• Equally at home discussing the molecular genetics of cavernous malformations or the history of philosophy and science, Issam Awad spearheads the Review and Update in Neuroscience for Neurosurgeons as Course Director, a position he has held since 1999. Under his leadership, the Course enrollment doubled. Dr. Awad is an inspiring lecturer and gifted moderator. Moreover, his charisma and down-to-earth interaction with the RUNN participants breathed life into the Course throughout the week. Dr. Awad was always to be found dining with RUNN students in the cafeteria or chatting after hours during the social gatherings. In this interview over lunch on the last day of the RUNN Course 2001 at Woods Hole, Dr. Awad elaborates on the history and philosophy of the Course:

    When was the first RUNN Course?

    The Course was started in 1982 by Dr. Henry Schmidek who was a professor of Neurosurgery at Harvard at that time. Dr. Schmidek had long been associated with neuroscientists at Woods Hole. He was very concerned that neurobiology was exploding in the 1980s way beyond the ability of neurosurgeons to keep up with it. He felt that in the 60s and 70s neurosurgeons still kept up with developments in neurobiology, but things were now getting out of hand. He thought there should be an opportunity for neurosurgeons to be immersed in a review of what had happened in the past year, hence the word research "update."

    Wasn't that in keeping with the tradition of early neurosurgeons such as Cushing who were neuroscientists?

    Yes! The neurosurgeons were the neuroscientists; the neuroscientists were usually either neurologists or neurosurgeons. But that tradition started to fade away with the increased complexity of clinical care and with the explosion of science and neurobiology, especially genomics, in the 60s and 70s. It became clear that neurosurgeons could not possibly keep up with everything that was developing in science. Dr. Schmidek felt that an update would be important, a research update in neuroscience for neurosurgeons (RUNN). He conceived of a 2-week course with 2-hour talks to provide depth rather than shallowness. He also came up with late evening social gatherings to discuss the activities of the day, as well as blocked time for library reading. (Those were the days before Medline and Pubmed, so that library was an indispensable physical resource of information.)

    .So that's how the Course started. Initially the RUNN Course was supported by the NIH and by registration fees. Soon the AANS started to work with Dr. Schmidek in sponsoring the Course and in arranging its administration and management. Among the people who were involved early on was Dr. Charles Hodge, who had been a RUNN Course faculty for many years and who became the next leader of the Course. Dr. Hodge's wife Cathy was the RUNN Course co-coordinator. (She started the tradition that the wife of the Course director was the one who handles the administrative work.) Originally, a joint committee of the AANS and the CNS called the "Joint Committee on Education" oversaw the Course. Under Dr. Hodge the Course remained 2 weeks, but the lectures were shortened to 90 minutes. Very heavy lobbying to program directors took place at that time. It soon became common knowledge among residency programs that the RUNN Course was a great resource for residents. The next director was Dr. Cordell Gross, who had been a faculty member and a co-director with Dr. Hodge. He and his wife Linda were the director and coordinator until 1998 when Dr. Gross developed metastatic cancer. I had been on the faculty since 1992 and was a co-director helping Dr. Hodge and Dr. Gross since 1996. The first Course that I was asked to direct was in 1999 and we put together the group of co-directors who remain: Ed Oldfield, Robert Dempsey, and Charles Hodge Allan Friedman, and Bruce Anderson. I asked my wife Kathy to coordinate it.

    I made several major changes in 1999. First, we asked the Society of Neurological Surgeons to assume the sponsorship of the Course instead of the AANS or CNS. That was very important since the Society of Neurological Surgeons, known as the "senior society," is the society of program directors. Hence, we put the Course directly under the auspices of the program directors themselves, instead of having to lobby to them from an outside organization. Second, I shortened the program to one week. Attendees and program directors alike had always been in favor of this change, but I had met with resistance from the co-directors in the past. Being in charge gives one the chance to make changes! We made it one week, and ever since that time the attendance has increased. We preserved the 90-minute lecture format because we didn't want the lectures to get short and shallow. In the one-week format we also added the evening lectures and we added emphasis on career development. We started to bring more speakers from the NIH to explain the career opportunities at the NIH. The attendance had actually been going down in the 1990s, which was a very serious concern. That was one of the reasons we changed the sponsorship and length of the program. We preserved the contribution of many of the senior faculty who had been around almost as early as the Course inception. you saw many of them here; Daniel Alkon ["Memory"] was one of them. They were in love with the Course believed in its principals. The rule I adopted for renewing faculty members was that as long as a faculty member received attendee evaluations of "excellent" or "very good" we would re-invite that individual. If an evaluation drops it opens up an opportunity for us to bring in a new person. We've started to bring in neurosurgeons to act as role models--people who are very successful in academic neurosurgery like Robert Friedlander and others--to show you how they did it.

    So originally RUNN faculty were mostly basic scientists?

    Yes, and mostly only very senior people at that. I was already a full professor before I was invited to come to give my first talk. But now we've changed all that and welcome people who only five or six years ago were sitting in those same [audience] chairs.

    And how does one decide as director what topics are appropriate?

    The co-directors and I have a review session where we look at topics that you guys [residents] generate on past evaluations, but quite frankly you guys [residents] don't really know that much about what's going on out there so we also talk among each other about what may be important issues, such as signaling, stem cells, apoptosis, etc. Some things are standard each year; other things go out of fashion. For example, we used to have talks on chaos theory and the EEG, now instead we have talks on functional MRI and cortical reorganization. When we think of a topic, we ask who would be the very best person to talk about it. We then toss around the names of both neurosurgeons and non-neurosurgeons.

    Some residents might read the RUNN Course description and think that it might make for a good Board review.

    It is not a board review. I tell people that it is could be a good chance to study for the Boards if you want to use some of the reading time for that purpose, but this is not what the RUNN Course is all about. First of all, it is about updating you on what is going on in neuroscience and on developments in neurobiology that can affect neurosurgical diseases. That way, you understand what's going on in science. Second, the Course develops scientific literacy. You may choose at some point in your life to delve more into topics that are presented and apply them within your career. If not, then at least you can better understand the scientific underpinnings of an article as you read it. The third real objective is to help you explore your own research involvement: if you have already done research, you can ask yourself the question, "Did I do it well, did I not do it well, and how can I do it better next time?" If you haven't done research, this gives you a good chance to start planning it.

    Do you think there is a best time for a resident in his residency training to participate in the Course?

    We would like the residents to come here before they take their long block of research time, but as you know, this is highly variable among programs. It is probably best that residents attend the RUNN Course before they waste a lot of time on research that's not focused. A lot of people think they know what they want to do but then they go into it in a very shallow way and they lose a lot of time.

    Most residency programs have some research going on at their respective institutions. What advantage comes with participation in the RUNN Course?

    This course is all about breaking down insularity; it's about opening things up. Every time I come here I learn five or six new things that I had no clue about. When I go back to my practice and to my teaching, my mind is more open about things; I can evoke analogies and connections that I didn't know existed before.

    Looking toward the future, what is the ideal size for the Course?

    I think that as long as we have more than fifty the Course is very healthy; there is a critical mass of people to ask questions (or if a few decide to take the afternoon off then there is not the situation where someone comes to talk and no one attends the lecture!) The numbers from the mid-eighties fluctuated around 40 residents. Toward the mid-nineties the numbers were going down.we had a year with only 34 people. We were very concerned that the Course would not survive under those conditions. Since we've restructured it in the past three years we've been increasing. This year we had 64 registrants. Now, if we had one registrant from each program, that would put us at about 112 and I don't think we can accommodate that; I think around 80 would be very good.

    The interview ended as the cafeteria closed and attendees made their way back to the lecture hall to hear the penultimate lecture "Signaling Pathways and Neural Cell Fate" by Murat Gunel of Yale (and a recent RUNN graduate). As the Course drew to a close, Dr. Awad's charge to the participants rang clear: "Do science. Do good science. Be a multi-dimensional person. Go for it. Do not make excuses."

     

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