A History of Neurosurgery in Canada

Canadian Women in Neurosurgery: From Early Pioneers to World Leaders

BACKGROUND

Since the emergence of neurosurgery as a distinct specialty ∼100 years ago in Canada, it took >40 years for Canadian women to enter the field in the province of Quebec, and longer in the other provinces.

METHODS

We provide a historical overview of Canadian women in neurosurgery, from the early pioneers to the modern-day leaders and innovators in the field. We also define the current participation of women in Canadian neurosurgery. Chain-referral sampling, historical books, interviews, personal communications, and online resources were used as data sources.

RESULTS

Our historical review highlights the exceptional journey and unique experiences of female neurosurgeons, describes their achievements, and identifies career obstacles and enabling factors. We also incorporate comments from Canadian female neurosurgeons, both retired and in active practice, addressing gender inequities in the field, and provide advice and encouragement to the new generations to come. Despite the achievements of these female trailblazers, women represent a small proportion of the Canadian neurosurgery trainees and the active workforce, in stark contrast to the increasing number of women in medical school.

CONCLUSIONS

To the best of our knowledge, this study represents the first historical overview of female women neurosurgeons in Canada. Providing a historical context will help us to better understand the important role of women in modern neurosurgery, identify persistent gender issues in the field, and provide a vision for aspiring female neurosurgeons.

Wilder Penfield and Academic Neurosurgery in North America: 1934-1945

Wilder Penfield was appointed as Chair of McGill University's newly created Department of Neurology and Neurosurgery in 1930 and Director of the Montreal Neurological Institute (MNI) in 1933. The departmental structure allowed Penfield to develop his own research priorities, and the MNI's clinics and laboratories allowed residents to train in neurosurgery and in basic science under one roof. This paper reviews the research performed by neurosurgical residents under Penfield's direction from 1934 to 1945 and argues that their initiation to laboratory research contributed to the emergence of neuroscience following the Second World War.

Burr holes, bone flaps, and goose quills: Dr Frank Turnbull, Vancouver's first neurosurgeon

Dr Frank Turnbull was a pioneer neurosurgeon - the first neurosurgeon in Vancouver, Canada. He started his practice in 1933 after spending time during a neurosurgical 'residency' with Dr Kenneth Mackenzie, Canada's first neurosurgeon. Dr Turnbull practiced at a time when the perception of his speciality was dim, and the resources available to him were limited. However, Dr Turnbull overcame these obstacles, and two World Wars to help change the landscape of neurosurgery in the northwest Canada, and his career achievements also extend into medical politics and medical education. This paper documents the life and adventures of Dr Frank Turnbull, pioneer neurosurgeon.

Recent Trends in Neurosurgery Career Outcomes in Canada

BACKGROUND

As with other specialties, Royal College of Physicians and Surgeons of Canada (RCPSC) trainees in Neurosurgery have anecdotally had challenges securing full-time employment. This study presents the employment status, research pursuits, and fellowship choices of neurosurgery trainees in Canadian programs.

METHODS

RCPSC neurosurgery trainees (n = 143) who began their residency training between 1998 and 2008 were included in this study. Associations between year of residency completion, research pursuits, and fellowship choice with career outcomes were determined by Fisher's exact test (p < 0.05, statistical significance).

RESULTS

In 2015, 60% and 26% of neurosurgery trainees had permanent positions in Canada and the USA, respectively. Underemployment, defined as locum and clinical associate positions, pursuit of multiple unrelated fellowships, unemployment, and career change to non-surgical career, was 12% in 2015. The proportion of neurosurgery trainees who had been underemployed at some point within 5 years since residency completion was 20%. Pursuit of in-folded research (MSc, PhD, or non-degree research greater than 1 year) was significantly associated with obtaining full employment (94% vs. 73%, p = 0.011). However, fellowship training was not significantly associated with obtaining full employment (78% vs. 75%, p = 1.000).

CONCLUSIONS

Underemployment in neurosurgery has become a significant issue in Canada for various reasons. Pursuit of in-folded research, but not fellowship training, was associated with obtaining full employment.

History of neurosurgery at University of Toronto: the St. Michael's story

In this paper, the authors describe the history of neurosurgery at St. Michael's Hospital, University of Toronto. St. Michael's has long been regarded as one of the top teaching and research hospitals in Canada. A detailed literature review of published and unpublished works was performed to formulate a succinct but in-depth review of its development, successes, and challenges. This fascinating 125-year history serves as a reminder of the importance of their institution's origins, and the authors hope that it will be a useful guide for developing programs around the world.