With studies revealing that nearly half of neurologists experience at least one symptom of burnout1,2 a special task force was launched in 2016 by the American Academy of Neurology (AAN) to research the problem. According to Sankar Bandyopadhyay, MD, associate professor of neurology, Penn State Health Milton S. Hershey Medical Center, “The first step in solving any problem, including burnout, is to recognize it. Physicians in general tend to deny, even to themselves, that they may be experiencing burnout.” Physician burnout is marked by feeling emotionally exhausted, being less empathetic with patients and being unsatisfied at work; in some cases there may be depression and substance use, abuse or addiction.3 The abbreviated Maslach Burnout Inventory is a validated self-administered questionnaire that identifies the presence and severity of burnout symptoms.4
Dr. Bandyopadhyay points out that there are evidence-based, proven interventions that those experiencing burnout can use to help themselves.5-7 “Maybe the most powerful of these is ‘mindfulness.’ It’s a strategy to reduce stress and re-frame how we think, to experience less frustration and boredom,” he says. In several trials with physician participants, formal mindfulness training significantly decreased depersonalization, emotional exhaustion and overall burnout scores.5-7 Continue reading
I looked at the clock. It showed 2:58 am. The ED hadn’t paged in 30 minutes. No calls from the floor either in at least 15. It was now or never. I hurried over to the refrigerator and threw my microwave dinner in to heat. Two minutes later, I heard the beep. My stomach was growling; I realized I hadn’t eaten anything in about 12 hours. Then, I realize the beeping wasn’t the microwave at all. BRAIN ATTACK arriving with ETA of 5 minutes…. I looked at the microwave and then the door and then back at the microwave. Shall I try to take a few bites before I run down to the ED? Do I bring it with me? Then, the pager goes off again, outside caller trying to reach an on-call doc. Forget it. I grabbed my laptop and ran to the ED to meet the incoming patient. No food, no water. I dial the outside line, “Neurology Emergency Line, this is the on-call doctor…” and my pager goes off a third time as I head down the steps…
Burnout (Noun): 1. The reduction of a fuel or substance to nothing through use or combustion. 2. Physical or mental collapse caused by overwork or stress.1
In January 2016, Penn State Children’s Hospital launched ‘Capable Kids,’ a care coordination program involving more than 200 patients. The program aims to better manage the complex medical needs of children with serious neurological diagnoses and reduce the burden on families. William Trescher, MD, division chief, pediatric neurology and president of the Child Neurology Foundation, says, “This idea stemmed from a Penn State Health Milton S. Hershey Medical Center retreat in 2014 when a number of clinicians from multiple specialties came together to explore ways to provide improved care for our patients and families.” Physicians, including those from pediatric gastroenterology, pulmonology, orthopedics and neurology, participate in the program, working together to address the needs of kids with very debilitating illnesses. Capable Kids is uniquely tailored to the needs and challenges of families in the surrounding community, which is largely rural or semi-rural. Continue reading
Over one million Americans are impacted with a primary autonomic system disorder, and the more common forms of these conditions include Postural Orthostatic Tachycardia Syndrome (POTS), Neurocardiogenic Syncope (NCS), Pure Autonomic Failure (PAF) and Multiple Systems Atrophy (MSA).1 In addition, seemingly vague symptoms such as unexplained palpitations, gastroparesis, orthostatic hypotension, syncope, flushing, unexplained sweating, abnormal nasal secretions or lachrymation, or sexual dysfunction can signal autonomic dysfunction (AD), especially in patients with diabetes. Other conditions commonly associated with AD are Parkinson’s disease and migraine. AD is often underdiagnosed or even dismissed, since patients may not recognize or report their symptoms, but early diagnosis of AD can be crucial. In diabetes patients in particular, AD has been shown to correlate with poor cardiovascular outcomes.2 Patients with any of these conditions who display symptoms of AD should receive testing, as this can show the severity of the dysfunction, indicate which body systems are involved, and direct a treatment plan.
Michael Sather, M.D., surgical director, Penn State Hershey Comprehensive Epilepsy Center, performing open surgery to place subdural electrodes directly on the surface of the brain with the ROSA™ system, which allows for precise placement of the relevant electrodes.
Technological improvements to both testing and treatment have revolutionized the field of epilepsy care in recent years. Clinicians seek to pinpoint the location of seizures to administer more targeted treatment. “There is a growing interest in identifying the seizure focus more precisely and noninvasively,” says Jayant Acharya, M.D., medical director, Penn State Hershey Comprehensive Epilepsy Center of Penn State Hershey Neuroscience Institute.
One example of this breakthrough technology is dense-array EEG, a noninvasive diagnostic technique that records electroencephalography with up to 256 electrodes versus standard techniques that typically employ 19-21 scalp electrodes.1 Past research has shown that information is lost unless EEG sampling provides an intersensor distance of no more than 2 cm, which would require 500 EEG channels distributed evenly over the head.2 This 256-channel sampling technology can approximate adequate spatial sampling and identify the precise area of neurological dysfunction.2 Acharya concludes, “In our setting, the most important feature is that it’s much more sensitive and specific in terms of localizing the seizure focus.” Continue reading
Neurosurgical practice has evolved greatly over the last decade, and has often been at the forefront of technological advancement.¹ Penn State Hershey Neuroscience Institute has increased its focus on fellowships and residencies to meet the growing demands of the field, including an increasing number of tumor resections and a trend towards coiling rather than clipping cerebral aneurysms.¹ Penn State Hershey features the largest number of fellowships in the country approved by CAST (Committee on Advanced Subspecialty Training, a committee of the Society of Neurological Surgeons).² Residents participate in a year of independent study, during which they may apply for one of the six CAST-accredited fellowships offered in peripheral nerve surgery, endovascular neurosurgery, functional neurosurgery, neuro-oncology, neurocritical care and spine surgery.² Continue reading
Penn State Hershey Neuroscience Institute, has a global perspective when it comes to providing quality, multi-disciplinary care. This is best represented by the Institute’s expansive global exchange program among neuroscience clinicians and researchers, spanning four continents. Every neurosurgical resident is given the opportunity to hone his or her skills abroad, and almost half choose to do so. The primary exchange program is with the Bureau of Public Health in Tianjin, China, a formal relationship that began in 2006. Through a grant funded by Integra Foundation, eight Penn State Hershey Medical Center faculty members have studied there, while thirty-four exchange students have learned alongside Penn State College of Medicine faculty.
The exchange program functions as part of a developing program to encourage collaboration between clinicians and researchers at Penn State Hershey Medical Center and Tianjin’s largest hospitals. These reciprocal relationships enable providers to share best practices and advanced technology to improve patient outcomes. From a clinical standpoint, foreign physicians can gain experience with virtually every neurosurgical procedure that is currently performed at Penn State Hershey Medical Center. In the research arena, groundbreaking studies are being conducted through the Center for Neural Engineering and Penn State Hershey Neurosurgery laboratory. Research is ongoing in neurodegenerative disease, brain iron deficiency, brain tumors, epilepsy, and brain-machine interfaces. Physicians from the US and China also collaborate on clinical trials, mutually benefiting with shared data from their genetically disparate populations. Continue reading
Robert Harbaugh, M.D., professor and chair of Penn State Department of Neurosurgery and director of Penn State Hershey Neuroscience Institute, encourages all members of his department to take an active role in the field. “One thing we encourage in our residency training, aside from the usual missions of education, patient care, and research, is involvement in organized neurosurgery.” As they train new residents, Penn State Hershey Neurosurgery faculty members also encourage younger physicians to pass on their knowledge and adopt a citizenship role in the field.
Harbaugh himself holds multiple leadership positions, including president of the Society of Neurological Surgeons. He previously served as immediate past president of the American Association of Neurological Surgeons and director and member of the Advisory Council of the American Board of Neurological Surgery. Harbaugh has traveled extensively to lecture on various topics, including his clinical specialty of cerebrovascular neurosurgery and his research work on computer modeling of intracranial aneurysms.
Robert E. Harbaugh, M.D., FAANS, FACS, FAHA
Director, Penn State Hershey Neuroscience Institute
Distinguished Professor and Chair, Department of Penn State Hershey Neurosurgery
Professor, Department of Engineering Science and Mechanics
RESIDENCY: Neurological Surgery, Dartmouth Hitchcock Medical Center
MEDICAL SCHOOL: Penn State College of Medicine