♪♪ >> Make a choice to begin anywhere in your life, and the next chapter of your journey has begun.

And along the way, be open to being inspired.

Listen to the conversations led by Dr.

Wayne A.I.

Frederick Howard University interim president, president emeritus, and Charles R. Drew, professor of surgery.

On "The Journey".

♪♪ >> Hello and welcome to "The Journey".

I'm Dr.

Wayne Frederick.

Today we're talking about the future of medicine and more importantly, the people we are preparing to lead it.

Training the next generation of physicians is about far more than mastering science and clinical technique.

It is also about learning how to listen to patients, understand families and communities, embrace innovation, and deliver care with compassion and purpose.

Joining me today is Dr.

Noor Malik, clinical assistant professor of neurosurgery at Howard University Hospital and Howard University College of Medicine.

Dr.

Malik is a neurosurgeon, educator, mentor, and researcher whose work gives her a unique perspective on how medicine is changing and what that means for the students and residents preparing to enter the profession.

Also joining us is Chris McGinley, an MD, PhD student at Howard University College of Medicine, whose research focuses on stroke recovery and brain repair.

As an aspiring neurosurgeon scientist, Chris brings the perspective of physician scientists in training as we explore how research, mentorship, and innovation are shaping the next generation of doctors.

We'll discuss the transition from college to medical school, the role of mentorship and hands-on clinical training, advances in medicine and technology, and how we ensure that innovation ultimately improves the lives of the patients and communities we serve.

So welcome to both of you.

Dr.

Malik, let me start with you.

You know, my daughter is actually interested in becoming an orthopedic surgeon.

And I was discussing with someone just earlier today about how some of these fields are so male-dominated.

So let's start there.

What inspired you to get into neurosurgery, and what do you think of the landscape of being in such a male-dominated field?

>> Thank you very much for inviting us today here.

And I think the question you asked is something that I most of the time, asked by so many students and residents that how did you do it in a male-dominated field?

And talking about this, we now know that women are, they make very small number in neurosurgery.

If we talk about even the black Americans, less than 4%, even male Americans go into neurosurgery.

So don't even think about women, right?

So it was -- it was hard.

It was not easy, but I think you need to understand why one become a neurosurgeon.

It's a specialty, which is very gratifying.

When you see a patient walking after a traumatic injury, spinal cord injury.

And when you see the journey that a family has to take over with a patient with difficult diagnosis, it's very gratifying.

And when I was in med school, I really wanted to be a plastic surgeon.

And we did some rotation.

And I was -- during one of the rotation in neurosurgery, I was so fascinated just by looking at the brain itself and the neurosciences, you know, learning more the anatomy and everything.

It just built in with time over within me.

And getting into residency was hard.

I had to do so many things to get into there.

But I think once you are a neurosurgeon.

There is no going back.

I would never think that I will ever be able to do anything if I have given another life.

>> And maybe you can describe to our audience kind of what your path was, where you went to medical school, and then where you did your neurosurgery training.

>> So I was, I went to med school in Pakistan, at Hamdard University and after med school, I did an internship In Pakistan, we're supposed to do one year of internship to graduate.

So I did an internship in Aachen University Hospital, and I rotated through neurosurgery subspecialty.

This is where I started my journey actually, when I scrubbed in with my mentors who were still close to me during my residency time, as I said that I wanted to be a plastic surgeon.

And as an intern, you were supposed to go through different ORs and seeing different cases.

That's how when, you know, I started my internship and I felt like, you know, this is something that I want to do.

And then I did my training there at AKU.

I worked there for six years as a resident, later, followed by an instructorship year in which I did almost like 400 cases in a year.

So it was a rigorous training.

It was long hours, long cases, you know, away from family.

But it's just, you have to be very passionate about the field if you really want to pursue this career.

And after doing residency, I worked there for one year as a junior faculty.

And then I moved to United States and I did a fellowship at Children's Hospital Colorado in pediatric neurosurgery.

I spent a year there and I had lovely mentors.

They were amazing.

And during that time, I learned new techniques, like all, you know, intraoperative neuromonitoring, laser interstitial thermal therapy, and all these new techniques.

And then I moved to Children's Hospital.

Sick kids, sick children in Toronto, did one year of fellowship there.

And after which I actually wanted to specialize in brain tumors, both in pediatrics and adults.

So I was given an opportunity to do a neurosurgical oncology fellowship at Mayo Clinic Rochester.

And I spent a year there.

And that's how -- that was my journey.

>> Good.

>> Yeah.

>> Lots of training, obviously, lots of time, but I'm pretty sure time well spent.

So Chris, with that in mind, it's a long journey ahead of you.

We started a program here at Howard University a few years back.

It's now called the Karsh Stem Scholar Program.

Bruce and Martha Karsh, have donated to the program to make it possible.

It allows students to come in as freshmen and pick a track to become an MD, PhD, or PhD in a STEM field.

About 50% of the students are picking, choosing to do MD, PhD.

I mentioned that because by our calculation, we take about 30-some students a year.

If 15 or 17 continue to pursue this track, we believe in 10 years we may double or quadruple even the number of black MD, PhDs in the country.

As you know, there are not very many people doing that.

What was your influence and interest in doing an MD, PhD?

>> Yeah, for sure.

First off, thank you for having me on here.

This is an incredible opportunity.

But ultimately, it really began from two things, really.

The first one was as I went from college and learning more about sciences and learning a little bit more about that.

I found this passion in neuroscience.

So that was the first thing.

And as I went on in my undergraduate years, I fell more and more in love with the subjects, especially neurodegenerative diseases.

And the second was actually my grandmother's diagnosis with cancer and leukemia.

She was my best friend growing up.

I had learned so many things from her.

We had so many great experiences and when she was diagnosed with leukemia, it was definitely devastating.

But one thing that I'm extremely beneficial for, and really changed the trajectory of what I wanted to pursue in life and what I wanted my passion to be was she got enrolled in a clinical trial.

And that clinical trial, I believe, had granted her more time.

And that time ultimately resulted in more memories that I was able to create with her and unforgettable -- unforgettable moments that I wouldn't probably have had otherwise.

And just seeing how she interacted with the physicians and just the possibility that that clinical trial had existed from just years of evidence and dedication towards finding a solution for these patients, was something that just really resonated with me and something I really wanted to turn into a passion of my own.

>> Well, my grandmother turned 102, this June, and so she and that's my closest relative.

Hopefully, my mom would see me and... But -- and so I understand how special a bond that is.

Now, the MD, PhD at Howard, you do two years and then you pursue the PhD portion.

Where are you on that journey?

>> That's correct.

So how Howard has it currently is a two, three, two format, or a two, four, two, depending on how much time you need for the PhD.

I'm currently in the PhD now.

I'm in my fifth year overall, third year of the PhD program.

And yeah, just looking to see how this year pans out and see if I might need an extra year or not.

>> And what is the focus of your research activity >> in the PhD program?

>> Yes.

So I look at stroke in Dr.

Byron Ford's lab and the Department of Anatomy in the College of Medicine.

And I look specifically at how does the brain repair itself after stroke?

What are some of the pathways that it does to help repair itself?

And what's really exciting is we're looking at a molecule that could be potentially used as a therapeutic to help the brain repair itself after stroke.

And the great thing is, is there's not really a lot available right now that's established to help the brain repair after stroke.

There's emergency treatments that are available and they're vast, like greatly important, but nothing to directly repair the brain after stroke.

The molecule that we're looking at seems like it can overcome the limitations of other similar therapies, and looks like it can help the brain repair itself after stroke.

So it's really exciting.

>> Yeah, that's very exciting.

The move from college to medical school is often a big transition.

You know, in college, there's some classes you can take where, you know, >> you could hang out all night.

>> Yeah.

>> And come and take your test.

And, you know, you'd probably do okay.

Medical school is a little bit different.

>> Absolutely.

>> What was your biggest transition going from college to medical school?

>> I love this question because it really reflects the growth that you go -- that medical students go through from college to medical school.

I think the biggest thing is the responsibility.

In college and undergrad, you learn facts, you apply them in a testing environment.

You take exams, and you try to get the best grades you can possibly get, build a strong application and hopefully get into medical school.

But in medical school, you still have a ton of science to learn.

You have to know diseases.

You have to know pathology, you have to know treatments.

But more importantly, you now start to realize that decisions that you make are not just for grades.

They're going to impact patients at some point, real patients and their loved ones.

So I think the responsibility definitely shifts.

>> Dr.

Malik, you know, to come back to you on the practice of neurosurgery today, there's obviously a lot happening with respect to technology in terms of how we approach these tumors.

Imaging is also a major factor as well.

I think you would agree your ability to actually see where tumor is, see what structures, you know, are around it.

I think imaging is vastly improved.

What are some of the changes you see down the pipeline that should interest and intrigue students to get into neurosurgery.

>> I think one of the major, innovative thing that I have seen over the years, even during my training too, is development of functional MRI.

And also, we are using, you know, Image-guided techniques to ablate tumor, to, you know, disrupt the blood-brain barriers, just like we are using laser interstitial thermal therapy in which we use the thermal energy to ablate the tumor to -- And this is also, this is done under MRI-guided, and also, as I said, use of functional MRI.

It will tell us like, you know, which area we are resecting.

And is it close to any eloquent brain, especially, you know, speech and motor areas.

So this is something which is interesting.

And I think during with the pipeline, I would also like to talk about focused ultrasound.

You know, nowadays people are using or, you know, when I was in Mayo, we had a trial and we enrolled patients in which we were using focused ultrasound to disrupt the blood-brain barriers, and especially in pediatrics, one of the pediatric tumors in which we disrupt blood-brain barriers to give chemotherapy to these children.

So I think, you know, the field is emerging.

It's very innovative, so yeah.

>> A lot of laypeople out there, maybe you can explain to them how the functional MRI works.

>> So in functional MRI, you ask patients to do the task.

Like you ask them to talk, to move their arms or legs.

And then this way it will increase the blood supply to that specific area of the brain.

And during the imaging that areas are picked up and you can see it later, you know, in the images like, okay, this is the right, you know, the frontal lobe is quite big.

So is the tumor actually affecting the area of the speech?

And not to forget that many people are bilingual and they can have multiple areas of speech too as well.

So you would like to save this special, you know, function of a human being when you are resecting the tumor.

And then nowadays, as the field is emerging, we used to make big incisions to resect all these big tumors.

Now the field has emerged so much that we try to cut as much vital tissue as we can and save functionality as much as we can.

So I think functional MRI is something that helps us a lot.

>> And, you know, as you mentioned, the field is changing in terms of the amount of surgery.

And I would say in the past, we would probably compromise some functionality for the sake of removing the tumor.

And we think of the bigger scope and obviously brain cancers, depending on the kind of brain cancer, you know, can have a devastating outcome.

What are some of the things that you think have improved the outcome outside of just the functional MRI and the surgery, the other types of treatments are getting any better?

>> So many trials recently.

I would like to talk about one of the trials, which is Indigo trial.

I think it was a game changer, which has recently approved by FDA for low-grade gliomas and low-grade gliomas, it affects young people.

And if you can find a specific type of, you know, lesion like, especially also development of genomics, you know, you can know that the biology of the tumor so well -- so much well that you can target that specific area.

And I think this -- talking about this trial, new therapeutic medication, new chemotherapy has developed, which is targeting these specific tumors.

So yes, besides imaging, you know, as I talked about focused ultrasound, I talked about laser interstitial thermal therapy.

And also the field is emerging from medication standpoint for new chemotherapeutic agents.

>> So when you look at the five-year survival for a patient with a high-grade brain tumor, what was it then and what is it today?

>> So yeah, I know we still have to do a lot of work for high-grade tumors.

There are trials which people which, I mean, it depends a lot about the biology of the tumor, to be honest.

So nowadays we use CSF and blood to look at the cell-free DNA in patients, you know, plasma as well as in CSF to find out whether they have a recurrence or not.

But to be honest, if you ask me that, as it changed significantly, I would say likely not, but it's a vast range.

Some patients, they can have great outcome and they can survive more than five years.

But for majority of patients, it's still for high-grade tumors, you know, the survival is not very great.

>> And so with that in mind, Chris, you're the next generation.

And what obviously we hope and want to see from you is that those outcomes are going to change.

>> Mm-hmm.

>> When you look back from elementary school, middle school, obviously your grandmother was a big influence, but what do you think of your science preparation that led you to what you eventually did in college and obviously now in med school?

But what about that, I would say, you know, between middle school and high school, which is where they say students often catch that bug.

What experiences you had that you think were instrumental in leading you here?

>> Yeah, yeah.

So ultimately, during that time period, so just for some context, I grew up in a single-parent household, and I was the oldest of three siblings.

So I spent a lot of time raising my siblings, and being able to spend time with them.

But it taught me a lot about patients.

And I started to realize the more that I interacted with my siblings, the more that I thought that I really liked patient care, the thought of patient care and being able to communicate with people and to instill any sort of advice or information I could to them.

And so I think that was something valuable that I learned.

And as I started to go from the younger years to high school to college, I got a job, I actually wanted to become a pharmacist at first.

And I started working in pharmacy at CVS pharmacy as a pharm tech.

And I realized that being there, it taught me a lot.

I got to connect with patients.

I heard so many fantastic stories.

And I have a lot of patients who I'm still friends with to this day.

And that was about seven years ago, and I still have very close bonds with them.

But what I learned was that I wanted to be a little bit more involved with the patient care.

And I think all the lessons that I've learned from, you know, being around my siblings, meeting those patients, being around my grandmom, especially, they taught me a very compassionate side of medicine and going through college helped me learn the science and the fundamentals, and the basis of diseases and everything like that, so that sort of led me to where I am today.

I hope I answered that question.

>> So for young people way closer to your age than mine, probably closer to both of your ages than mine, they often are very concerned about the length of time.

I remember when my daughter first started developing an interest in medicine.

She would ask me that question, I felt like every other week, you know, "Did you say 13 years or did you mean 12?"

I was like, "It was 13."

And I'm curious as to especially for neurosurgery.

And maybe you can explain this, especially the younger folks in the audience how long training is, you know, you're doing an MD, PhD, so you've added on even more time to it.

And then a neurosurgery residency, might be another 7 years or 9 years depending where you train.

So I'm curious as to if you could map that out.

And what's your perspective about the time?

How do you approach the daunting, what seems like a daunting amount of time?

>> Yeah, I smile because a lot of my friends, especially in medical school, have talked about this and they're basically saying like, "You're never going to become an attending."

And I'm sure Dr.

Malik has probably heard this >> at some point too.

>> Yeah.

>> But for me, I love being a student.

I have never seen the length to be an issue at all.

I love to learn.

This is the opportunity where I get to learn the most, that I'm going to be able to learn in one particular protected time period.

So I'm trying to maximize how much I can learn and how much I can accomplish in those times, but for the layout, so after high school, so I had four years of undergrad, and then after that, I took two gap years and then finally got in.

I knew that I wanted to pursue an MD, PhD.

MD, PhD, give or take is anywhere from about 7 to 9 years, depending on what your project is and sort of what your aims are and what you want to accomplish in that PhD and what questions you want to answer.

And then after that, you pursue a residency, which is usually seven years.

And then it can even be longer than that if you want to specialize and do something like a fellowship, which can be an extra one to two years, which admittedly, I do intend to do.

So a long, long time, but for me, I've never seen the length to be an issue.

It's something I'm extremely passionate about.

And honestly, to me, it's one of the best specialties in the world.

It's an extremely vulnerable population that you get to work with.

And someone, one of my mentors who used to be here at Howard taught me that, you know, the decisions that you make for these patients is often between bad and worse.

And so if I could give whatever amount of time that I can give to a patient to help them out in any sort of way, even if it's small, then it would mean all those years were worth it.

>> Yeah.

You know, 14 or 16 years can seem daunting.

But I think if you obsess about the journey, which is my philosophy as opposed to the destination, you know, I think you get yourself in the right groove.

You know, I ran the American Cancer Society as the CEO.

And one of the things I was daunting was having our workmates show up with diagnoses, and one of them in particular had shown up with a brain tumor.

And, you know, it was a very hectic weekend, as these things always seemed to happen on.

And, you know, getting him the care and so on was important to him.

And so far he's had a good outcome.

As you mentor students and you think about, you know, the next generation coming along, how do you look at, I would say, the art of medicine, the communication, techniques, being able to show compassion, but at the same time, you know, be realistic and pragmatic with families about how they prepare for, as Chris was saying, what may be bad or worse, you know, outcomes.

And how do you see your role in doing that for to teach students and residents?

>> I think -- I'm glad you asked this question.

And it is a very important question.

And I think it is, you know, it's as you said, it's a journey.

So it's a journey for students to when they come to med school, they learn this is not going to happen in a day or two.

So they learn with time that, you know, they come and see us.

How do we talk to our patients?

And it is very important that we teach our students that, you know, learning science and becoming an excellent physician is important, but it is equally important to be compassionate, empathetic, and know your patient.

You have to understand that this is not only a chart or a CT, or an MRI.

There's a person behind it.

There's a family, and there's a story behind it.

So this is something that they learn over time.

And it is a process.

And I told -- I tell them that you have to, in order to be an excellent physician or scientist, you have to be good learner.

And if you have time and you spend time with families, then you know that you know, all they care at the end is you are with them.

So for example, if in my case, if you know, neurosurgery is very, is challenging and oftentimes you do get complications too.

And, you know, if I have a patient and I see like, you know, the journey is going to be long and with severe traumatic brain injury or have a complication or anything.

I try to give them my own number.

You know, I be with the family in this time.

So, you know, they have to be a good listener.

>> You know, we usually close the show by asking this question, and I think it's probably suitable for both of you.

And that is why, Howard, for the young person who's listening and says they want to be the next Chris McGinley and come to Howard, pursue an MD, PhD, take 14 to 16 years before they feel like a real adult with a real job.

What's your message for why, Howard?

>> Definitely.

And it's sort of to piggyback off of what Dr.

Malik said.

But I think one thing Howard does exceptionally well is and you can see it in their mission statement, is the commitment to the underserved.

And they stick to that through and through.

And that's something that is emphasized from every single level to my peers, to my mentors, to the professors.

You see it in the hospital.

You see it in every single facet of Howard University College of Medicine.

And that's something that I've come to really love.

I came from an underserved community where it was very likely for an African American individual to be incarcerated than to achieve or obtain a bachelor's degree.

And so seeing this disparity, and to be at Howard and see it up front every single day is, is something that will stay with me forever.

And that's something that I deeply love about Howard and has taught me to really be a very, much more compassionate and understanding individual and to understand that people, what they go through on every day-to-day basis, it doesn't just stop in the clinic, it doesn't stop in the hospital.

It continues when they go home.

And the lessons I've learned from Howard, there are just things that have shaped me and sort of how I want to be as a future, hopefully, neurosurgeon.

>> Alright.

And Dr.

Malik, I mean, you've been all over the world.

You know, growing up in Pakistan, training there initially, and then coming to the US at some of the major institutions and Canada as well.

For you, why Howard?

>> I think, the mission is exactly the same.

You know, I came from Pakistan and I grew up in a very small area.

And I belong to a tribe, which is called Baloch.

And people are -- It's very impossible for women to grow in a Baluch community.

I should not be saying it's impossible because people -- because things are changing.

But it was hard.

And I think, Howard kind of resonated to my past.

So that is one of the reasons, you know, that I chose Howard, that, you know, we serve communities, which are underserved and they are very appreciative, the patients that we treat.

And I also believe that, you know, that we should not be -- We should not stop any conversation without not talking about the first neurosurgeon, you know, who came from Howard, the black neurosurgeon, Dr.

Green.

He was a Howard graduate, and he was not given an opportunity to be trained in the United States.

And he went to MNI in Canada.

So I think this is all like, we kind of resonate the same mission of Howard.

So that was one of my reason to choose Howard.

And...we continue to do our best.

>> Excellent.

Well, Dr.

Malik, we certainly appreciate you here at the university and the care that you're providing to the community.

And Chris, we look forward to your research.

Sounds like it could be very exciting.

And just as importantly, we look forward to you being a neurosurgeon as well.

And hopefully, somebody, not me, because by then there will be somebody else will be here to recruit you back to Howard.

>> Absolutely.

>> Thank you.

>> So, Dr.

Malik and Chris, thank you for joining us and for sharing your perspectives on how we prepare the next generation of physicians.

What we've heard today is that the future of medicine will be shaped not only by new technologies, new treatments, and new discoveries, but by how well we prepare physicians and physician scientists to connect these advances to the people and communities they serve.

At Howard, that responsibility has always been central to our mission, developing talented professionals who combine excellence with service, leadership and a commitment to improving lives.

As medicine continues to evolve, preparing physicians who are innovative, compassionate, adaptable and grounded in the needs of their patients will remain essential.

I'm Dr.

Wayne Frederick.

Please join me next time on "The Journey".

♪♪ And made possible by contributions from viewers like you.

For more information on this program or any other program, please visit our website at www.whut.org.

Thank you.