreign medical graduates working to gain clinical experience in the US prior to residency. The PRF system synergistically relieves some of the burden of call and nonoperative tasks from the junior residents, while granting crucial neurosurgery training to foreign medical graduates.

Another change to the curriculum has been Neurosurgery 2.0, a system where primary weekday in-house call duty is taken by APPs. This aids duty-hour compliance and continuity of care without call and postcall days, and allows residents more availability for research, academic study, and operative experience. This system also provides neurosurgical training to APPs. The 2.0 system, although it has been in existence for only a couple of years, has proven successful in increasing duty-hour compliance, case numbers, and research productivity. Dr. Raj Shrivastava has served as program director since 2020. His tenure has seen the implementation of a dedicated academic day for junior residents, to synergize with the goals of Neurosurgery 2.0 to facilitate education and research.

The department has increased focus on diversity efforts. Dr. Germano has stepped into the new role of vice chair for diversity and inclusion, and is former president of Women in Neurosurgery. Dr. Ian McNeill, a recent resident alumnus, founded the organization Doctors Reaching Minority Males Exploring Neuroscience, a summer mentorship program for Black and Latino high schoolers interested in studying neuroscience. Current resident Dr. Halima Tabani is among the first Muslim women wearing a hijab to be a neurosurgery resident in the US. The department has a long history of promoting diversity in neurosurgery, having trained 10 female neurosurgeons between 1964 and 2013, accounting for 2.6% of all female neurosurgery graduates from ACGME-accredited programs in that time.28

Conclusions

Neurosurgery at The Mount Sinai Hospital has an illustrious history in patient care, innovation, and training neurosurgical leaders. Neurosurgery has grown from a division within general surgery at a small hospital to a large department in one of the largest health systems in New York City. The year 2021 marks the 75th anniversary of residency training at The Mount Sinai Hospital. The program has continuously molded accomplished neurosurgeons through high clinical volume and access to cutting-edge neurosurgical research.

Addendum

After further reviewing our article, we want to add an addendum highlighting the myriad contributions of a diverse workforce to the success of the department and residency training program.

The Department of Neurosurgery at Mount Sinai has made a conscious effort over the years to bridge the gap in gender equality within the field of neurosurgery. The residency program has graduated 14 women, in addition to 2 women among the current resident cohort and 2 incoming female residents. Many of these alumnae have gone on to secure senior and leadership positions in neurosurgery. Dr. Jamie Ullman, graduate of 1996, is director of neurotrauma at North Shore University Hospital within the Northwell Health system and a past president of Women in Neurosurgery (WINS). Dr. Sharona Ben-Haim, graduate of 2015, is director of the Surgical Epilepsy Program at the University of California, San Diego, and is the current chair-elect of WINS. The accomplishments of female administrators and attendings in the Department of Neurosurgery are equally impressive. Angeles Delgado-Skerret has served as the residency program coordinator for over 10 years, and her incredible devotion and dedication are indispensable to all members of the department. Dr. Neha Dangayach, a neurocritical care specialist, is the co-director of the Neurosciences Intensive Care Unit at The Mount Sinai Hospital and established the Neuroemergencies Management and Transfers program for the entire Mount Sinai Health System. Dr. Johanna Fifi, a neurointerventionalist, is the co-director of the Pediatric Cerebrovascular Program and is recognized as a leader in the field of neuroendovascular surgery. She has served on the boards of two subspecialty societies, has led multicenter clinical trials, and has been chair of the national committee overseeing neuroendovascular fellowship program certifications for the Committee on Advanced Subspecialty Training/Society of Neurological Surgeons.

Dr. Isabelle M. Germano established the multidisciplinary brain tumor program at Mount Sinai, including the first neurosurgery laboratory in brain tumor basic/translational research as principal investigator of National Institutes of Health/National Cancer Institute (NIH/NCI) R01 grants. Her translational research on brain tumor has been funded by NIH/NCI, FDA, private foundations, and industry. She is recognized as a national leader in brain tumor neurosurgery for her many clinical and translational contributions. These include a nationwide first-in-human use of the optical digitizer to perform minimally invasive neurosurgical procedures and a first-in-human clinical trial in New York State using gene therapy for recurrent glioblastoma. Dr. Germano is the AANS/CNS Section on Tumors chair (2022–2024), the first woman since its establishment in 1984, and former president of the AANS/CNS Section on Women in Neurosurgery, the only faculty in the department to have served as chair of two AANS/CNS joint sections. She also served as the World Federation of Neurosurgical Societies chair for education and training for two terms (2017–2021) and is internationally recognized as a neurosurgery educator, having organized, directed, and/or served as an instructor for nearly 300 practical courses for neurosurgeons and trainees in the United States and abroad, and has published the book Neurosurgery and Global Health.29

The faculty, residents, and alumni of Mount Sinai Neurosurgery are heavily involved in promoting diversity and equality in neurosurgery, as evident by the significant number of high-impact academic publications exploring this topic. Dr. Germano and Dr. Ullman were authors on the landmark paper “The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery.”30 This study was pivotal in identifying barriers to the advancement of women within both academic and community-based neurosurgery and establishing a strategic plan for improving recruitment and retention. Dr. Ben-Haim is the senior author on the follow-up paper recently published in Neurosurgery, “Gender equality in neurosurgery and strategic goals toward a more balanced workforce,”31 which acknowledged the progress made and projected new benchmarks for the future. Dr. Ben-Haim also led the critical study “Pregnancy and parental leave among neurosurgeons and neurosurgical trainees.”32 Another study, “Racial and ethnical diversity within the neurosurgery resident and faculty workforce in the United States,” was conducted by several Mount Sinai medical students and residents, with Dr. Germano as senior author, and focused on identifying trends in racial and ethnic diversity.33 “Academic productivity of United States neurosurgeons trained abroad” is a study that examined the academic productivity of neurosurgeons with international medical or residency training.34 It was led by Mount Sinai medical students and residents, with Dr. Tanvir Choudhri as senior author.

Additionally, the department has been committed to training a diverse and international resident cohort since the establishment of the residency program. The first resident, Dr. Aaron Beller, was a Jewish immigrant from Poland who had been subjected to a concentration camp in Nazi Germany.10 Dr. Paul Teng, Dr. Yun Peng Huang, and Dr. Hang Byun soon followed. The residency training program's rich history of training neurosurgeons from underrepresented backgrounds continues with recent graduates Dr. Ian McNeill and Dr. Ernest Barthélemy, and current residents Dr. Alejandro Carrasquilla and Dr. Noah Nichols. Dr. Barthélemy is the cofounder of the Society of Haitian Neuroscientists and an emerging figure in global neurosurgery. He is completing a neurotrauma fellowship at University of California, San Francisco, and was recently recruited to the position of director of neurosurgery to re-establish academic neurosurgery at SUNY Downstate Medical Center in Brooklyn, New York. Since 2016, with the addition of the preresidency fellowship program, the department has made significant and successful contributions to inclusiveness in neurosurgery by providing international applicants a platform to launch careers in the field within the United States. Mount Sinai is committed to establishing a diverse training program that continues to foster and develop emerging leaders.

Acknowledgments

We are indebted to the librarians and staff of the Levy Library and Arthur H. Aufses, Jr. MD Archives at the Icahn School of Medicine at Mount Sinai—in particular Ms. Barbara Niss, Mr. Terrell Artis, and Mr. Edmund Jessup—for their support and historical recordkeeping. We also extend our gratitude to Hang Byun, MD, and Frank Moore, MD, for their primary historical accounts.

Disclosures

Dr. Mocco is a consultant for Cerebrotech, Viseon, Endostream, RIST, Synchron, Viz.ai, Perflow, and CVAid. He has direct stock ownership in Cerebrotech, Imperative Care, Endostream, Viseon, BlinkTBI, Myra Medical, Serenity, Vastrax, NTI, RIST, Viz.ai, Synchron, Radical, and Truvic.

Author Contributions

Conception and design: Shrivastava, Kellner. Acquisition of data: Carr, Zimering, Beroza, Melillo, Kellner. Analysis and interpretation of data: Carr, Zimering, Melillo, Kellner. Drafting the article: Shrivastava, Carr, Zimering. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Shrivastava. Administrative/technical/material support: Beroza, Melillo. Study supervision: Shrivastava, Bederson.

References

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    Hirsh J, Doherty B. The First Hundred Years of the Mount Sinai Hospital of New York, 1852-1952. Random House;1952.

  • 2

    Oppenheim JS. Neurosurgery at the Mount Sinai Hospital. J Neurosurg. 1994;80(5):935938.

  • 3

    The Society of Neurological Surgeons. The Society of Neurological Surgeons: An Historical Perspective. Accessed January 27, 2021. https://www.societyns.org/about/history-detail/historical-perspective

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Elsberg CA. The development of neurological surgery in New York City during the past twenty-five years: with remarks on advances due to experiences in the First World War. Bull N Y Acad Med. 1942;18(10):654664.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Quest DO, Pool JL. A history of the Neurological Institute of New York and its Department of Neurological Surgery. Neurosurgery. 1996;38(6):12321236.

  • 6

    Touroff AS, Aufses AH. Harold Neuhof 1884-1964. J Mt Sinai Hosp N Y. 1964;31(XIII):XIV.

  • 7

    Neuhof H. The treatment of craniocerebral wounds and its results. Ann Surg. 1920;72(5):556588.

  • 8

    Schweigert M, Dubecz A, Stadlhuber RJ, Stein HJ. Modern history of surgical management of lung abscess: from Harold Neuhof to current concepts. Ann Thorac Surg. 2011;92(6):22932297.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Aufses AH, Niss B. This House of Noble Deeds: The Mount Sinai Hospital, 1852-2002. New York University Press;2002.

  • 10

    Segal R, Shoshan Y, Israel Z, et al. Neurosurgery at the Hadassah-Hebrew University Medical Center in Jerusalem. Neurosurgery. 2005;56(5):11351148.

  • 11

    Ransohoff J. Leo M. Davidoff, 1898-1975. J Neurosurg. 1976;45(1):12.

  • 12

    Marti A. The early history of neurosurgery in New York. Mt Sinai J Med. 1997;64(3):155159.

  • 13

    Elsberg CA. The Story of a Hospital; The Neurological Institute of New York, 1909-1938. Paul B. Hoeber;1944.

  • 14

    Berman AJ. Leonard I. Malis. Surg Neurol. 1985;23(5):464467.

  • 15

    Malis JL. Technical contributions of Leonard I. Malis. Mt Sinai J Med. 1997;64(3):172181.

  • 16

    Camins MB, Moore FM, Carmel PW. Leonard I. Malis. 1919–2005: "a legend in his own time". J Neurosurg. 2006;104(2):332333.

  • 17

    Post KD, Jackson IMD, Reichlin S. The Pituitary Adenoma. Plenum Medical Book Co;1980.

  • 18

    Hartocollis A. 2 hospital networks agree to merge, raising specter of costlier care. New York Times Jul 17, 2013. Accessed January 27, 2021. https://www.nytimes.com/2013/07/17/nyregion/2-hospital-networks-agree-to-merge-raising-specter-of-costlier-care.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Khan NR, Thompson CJ, Taylor DR, et al. An analysis of publication productivity for 1225 academic neurosurgeons and 99 departments in the United States. J Neurosurg. 2014;120(3):746755.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Blue Ridge Institute for Medical Research. Ranking Tables of NIH Funding to US Medical Schools in 2020 as compiled by Robert Roskoski Jr. and Tristram G. Parslow. Accessed January 27, 2021. http://www.brimr.org/NIH_Awards/2020/default.htm

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Mascitelli JR, Schlachter L, Chartrain AG, et al. Navigation-linked heads-up display in intracranial surgery: early experience. Oper Neurosurg (Hagerstown). 2018;15(2):184193.

  • 22

    Oxley TJ, Yoo PE, Rind GS, et al. Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience. J Neurointerv Surg. 2021;13(2):102108.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Titano JJ, Badgeley M, Schefflein J, et al. Automated deep-neural-network surveillance of cranial images for acute neurologic events. Nat Med. 2018;24(9):13371341.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Kleitsch J, Nistal DA, Romano Spica N, et al. Interhospital transfer of intracerebral hemorrhage patients undergoing minimally invasive surgery: the experience of a New York City hospital system. World Neurosurg. 2021;148(e390):e395.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Benzil DL, Zusman EE. Defining the value of neurosurgery in the new healthcare era. Neurosurgery. 2017;80(4S):S23S27.

  • 26

    Asher AL, McCormick PC, Selden NR, Ghogawala Z, McGirt MJ. The National Neurosurgery Quality and Outcomes Database and NeuroPoint Alliance: rationale, development, and implementation. Neurosurg Focus. 2013;34(1):E2.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Edgar L, McLean S, Hogan SO, et al. The Milestones Guidebook. Accreditation Council for Graduate Medical Education; 2020.Accessed January 27, 2021. https://www.acgme.org/Portals/0/MilestonesGuidebook.pdf

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Renfrow JJ, Rodriguez A, Wilson TA, Germano IM, Abosch A, Wolfe SQ. Tracking career paths of women in neurosurgery. Neurosurgery. 2018;82(4):576582.

  • 29

    Germano IM, ed. Neurosurgery and Global Health. Springer; 2022.

  • 30

    Benzil DL, Abosch A, Germano IM, et al. The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. J Neurosurg. 2008;109(3):378386.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Plonsker JH, Benzil D, Air EL, Woodrow S, Stippler M, Ben-Haim S. Gender equality in neurosurgery and strategic goals toward a more balanced workforce. Neurosurgery. 2022;90(5):642647.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Gupta M, Reichl A, Diaz-Aguilar LD, et al. Pregnancy and parental leave among neurosurgeons and neurosurgical trainees. J Neurosurg. 2020;134(3):13251333.

  • 33

    Asfaw ZK, Soto E, Yaeger K, et al. Racial and ethnical diversity within the neurosurgery resident and faculty workforce in the United States. Neurosurgery. Published online April 8, 2022. doi:10.1227/neu.0000000000001920

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Li AY, Asfaw ZK, Kalagara R, et al. Academic productivity of United States neurosurgeons trained abroad. World Neurosurg. 2021;152:e567e575.

  • Collapse
  • Expand

Illustration from Xu et al. (pp 1418–1430). With permission from Juan Carlos Fernandez-Miranda and The Neurosurgical Atlas by Aaron Cohen-Gadol.

  • FIG. 1.

    Dr. Ira Cohen, first chairman of the Department of Neurosurgery from 1932 to 1950. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY.

  • FIG. 2.

    Dr. Sidney W. Gross, chairman from 1956 to 1970. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY.

  • FIG. 3.

    Dr. Kalmon D. Post (left) and Dr. Leonard I. Malis (right). Dr. Malis served as chairman from 1970 to 1991. Dr. Post served as chairman from 1991 to 2008 and is current chairman emeritus. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

  • FIG. 4.

    Upper: Dr. Malis and his initial microscope. Lower: Dr. Bederson’s current microscope setup with augmented-reality overlay. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

  • FIG. 5.

    Dr. Joshua B. Bederson, present chairman since 2008. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

  • FIG. 6.

    Residents and faculty at the 2019 Annual Neurosurgery Charity Softball Tournament. Courtesy of The Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine at Mount Sinai/Mount Sinai Health System, New York, NY. Figure is available in color online only.

  • 1

    Hirsh J, Doherty B. The First Hundred Years of the Mount Sinai Hospital of New York, 1852-1952. Random House;1952.

  • 2

    Oppenheim JS. Neurosurgery at the Mount Sinai Hospital. J Neurosurg. 1994;80(5):935938.

  • 3

    The Society of Neurological Surgeons. The Society of Neurological Surgeons: An Historical Perspective. Accessed January 27, 2021. https://www.societyns.org/about/history-detail/historical-perspective

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Elsberg CA. The development of neurological surgery in New York City during the past twenty-five years: with remarks on advances due to experiences in the First World War. Bull N Y Acad Med. 1942;18(10):654664.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Quest DO, Pool JL. A history of the Neurological Institute of New York and its Department of Neurological Surgery. Neurosurgery. 1996;38(6):12321236.

  • 6

    Touroff AS, Aufses AH. Harold Neuhof 1884-1964. J Mt Sinai Hosp N Y. 1964;31(XIII):XIV.

  • 7

    Neuhof H. The treatment of craniocerebral wounds and its results. Ann Surg. 1920;72(5):556588.

  • 8

    Schweigert M, Dubecz A, Stadlhuber RJ, Stein HJ. Modern history of surgical management of lung abscess: from Harold Neuhof to current concepts. Ann Thorac Surg. 2011;92(6):22932297.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Aufses AH, Niss B. This House of Noble Deeds: The Mount Sinai Hospital, 1852-2002. New York University Press;2002.

  • 10

    Segal R, Shoshan Y, Israel Z, et al. Neurosurgery at the Hadassah-Hebrew University Medical Center in Jerusalem. Neurosurgery. 2005;56(5):11351148.

  • 11

    Ransohoff J. Leo M. Davidoff, 1898-1975. J Neurosurg. 1976;45(1):12.

  • 12

    Marti A. The early history of neurosurgery in New York. Mt Sinai J Med. 1997;64(3):155159.

  • 13

    Elsberg CA. The Story of a Hospital; The Neurological Institute of New York, 1909-1938. Paul B. Hoeber;1944.

  • 14

    Berman AJ. Leonard I. Malis. Surg Neurol. 1985;23(5):464467.

  • 15

    Malis JL. Technical contributions of Leonard I. Malis. Mt Sinai J Med. 1997;64(3):172181.

  • 16

    Camins MB, Moore FM, Carmel PW. Leonard I. Malis. 1919–2005: "a legend in his own time". J Neurosurg. 2006;104(2):332333.

  • 17

    Post KD, Jackson IMD, Reichlin S. The Pituitary Adenoma. Plenum Medical Book Co;1980.

  • 18

    Hartocollis A. 2 hospital networks agree to merge, raising specter of costlier care. New York Times Jul 17, 2013. Accessed January 27, 2021. https://www.nytimes.com/2013/07/17/nyregion/2-hospital-networks-agree-to-merge-raising-specter-of-costlier-care.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Khan NR, Thompson CJ, Taylor DR, et al. An analysis of publication productivity for 1225 academic neurosurgeons and 99 departments in the United States. J Neurosurg. 2014;120(3):746755.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Blue Ridge Institute for Medical Research. Ranking Tables of NIH Funding to US Medical Schools in 2020 as compiled by Robert Roskoski Jr. and Tristram G. Parslow. Accessed January 27, 2021. http://www.brimr.org/NIH_Awards/2020/default.htm

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Mascitelli JR, Schlachter L, Chartrain AG, et al. Navigation-linked heads-up display in intracranial surgery: early experience. Oper Neurosurg (Hagerstown). 2018;15(2):184193.

  • 22

    Oxley TJ, Yoo PE, Rind GS, et al. Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience. J Neurointerv Surg. 2021;13(2):102108.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Titano JJ, Badgeley M, Schefflein J, et al. Automated deep-neural-network surveillance of cranial images for acute neurologic events. Nat Med. 2018;24(9):13371341.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Kleitsch J, Nistal DA, Romano Spica N, et al. Interhospital transfer of intracerebral hemorrhage patients undergoing minimally invasive surgery: the experience of a New York City hospital system. World Neurosurg. 2021;148(e390):e395.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Benzil DL, Zusman EE. Defining the value of neurosurgery in the new healthcare era. Neurosurgery. 2017;80(4S):S23S27.

  • 26

    Asher AL, McCormick PC, Selden NR, Ghogawala Z, McGirt MJ. The National Neurosurgery Quality and Outcomes Database and NeuroPoint Alliance: rationale, development, and implementation. Neurosurg Focus. 2013;34(1):E2.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Edgar L, McLean S, Hogan SO, et al. The Milestones Guidebook. Accreditation Council for Graduate Medical Education; 2020.Accessed January 27, 2021. https://www.acgme.org/Portals/0/MilestonesGuidebook.pdf

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Renfrow JJ, Rodriguez A, Wilson TA, Germano IM, Abosch A, Wolfe SQ. Tracking career paths of women in neurosurgery. Neurosurgery. 2018;82(4):576582.

  • 29

    Germano IM, ed. Neurosurgery and Global Health. Springer; 2022.

  • 30

    Benzil DL, Abosch A, Germano IM, et al. The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery. J Neurosurg. 2008;109(3):378386.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Plonsker JH, Benzil D, Air EL, Woodrow S, Stippler M, Ben-Haim S. Gender equality in neurosurgery and strategic goals toward a more balanced workforce. Neurosurgery. 2022;90(5):642647.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Gupta M, Reichl A, Diaz-Aguilar LD, et al. Pregnancy and parental leave among neurosurgeons and neurosurgical trainees. J Neurosurg. 2020;134(3):13251333.

  • 33

    Asfaw ZK, Soto E, Yaeger K, et al. Racial and ethnical diversity within the neurosurgery resident and faculty workforce in the United States. Neurosurgery. Published online April 8, 2022. doi:10.1227/neu.0000000000001920

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Li AY, Asfaw ZK, Kalagara R, et al. Academic productivity of United States neurosurgeons trained abroad. World Neurosurg. 2021;152:e567e575.

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