Letter to the Editor. Neurosurgical residency abroad: chasing a dream in unknown lands

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  • 1 Medical-Surgical Research Center, University of Cartagena, Cartagena, Colombia; and
  • 2 Biomedical Research Center, University of Cartagena, Cartagena, Colombia
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TO THE EDITOR: We read with great interest the article by Morcos1 (Morcos JJ. Brief encounters that last a lifetime: an immigrant neurosurgeon’s reflections on American exceptionalism, George Floyd, sunlight, and race. J Neurosurg. 2020;133[5]:1612–1615). The author, through lived experiences, tries to make us aware of the importance that small moments play in the life of an immigrant professional, focusing on his devotion to the career of medicine as he crossed all the barriers that appear on that complex road. First of all, we want to thank the author for sharing such a moving anecdote, which will surely have a positive impact on all readers of this prestigious journal.

As stated in the article, every doctor has the fortune or misfortune (depending on the perspective) of experiencing such narrated events. These experiences do not necessarily have to be so traumatic and heartbreaking to have such a revealing effect. Some of the mentioned moments can overflow with happiness, gratitude, and well-being for those who live it, without the need for a drop of suffering or pain. And if we thought that injustices were left behind in the past, we are wrong, because, in 2020, George Floyd suffered the agony of begging for his life to a man who lacked mercy or compassion.1 There are then thousands of situations from which a positive message could be drawn, that have applicability in our medical exercise, with just having a little more empathy.

There are groups of people called “dreamers,” who have far greater aspirations than their present situation. A clear example of these people are the so-called international medical graduates,2 who go in search of unfamiliar lands that welcome them to carry out their residencies and promote their careers. It is these kinds of experiences that generate awareness about all the work that needs to be done to build a just and promising future for future generations that guarantees the best possible quality of life. All this to surpass themselves and to demonstrate that, despite any heartbreaking circumstance, the impetus is there to provide security and hope to those in need, as did that American marine, despite the discrimination and hatred to which he was subjected for not being a Lebanese citizen.1 That’s right; that marine of the unknown name was a dreamer who, without thinking it, inspired the story of another great dreamer, a neurosurgeon, who illuminates students, doctors, and specialists who in essence seek the same thing with his words: to pursue their dreams and discover their happy place and ideal profession.

In Latin America, a region with high rates of corruption and inequality in the world,3 this path becomes more difficult because there is no solid support from the state for those who do not belong to a good socioeconomic class and cannot access a university that has active agreements for international exchanges and internships. Likewise, there are still sociocultural barriers such as scientific racism, where opportunities are overshadowed by the fact of not belonging to societies of reputation or being from distant places where one aspires to participate, wasting the scientific potential of those professionals.

There are obstacles that will have to be overcome, such as the economic gap, the admission of dreamers, the government policies of the elected country and the institutional policies of a university, and the time limit, among many others,4 but, for a dreamer, these difficulties will not be greater than their aspirations. On the contrary, they will be an opportunity to better prepare for the competition.

Those of us who are looking for a neurosurgical residency abroad, looking for a better quality of life and preparation under reconnaissance tutors, hope that many of these barriers will disappear to facilitate this process and so that we can have the opportunity to demonstrate that from anywhere in the world, medical-scientific potential can be found.

Disclosures

The authors report no conflict of interest.

References

  • 1

    Morcos JJ. Brief encounters that last a lifetime: an immigrant neurosurgeon’s reflections on American exceptionalism, George Floyd, sunlight, and race. J Neurosurg. 2020;133(5):16121615.

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  • 2

    Kuczewski MG, Brubaker L. Medical education for “Dreamers”: barriers and opportunities for undocumented immigrants. Acad Med. 2014;89(12):15931598.

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  • 3

    Pring C, Vrushi J. Global corruption barometer: Latin America & the Caribbean 2019—citizens’ views and opinions of corruption. Transparency International. Accessed January 26, 2021. https://www.transparency.org/en/publications/global-corruption-barometer-latin-america-and-the-caribbean-2019#

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  • 4

    Berns JS, Ghosn M, Altamirano RR. International medical graduates in nephrology: roles, rules, and future risks. Am J Kidney Dis. 2018;72(1):113117.

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  • University of Miami, FL

Response

I thank the authors very much for their interest in my nontraditional publication. It was borne from the unsettling socioeconomic times our nation is facing. I am delighted that it also inspired the authors to extend the theme of my essay and include their own reflections about what it means to be a dreamer on the global neurosurgical stage. Inequities with regard to access to a quality neurosurgical education abound everywhere in our world and permeate every level: race, gender, ethnicity, religion, and economical and geographical factors, among others. Our global community of 50,000 neurosurgeons has been quite adept at describing the problems but is not very well equipped at solving them. To solve them, a true and highly complex multidisciplinary approach is needed, one that relies on the buy-in and coordination of nations, governments, and institutions as well as the corpus of neurosurgery: not an easy task.

Neurosurgery remains the “queen of the surgical disciplines” as far as I am concerned. We seem to live in a time where some of my generation find it trendy to perhaps prejudge those young millennial medical students that are said to be attracted to softer paths in life; whose souls some say lack the “right stuff,” the grit and focus that surely define the quintessential neurosurgeon of yesteryears. To those skeptics who would like to believe that the generational gap has doomed the future of neurosurgery, I say look no further than the makeup of candidates for neurosurgical residency positions today. It never ceases to amaze me how more driven, brilliant, and accomplished each match group is, year after year. Competition for residency training positions in the US is fiercer than ever, because the talent pool is stronger than ever. Yes, indeed, “foreign graduates”—like my former self at one time—still face today an enormous figurative wall. It may feel unfair, as it certainly did when I faced it, but it is entirely understandable. It is not a wall of discrimination but a wall of opportunity. To the high jumper, it will be just a pebble on the road, a stepping-stone to a future of great accomplishments.

I commend the authors for recognizing that indeed “these difficulties will not be greater than their aspirations.” But, unlike the authors, I do not wish that these barriers disappear. I only wish them to be equal-opportunity barriers, applicable, in different forms, and perhaps at different stages, to foreign and domestic applicants alike. Only then will we know that our mission as educators is being fulfilled, and that we have selected to train the best hearts and minds available today that will be equipped tomorrow to outshine their mentors and carry neurosurgery to a level unimaginable to their teachers’ generation.

I look forward to one day seeing the authors, in their personal quest to follow their dreams, on top of that wall. They will love the landscape from there. When I do, I will remind them that dreaming is not a prerogative of the young. In fact, like a heartbeat, it never ceases in a fulfilled mind, and a mind that stops dreaming is a spirit that dies. They will in time realize that dreaming is not a temporary means to an end, but a way of life. It is a good thing, when done well. But they do not need to take it from me. A much more eloquent writer said it:

I prefer to be a dreamer among the humblest, with visions to be realized, than lord among those without dreams and desires.

Gibran Khalil Gibran

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Contributor Notes

Correspondence Ivan Lozada-Martinez: ivandavidloma@gmail.com.

INCLUDE WHEN CITING Published online February 19, 2021; DOI: 10.3171/2020.11.JNS204112.

Disclosures The authors report no conflict of interest.

  • 1

    Morcos JJ. Brief encounters that last a lifetime: an immigrant neurosurgeon’s reflections on American exceptionalism, George Floyd, sunlight, and race. J Neurosurg. 2020;133(5):16121615.

    • Search Google Scholar
    • Export Citation
  • 2

    Kuczewski MG, Brubaker L. Medical education for “Dreamers”: barriers and opportunities for undocumented immigrants. Acad Med. 2014;89(12):15931598.

    • Search Google Scholar
    • Export Citation
  • 3

    Pring C, Vrushi J. Global corruption barometer: Latin America & the Caribbean 2019—citizens’ views and opinions of corruption. Transparency International. Accessed January 26, 2021. https://www.transparency.org/en/publications/global-corruption-barometer-latin-america-and-the-caribbean-2019#

    • Search Google Scholar
    • Export Citation
  • 4

    Berns JS, Ghosn M, Altamirano RR. International medical graduates in nephrology: roles, rules, and future risks. Am J Kidney Dis. 2018;72(1):113117.

    • Search Google Scholar
    • Export Citation

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