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JABSOM is spearheading an effort to recruit and train the next generation of neurosurgeons so the 1.45 million who live in the state can count on accessing this critical care for years to come.
Hawaiʻi has been grappling with a shortage of neurosurgeons for a while, as the number of practicing surgeons isn’t sufficient for the size of the state’s population. This often leaves patients with long wait times and many people living in the more remote parts of the state can’t access the care they need without travel and added expenses. And in a field where time can make a big difference in health outcomes, this reality presents a serious issue for the medical landscape in Hawaiʻi.
When Hawaiʻi native and JABSOM alumnus Thomas Noh, MD, returned to the island to join the faculty at JABSOM and practice neurosurgery himself, he recognized this problem – and knew that it was only going to get worse as the current group of neurosurgeons aged and retired. No new neurosurgeons from JABSOM had started practicing in Hawaiʻi during the seven years he was away for his residency and he wasn’t aware of any current students that had declared an interest in the field. With many of his colleagues nearing retirement, he knew something needed to change.
Training the Next Generation of Neurosurgeons
“It was very clear that if we didn't do something about this, I wasn't going to have any partners in the future and those living in Hawaiʻi weren’t going to have reliable access to neurosurgeons,” he said. “There was an opportunity, and a need, for JABSOM to build interest in the field and get more people excited about going into neurosurgery.”
Mentors were an important pillar of Noh’s training and education, so he developed an idea to offer more mentorship through JABSOM to help introduce students to neurosurgery – and to empower them with the skills and knowledge they’ll need to succeed in a competitive, and rigorous, field of medicine.
“One of Hawaiʻi's super powers is that we have incredibly bright, very motivated students who want to make Hawaiʻi their home,” he said. “If we can connect this pool of extremely qualified candidates with opportunities across neurosurgery, there’s hope that some of these students will get excited about it and want to build a career in Hawaiʻi.”
So, Noh, a Clinical Assistant Professor at JABSOM, launched an effort to connect more students with neurosurgery, which included inviting students to join his surgical rotations, expanding their network of professional contacts in the field, and offering opportunities to get involved with research projects in his lab. Word spread, and JABSOM now has several students and graduates who are pursuing neurosurgery – many of which have also expressed a desire to return to Hawaiʻi to serve the islands.
Fostering a Sense of Belonging
Third-year medical student, Janette Bow-Keola, is one of these students.
Bow-Keola became interested in neurosurgery when she was an undergraduate student at the University of California, Berkeley conducting research at the University of California, San Francisco and learned how it could help a patient with Parkinson’s manage tremors. When she understood how impactful it was for the patient and their quality of life, she was immediately interested in pursuing a career in it.
“I’ve seen neurosurgeons give a functionality back to their patients that they weren’t sure would be possible to achieve again,” she said. “Thinking about being able to do this myself – and restore hope through medicine – was incredibly enticing.”
But, as appealing as it sounded, she wasn’t sure neurosurgery was for her.
“When I started med school, I had the idea that I wanted to pursue neurosurgery, but I didn't think it was really achievable, coming from my background as an underrepresented person in medicine,” she said. “I struggled with imposter syndrome and doubting whether I was right for medicine or worthy of going into neurosurgery.”
JABSOM turned out to be the ideal place for Bow-Keola as Noh believes it’s especially critical to mentor students from underrepresented communities who face greater barriers for getting into neurosurgery.
“Underrepresentation is such a huge issue in neurosurgery, especially for women,” Noh says. “Which is why this kind of effort is so vital, to empower more women to see themselves in the field.”
Empowering Students through Hands-On Experience
When she arrived at JABSOM, Bow-Keola met Noh and he reassured her that her aspirations were attainable and that JABSOM could help her get the training and experience she needs to go into neurosurgery. Bow-Keola decided to explore neurosurgery and she’s been getting hands-on experience in Noh’s clinic and contributing to his research projects. Now, she’s no longer doubting whether there’s a place for her in neurosurgery.
“Through the experience I’m getting at JABSOM, I’ve built confidence in myself and my training and what I can offer patients,” she said.
Bow-Keola fully intends on returning to Hawaiʻi once she’s finished her medical education so she can help the community that’s been such an important pillar in her life. She knows there’s a shortage of practitioners and she wants to be part of the solution.
“I’ve always felt connected to Hawaiʻi and knew that I wanted to give back to the community that helped me get to where I am today,” she said. “I want to serve the Native Hawaiian population by addressing disparities in the health care system and increasing the standard of care, especially given the declining population of surgeons.”
Bow-Keola has firsthand experience navigating the challenges of an inequitable health care system. She was diagnosed with Graves’ disease when she was 13 and since she was from an underserved background, her family struggled to find affordable medical care and her disease progressed as she couldn’t get the yearly checkups she needed.
The biggest gamechanger was finding a doctor who considered how her socioeconomic factors were contributing to her disease.
“That was what brought medicine into the forefront of my mind and planted the seed for me to want to help others,” she said. Now, she wants to channel that into neurosurgery and has found JABSOM to be a prime educational partner to do it.
“JABSOM is constantly giving us ways to hear the patient's perspective, including how they feel treated by the system and their doctors, and what we can do better in the future,” she said. “We’re learning about inequities across health care and developing approaches for how to be more culturally competent – and sensitive to the intersecting factors that influence our patient’s life.”
There are no residency opportunities for neurosurgery in Hawaiʻi for Bow-Keola or her classmates so she’ll have to leave the state while she finishes her medical training, but she plans to come back on the other side of it. And, Noh is hopeful that as more JABSOM students get interested in neurosurgery, more will return to Hawaiʻi and keep building a more promising future, together.
“That’s a special thing about Hawaiʻi,” he said, “We have an incredible network here, and if we keep supporting one another and lifting each other up, it’s going to help us all find a way to come back and take care of each other.”
A Trailblazer in Neurosurgery – First Native Hawaiian Female Resident
That’s exactly what Andie Conching, MD ’25, intends to do. When Conching graduated last spring, she became the first known woman of Hawaiian descent to become a resident in neurosurgery. She’s currently completing her residency through the University of California, Davis, and plans to return to Hawaiʻi when she’s done to help expand access to neurosurgery across the state.
JABSOM’s commitment to Native Hawaiian health was a large part of why Conching decided to return to Hawaiʻi for medical school – and pursue a career in neurosurgery.
Conching got her undergraduate degree in neuroscience at Dartmouth College and joined a lab at the National Institutes for Health (NIH) to work on neuro-oncology research. She loved studying the brain but realized her heart was in patient care – and that she felt called to serve her home community back in Hawaiʻi.
“I always had an underlying vision that my dream career would somehow combine my interest in neurosurgery with my desire to address health disparities – especially for Native Hawaiians,” said Conching. “I grew up learning to give back to the community that raised me and I realized I wanted to go to medical school.”
Mentorship from Noh and local neurosurgeons was key to Conching deciding to pursue neurosurgery – and feeling confident in her abilities to do it. She scrubbed into shadow neurosurgery procedures, learned vital clinical and surgical skills, and felt the power of teamwork to improve health outcomes. She also collaborated with Noh on a research project that examined the decision-making scale that’s used in emergency rooms to determine whether pediatric patients with head trauma should get a CT scan. This is a tool that holds important implications for neurological care because pediatric patients face a higher risk of tumor development when getting a CT scan. They presented their work to the Congress of Neurological Surgery, where they were recognized for their contributions to pediatric research.
“Mentorship is really accessible at JABSOM because there’s a strong community of neurosurgeons around Hawaiʻi who will help open doors for students who show that they want to put in the effort to go into neurosurgery,” said Conching. “Learning from neurosurgeons in Hawaiʻi, and collaborating on research projects, really reaffirmed that I want to make an impact in this field – and help meet the need for more neurosurgeons serving Hawaiʻi.”
Conching hopes and plans to return to Hawaiʻi to practice medicine – and hopefully inspire other women to follow in her footsteps. She’s grown accustomed to often being the only woman in the room – and always the only woman of Hawaiian descent, and she hopes that changes during her career.
“I can't wait to not be the first and only woman of Native Hawaiian descent in neurosurgery,” she said.
She’s grateful that JABSOM helped give her the confidence to go into a field where women and Native Hawaiians are so underrepresented. While she might not have seen herself represented in neurosurgery, specifically, she felt empowered by seeing all of the doctors at JABSOM from underrepresented communities.
“Sometimes, it feels like things like neurosurgery are out of reach when you don’t see yourself represented, but I know this will change as representation in neurosurgery increases and more women, and more Native Hawaiians go into the field. I hope our generation helps empower others to believe in themselves and see that they have a place in neurosurgery.”
