Neurology & Neurosurgery

Neurosurgery Chief Resident Breaks Down Sex-Based Barriers in Research, Career

May 25, 2022 - Eden McCleskey

In 2021, Dr. Amanda Jenson became the Houston Methodist neurosurgery training program's first female chief resident, six years after becoming its first female resident.

"I know, it's a little shocking," Dr. Jenson acknowledges. "But female neurosurgeons are severely underrepresented across the board."

Though more than 50% of U.S. medical students are female, women comprise only 12% of neurosurgery residents and 5% of practicing neurosurgeons certified by the American Board of Neurological Surgery (ABNS). According to the ABNS, only 25 full-time academic neurosurgeons in the U.S. are female.

Perhaps not coincidentally, it's the longest residency program in medicine. At seven years, it's a full four years longer than internal medicine and pediatrics, three years longer than OB/GYN and dermatology and two years longer than general surgery and orthopedics.

"I think the field attracts fewer women because of the long and challenging residency, in your prime years for starting a family," Dr. Jenson says. "But it seems like the trends are moving in the right direction. We went from zero women in our program to three in just a few years. Our residency program director, Dr. David Baskin, and department chairman, Dr. Gavin Britz, are driving efforts nationally to recruit more women into neurosurgery, creating a supportive environment for residents to pursue both personal and career goals."

As a proud mother of a nearly 1-year-old daughter, a leader of a nationally renowned residency program and a published author on a provocative new line of research involving glioblastoma, Dr. Jenson is doing her part to be a model of working mom success. Although her journey here has not been easy, it has helped reinforce her passion and purpose to make a difference in patients' lives.

She sat down with Leading Medicine to discuss what drew her to the field, how a personal tragedy impacted her work and why she donated her placenta to help uncover a mystery related to glioblastoma and sex cells.

Q: What was it about neurosurgery that attracted you in the first place?

It's a cliché, but I always knew I wanted to be a doctor. In college, some of my psychology classes really interested me, learning about neurotransmitters, action potentials, etc. I signed up for neuroscience classes and absolutely fell in love with the brain. I love that the more we learn about it, the more we realize we don't know. It's fascinating to me.

Then, in the third year of medical school, when you do all your rotations, I also fell in love with the operating room. Time flies when you're performing surgery. Even though you're standing on your feet all day and you can't even break to go to the bathroom, it's an adrenaline rush and it hooked me right away.

I didn't deliberately choose the most difficult path, it's just that it brought together my love of the brain and love of surgery and I couldn't see myself pursuing anything else.

Q: How did you get involved in the glioblastoma research?

I was pregnant during my fourth year of residency and, unfortunately, I had HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome. It's a life-threatening preeclampsia condition which required that I have an emergency c-section at 26 weeks. My son was only 1 lb., 4 oz., and he only lived a week.

After going through that, I needed a little space to recover mentally and physically. I had been looking up everything I could about HELLP syndrome. It's incredible how the body responds to being pregnant, the lengths it will go to protect the fetus. In my case, it went so far that it almost killed me.

Coincidentally, there was a researcher named Dr. Martyn Sharpe looking at this same thing, but in relation to glioblastoma. Dr. Baskin facilitated an opportunity to work in his laboratory with Dr. Sharpe and has been 100% supportive of my research efforts. Dr. Sharpe is so knowledgeable about glioblastoma that he can flip through a transcriptome database and recognize hundreds upon hundreds of gene markers by sight. He found some he didn't recognize, looked them up and found they're normally only seen in cells — fetal, placental and testicular — associated with reproduction. He developed a theory that maybe this was a tumor survival strategy: that it was signaling the immune system not to attack the cancer cells. The immune system, after all, is designed to attack foreign cells except when they're related to reproduction, when it starts protecting those cells to allow them to grow.

We started working on this research together because the timing and interest lined up. The findings were very convincing. The more reproductive markers found in the tumor, the faster the patient died. The cancer cells were camouflaged from the immune system and their body just let the tumor take over. It's pretty astounding that this connection hasn't been made before. I'm hoping it will turn out to be a real breakthrough in cancer research. I feel like there's a lot more going on there — we're just at the tip of the iceberg.

Q: How did donating your placenta tie into the study?

While I was working with Dr. Sharpe and Dr. Baskin on this research, I got pregnant again. I was able to make it to 34 weeks before signs of preeclampsia appeared. Chelsea was almost a full five pounds at birth. She was healthy and everything's been great.

I donated my placenta because one thing we need to do is prove that glioblastoma tumors are producing these placental and fetal markers. You can stain the placenta for different markers to show that they are the same as the ones being expressed in glioblastoma tumors. Before I joined the lab, Dr. Sharpe did the same thing with testicles. He used monkey testicles to identify the markers that were found in the tumors.

Q: So interesting! Will you be continuing this work?

I'd like to, but the next step in my career is to pursue a pediatric neurosurgery fellowship, my last year of training! After everything I went through when I lost my son, I feel like I want to save as many babies as I can. I've been in those parents' shoes, so I have empathy plus the skill set to help. There are a lot of exciting fetal procedures I'm interested in, like intrauterine tethered cord surgeries. Also, I still love tumors. There's a need for pediatric neurosurgeons who can safely remove tumors.

Q: Do you still want to be a role model for future female neurosurgeons?

Of course! When I'm an attending, I'd like to be a mentor and advocate and show that, yes, you can go into this physically and mentally demanding field, even if you are a woman. I think it's becoming more acceptable and more of the norm. It's okay to get pregnant and have kids. Hopefully it will help progress our field.

Believe it or not, people used to say to me, "Oh, you want to be a neurosurgeon instead of a mom?" It motivates me to prove them wrong. Since becoming a mom, I feel like I work even harder because I'm doing it for even more of a purpose.

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