Rutgers Neurosurgery: Training the Next Generation of Neurological Surgeons in the Diverse State of New Jersey

Author(s): Michael S. Rallo, B.S., Chandler Berke, B.S., Neil Majmundar, M.D., Hai Sun, M.D., Ph.D. 

Introduction to Rutgers Neurosurgery 
The Department of Neurological Surgery at New Jersey Medical School (NJMS) in Newark, NJ was founded by Dr. Peter W. Carmel under the auspices of the University of Medicine and Dentistry of New Jersey (UMDNJ). Under Dr. Carmel’s leadership from 1994 to 2009, New Jersey Medical School and University Hospital developed into a destination for individuals seeking neurosurgical care for their brain and spine maladies [1]. Following the official integration of UMDNJ and Rutgers in 2013, the Rutgers Department of Neurological Surgery was established and brought together the faculty and resources of NJMS in Newark and its sister institution, Robert Wood Johnson Medical School (RWJMS), in New Brunswick. The most recent merger of the Robert Wood Johnson Health Network, Saint Barnabas Health System, and Rutgers Biomedical and Health Sciences has created one of the largest health networks in the nation while expanding the Department’s reach throughout the State of NJ. Today, the Rutgers Department of Neurological Surgery boasts over 20 clinical and research faculty at three primary institutions with expertise across a range of neurosurgical subspecialties and scientific disciplines [2]. The wide breadth and diversity within the Department ensures that neurosurgical trainees receive the most comprehensive training possible. 
 
Structure of the Residency Program 
As of the 2021-2022 academic year, Rutgers is home to 18 neurosurgery residents and 3 fellows [3]. The program currently operates on a “2.5” model, alternating between 2 and 3 residents per year. Clinical training is at the core of the program with residents having the opportunity to train in all major subspecialties of neurosurgery utilizing the most advanced techniques and equipment. Throughout the academic year, Wednesdays are reserved for protected educational time including clinical didactics, outpatient clinics, research workshops, journal clubs, and academic projects. During the summer, this time is typically spent performing cadaveric dissections and engaging in practical skills simulations [4]. 
 
Achieving Clinical Excellence Across Three Unique Practice Environments  
Through its partnership with the RWJBarnabas Health System, Rutgers Neurosurgery provides clinical services at three distinct training sites. University Hospital (UH), historically the “epicenter” of the residency training program, is a major urban facility located in Newark, NJ. As a Level 1 trauma center and home to an exclusive twelve-bed neurosurgical intensive care unit, UH serves as the premier site for resident training in neurotrauma and critical care. In addition, UH is a designated comprehensive stroke center providing excellent exposure to a variety of emergent and elective cerebrovascular cases [5]. Robert Wood Johnson University Hospital (RWJUH) is the 624-bed academic flagship of the RWJBarnabas system which is based on the vibrant Rutgers - New Brunswick campus [6]. This campus is home to the National Cancer Institute (NCI)-designated Cancer Institute of New Jersey (CINJ) which brings together expertise in neurosurgery, neuro-oncology, radiation oncology, and basic/clinical research. In addition, the CINJ-based gamma knife suite offers opportunities for resident involvement in stereotactic radiosurgery [7]. As a level 1 trauma and comprehensive stroke center, RWJUH provides residents with additional exposure to the evaluation and management of patients with neurotrauma and cerebrovascular disease. A state-of-the-art neurological intensive care unit managed by a dedicated team of neuro-intensivists ensures that neurosurgical patients receive the highest quality and most up-to-date perioperative care. In addition, the neurosurgical service at RWJUH is staffed by a phenomenal team of mid-level providers allowing even junior residents to spend much of their time in the operating room [6]. The Cooperman Barnabas Medical Center is a large suburban community hospital located in Livingston, NJ which features robust general neurosurgery, neuro-oncology, and neuro-endovascular programs [8]. 
 
While each of the three training sites has its own unique clinical focus and overall “feel”, they share a number of features including dedicated neurosurgical operating rooms and state-of-the-art resources. This affords residents the opportunity to engage in the delivery of neurosurgical care in a diversity of practice environments without compromising the quality of care offered by a large academic system.  
 
Harnessing the Resources of a Major Research University to Develop the Next Generation of Neurosurgeon-Scientists  
Rutgers Neurosurgery has a storied history of excellence in the training of neurosurgeons across basic, translational, and clinical research disciplines. From the time he founded the Department in 1994, Dr. Carmel established an environment that fostered trainee and faculty research productivity resulting in the Department of Neurological Surgery becoming the school’s most prolific exporter of scientific research [9]. Today, faculty at Rutgers Neurosurgery are engaged in research spanning from epilepsy and neurostimulation to neurotrauma and neuropathic pain. Research training is overseen by Dr. Detlev Boison, the Vice Chair for Research and an esteemed neuroscientist specializing in adenosine biochemistry, and Dr. Hai Sun, the Assistant Director of Research and a distinguished neurosurgeon-scientist studying pathogenic mechanisms of epilepsy [10]. The Department of Neurological Surgery is home to a number of research laboratories including the Reynolds Family Spine Laboratory, directed by Dr. Stella Elkabes, which seeks to address issues related to spinal cord injury, such as neuropathic pain, and other paralytic ailments including multiple sclerosis [11]. A robust cancer program, led by Dr. Pankaj Agarwalla, seeks to elucidate the pathways underlying the tumorigenesis and metastasis and identify targets for novel therapies including immunotherapy [12]. Consistent with its strong cerebrovascular and endovascular surgery program, Rutgers faculty including Drs. Gaurav Gupta and Priyank Khandelwal have been major contributors to clinical research centered on stroke and other neurovascular diseases [13,14]. In addition to traditional laboratory-based and clinical research, Rutgers Neurosurgery faculty are involved in large-scale projects with the goal of directing public policy through the Health Outcomes, Policy, and Economics (HOPE) Center. These include projects involving optimization of healthcare delivery systems, determination of local and national outcomes and identification of areas for improvement, and modeling of healthcare economics and impact [15]. In addition to research within the Department, residents can take advantage of the incredible diversity of biomedical sciences laboratories across the Rutgers New Brunswick and Newark campuses. 
 
Education and involvement in research are considered a critical component of neurosurgical training and is integrated throughout the residency program. Wednesdays are dedicated academic days which permit residents the time to meet with faculty research mentors, develop and execute research methods, and prepare and review manuscripts. These academic days are supplemented by journal clubs, statistical methods workshops, and visiting professor lectures to provide structured education in critical appraisal of research literature and design of scientific projects [4]. The PGY-5 year provides residents with the opportunity to pursue dedicated research time in the laboratory or clinical setting. In the past, residents have also taken the opportunity to pursue advanced degrees such as Masters in Public Health [16]. In addition to developing their own research skills, Rutgers residents have been at the forefront of mentoring undergraduate, graduate, and medical students interested in neurosurgery. Project Neuron, an initiative started by residents Kevin Zhao, DO and Grant Arzumanov, DO, helps to connect these students with projects in need of assistance [17].  
 
Ensuring Resident Wellness 
One of the biggest strengths of the residency program is the camaraderie and cohesiveness among the team of residents. Put simply, the program boasts an excellent “espirit de corps”. In previous years, the program has organized numerous social events to promote resident bonding including hockey games at Prudential Center, hikes along the beautiful Appalachian trail, and book or movie nights at the chairman’s home. The Department has also regularly participated in the Annual Neurosurgery Charity Softball Tournament held nearby in New York City’s Central Park. Despite the many hours spent together at work, the residents regularly socialize with one another in their free time and truly emulate a “family spirit”.  
 
The program’s location in the heart of the New York Metro Area lends easy access to Manhattan, Philadelphia, the Poconos, the Jersey Highlands, and, of course, the Jersey Shore. Jersey City is one of the most popular locations for the residents to live as it provides proximity to both University Hospital in Newark and Cooperman Barnabas Medical Center in Livingston and is just a 40-minute drive down the Turnpike to RWJUH in New Brunswick. Jersey City also features a vibrant nightlife with restaurants of diverse cuisines and numerous bars and clubs [4]. 
 
Residency Outcomes and Opportunities for Further Training 
Residents graduating from the Rutgers Neurosurgery Program have gone on to become leaders in academic and private practice neurosurgery. There is currently a 50/50 split between residents pursuing private versus academic practice with an increasing trend toward academic appointments in recent years. The commitment of Rutgers Neurosurgery residents to academic achievement has been demonstrated by an increasing number of authored publications from the Department each year. In the academic year 2019-2020, residents were involved in a total of 245 projects resulting in over 200 publications and numerous conference presentations [4]. According to one recent report, Rutgers ranked 15th in the number of first author medical student publications in neurosurgery out of the 118 total neurosurgery programs assessed [18]. Involvement in organized neurosurgery is also encouraged with residents regularly attending national and local neurosurgery meetings such as those of the New York Society of Neurosurgery. Several residents, including the current PGY-7 Dr. Majmundar, have also been elected to serve on the Young Neurosurgeons Committee [19]. 
 
Subspecialization is also becoming more common with 66% of residents pursuing advanced fellowships including spine, neurosurgical oncology, and vascular. Several residents have also opted to pursue advanced training through enfolded fellowships during the PGY-5 year with recent examples including Neurocritical Care at Rutgers and Endovascular Neurosurgery at the Barrow Neurological Institute. Currently, the Department runs a CAST-accredited Endovascular Surgical Neuroradiology Fellowship Program run by Dr. Priyank Khandelwal. Fellows are trained at both NJMS-UH and RWJMS-RWJUH both of which are Comprehensive Stroke Centers with combined case volumes between 1,200 to 1,300 cases per year. Faculty include dual-trained neurosurgeons (Drs. Gaurav Gupta, Hai Sun, and Amit Singla), interventional neurologists (Drs. Priyank Khandelwal and Emad Nourollah-Zadeh), and interventional neuroradiologists (Dr. Sudipta Roychowdhury) [20].  
 
Conclusion 
In the heart of New Jersey, the Rutgers Neurosurgery Program trains residents to become proficient neurosurgeons prepared for independent practice or advanced fellowship training. By leveraging the extensive resources of a major research university, residents can tailor their educational experience beyond neurosurgery to become leading biomedical scientists, public health experts, or healthcare administrative leaders. The three distinct training sites through which Rutgers’ residents rotate ensure that graduates are prepared to excel in various practice environments ranging from local community hospitals to large academic centers. The comprehensive training and fostering community ensure that residents are prepared for wherever the next step of their career will take them.  
 
If you are interested in the Rutgers Neurosurgery Program, please feel free to browse our website (https://sites.rutgers.edu/rbhs-neurological-surgery/) and follow us on Twitter (@RUNeurosurgery) and Instagram (@rutgersneurosurgery).   
 
References 
1.    Miller T. Interview With Peter W. Carmel, MD, FAANS. AANS Neurosurgeon2017. 
2.    RBHS Neurological Surgery Faculty. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/type/njms/, 2022. 
3.    RBHS Neurological Surgery Residents. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/type/residents/, 2022. 
4.    Rutgers Department of Neurosurgery Residency Training Program. In:2020. 
5.    Neurosurgery at University Hospital. 2022; https://uhnj.org/specialized_services/neurosurgery/index.shtml, 2022. 
6.    RWJUH Clinical Neurosciences Center. 2022; https://www.rwjbh.org/rwj-university-hospital-new-brunswick/treatment-care/neurosciences/. Accessed 2022. 
7.    CINJ Neuro-Oncology Program. 2022; https://www.cinj.org/patient-care/neuro-oncology-program, 2022. 
8.    Brain Surgery at Cooperman Barnabas. 2022; https://www.rwjbh.org/saint-barnabas-medical-center/treatment-care/neurology-and-neurosurgical-services/department-of-neurosurgery/brain-surgery/, 2022. 
9.    Augentein S. Newark surgeon sworn in as president of the American Medical Association. NJ.com2011. 
10.    Research Overview. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/research-overview/, 2022. 
11.    The Reynolds Family Spine Laboratory. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/research-overview/tim-reynolds-spine-research-center/, 2022. 
12.    Cancer Research. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/research-overview/cancer-research/, 2022. 
13.    Cerebral Vascular Computational Laboratory. 2022; https://njms.rutgers.edu/departments/neurosurgery/cerebral_vascular.php, 2022. 
14.    Cerebrovascular and Endovascular Neurosurgery Center. 2022; https://rutgershealth.org/services/neurosurgery/cerebrovascular-and-endovascular-neurosurgery-center, 2022. 
15.    Rutgers Neurosurgery Health Outcomes, Policy, and Economics (H.O.P.E.) Center. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/research-overview/h-o-p-e-center/, 2022. 
16.    Research Education. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/research-education/, 2022. 
17.    Project Neuron. 2022; https://projectneuron.com/about-us/, 2022. 
18.    Price G, Lakomkin N, Kamat S, Baron RB, Scherschinski L, Hadjipanayis C. Medical Student Publications in Neurosurgery: At Which U.S. Academic Institutions Do Medical Students Publish Most? World Neurosurg. 2021;147:181-189 e181. 
19.    Young Neurosurgeons Committee. 2022; https://www.aans.org/en/Trainees/Young-Neurosurgeons-Committee, 2022. 
20.    Neuroendovascular Surgery Fellowship Program. 2022; https://sites.rutgers.edu/rbhs-neurological-surgery/fellowship-training-program/, 2022. 

Conflicts of Interest: The authors report no conflicts of interest concerning the material or methods used to develop this manuscript.

Acknowledgements: No acknowledgements

Editor(s)
Gretchen M. Koller, BS
Co-Editor-In-Chief

Brain & Spine Report
Medical Student Neurosurgery Training Center