ARTICLE IN BRIEF
Joseph Safdieh, MD, FAAN, incoming editor-in-chief of Neurology Today, discusses his passion for education and the people that shaped his journey in neurology.
Growing up in the close-knit Sephardic Jewish community in Gravesend, Brooklyn, in the 1980s and 1990s, Joseph Safdieh, MD, FAAN, knew well what was expected of him. Like his father, a retailer, and his uncles, who worked in the fabric business, he and his two younger brothers would, of course, grow up and start a business career, get married, and have a family. Education was valued, but not to the extent that young people in his family thought much about going to college.
“College was maybe a nice thing to do, but the main expectation — for men, anyway — was that you would go into business. But that never sat well with me,” said Dr. Safdieh, an associate professor of neurology and director of the medical student neurology clerkship at Weill Cornell Medical College in New York, who succeeds Steven P. Ringel, MD, FAAN, as editor-in-chief of Neurology Today, as of July 1.
“I sensed that even though building your own business is something you can be proud of, it wasn't something that would satisfy me.”
Naturally inquisitive, Dr. Safdieh loved both learning and teaching from an early age. “I was the nerd. I wore the glasses. I wrote multiple choice questions for my classmates in seventh grade, and had little study groups,” he said. “Even then, I loved the process of learning by explaining things to others.”
So for high school, his parents enrolled him at the Yeshiva of Flatbush, a Jewish day school offering a wider variety of options and interests. The school had graduated many doctors, and even a few Nobel laureates. “I spent a lot of time in high school thinking about how I could best blend my love for science with my love for teaching and learning,” he said. “Even at that early point, I was thinking that I'd love to go into medicine but not just see patients — I also wanted to figure out how to pursue my passion for teaching.”
With New York City in his bones, Dr. Safdieh had no desire to venture far afield for college, so he entered New York University. His heavy load of AP credits meant that he could finish college in three years, but that gave him even less time to figure out his path. Serendipitously, his freshman year — 1995-1996 — was also the year that New York University, long known for its strong neuroscience graduate program, decided to launch an undergraduate neuroscience major.
“Apparently, many of the faculty weren't thrilled by the idea because they felt they'd have to babysit college kids,” he said. “So they initially only allowed 15-20 students to enter the major that first year. I got in, and I was thrilled because it was a very competitive group, and it allowed me to become a neuroscience major.”
Dr. Safdieh quickly became fascinated with biopsychopharmacology, and how drugs like antidepressants and seizure medications affect the brain. “The mystery was intriguing to me — how much we were actually doing, but how little we knew about just why we were doing what we were doing. We knew about neurotransmitters and receptors that did this and that, but it was very hand-wavy as to why.”
The 1990s, of course, was the “decade of the brain,” with an explosion of brain research that reached critical mass just as Dr. Safdieh was entering NYU Langone School of Medicine — and he already knew what he wanted to do. “At our first medical school orientation, people were asking each other what specialty they were thinking of going into, and everybody would say things like, maybe pediatrics, maybe internal medicine, maybe this, maybe that,” he said. “But I knew I wanted to be a neurologist. I had such intellectual curiosity about the brain and how it works and how little we understand it. The kidneys, the liver, the lungs, the heart — they all exist to provide an environment that the brain needs to survive. Everything else can be replaced, but not the brain. We are what our brain is.”
Dr. Safdieh's first mentor in neurology was his clerkship director, Richard M. Hanson, MD, who headed the neurology clerkship at the Veterans Administration New York Harbor Hospital. His logical, systematic and organized approach to the specialty helped the young neurologist get his head around the complex specialty. “What I love about neurology is that even though we don't fully understand the brain and how it works, when you see a patient with a neurological symptom, there's a structured approach to it that can be taught and can make things that are seemingly complicated very approachable,” he says. “Dr. Hanson is the first person who taught me that. He took that logical approach but in a very humanistic way.”
A PASSION FOR EDUCATION
When it came time to interview for his neurology residency, Dr. Safdieh found himself feeling like an oddity. He was graduating at the top of his class from medical school, but unlike most of his peers, he had little interest in pursuing a career in basic or clinical research. Instead, his interest in becoming an academic neurologist was pursuing a career in neurology education. “I wanted to de-mystify neurology,” he said. “That was my career objective: helping people who don't think they understand neurology recognize that they can care for a patient with a neurologic symptom. I do love research, but again, I especially love the lessons it teaches us.”
In interview after interview at top-ranked academic institutions, when Dr. Safdieh mentioned his desire for a career in neurology education, “They looked at me like I had three heads.” Until his interview at NewYork-Presbyterian/Weill Cornell, with Lisa DeAngelis, MD, FAAN, the chair of neurology at Memorial Sloan-Kettering Cancer Center (and since 2011, chair of the AAN's Science Committee).
Dr. DeAngelis asked what he wanted to do in his career, and bracing himself for the usual blank response, Dr. Safdieh answered honestly that he loved teaching and wanted to be a neurology educator. “She actually lit up! She said, ‘I know exactly who you need to speak to, a great mentor at the University of Rochester. If you match here, I'll make sure you meet him.’”
True to her word, after Dr. Safdieh ranked Cornell number one in his match list and successfully matched there, Dr. DeAngelis introduced him to noted neurology education expert Ralph Jozefowicz, MD, FAAN. “I wasn't his resident, so he had no real incentive to help me, but he took me under his wing and checked in with me every few months to help me solidify this nebulous concept of how I could operationalize my interest in neurology education.”
At the end of his residency, Dr. Safdieh completed a two-month elective in Rochester through the American Neurological Association, as a visiting instructor in one of Dr. Jozefowicz's courses.
With such a welcoming environment for his passion for education, it's little wonder that Dr. Safdieh remained at Weill-Cornell after completing his residency, where his current chair, Matthew Fink, MD, FAAN, has allowed him to pursue his vision of developing a division of neurology education. “He's a rock for me. He's the kind of person that never really says no. He always figures out a way to make happen what you need,” he says. “Even though this division does not generate revenue, because we're not billing patients or getting grants, we've figured out how to make it work, because he's always looking for the betterment of the department as a whole.”
Weill Cornell was no exception to the general rule in most academic medical centers, where the education leg of the classic three-legged stool was the wobbly one. “Everybody thinks about research and clinical practice, and education is peripheral,” Dr. Safdieh said. “But I've been given the freedom to start from the ground up, developing a brand-new formal clerkship curriculum for neurology medical students. We've set up a weekly three-hour time slot to go through that curriculum, developed a study plan, and most importantly, reframed the way we teach everything. We've changed it from ‘Let's learn about this disease or that medication,’ to ‘Let's learn how you ask patients questions when they present with a symptom.’ A medical student who's not going to be a neurologist doesn't need to know everything about Parkinson's or epilepsy, but they do need to know the right questions to ask a patient with tremor or seizure or back pain. If we're going to eradicate ‘neurophobia’ among medical students, everybody who graduates from this program has to learn not to become paralyzed when they see a patient with a neurological symptom.”
Success begets success. His new program quickly became recognized by medical students as the strongest of the clerkships, prompting inquiries from the dean's office about just what those guys in the neurology clerkship were doing and how it could be generalized. And more resources were funneled into the program — allowing for the hiring of an associate clerkship director and more staff to run a sub-internship program. Most recently, department chair Dr. Fink was able to hire another faculty member, whose clinical specialty is in movement disorders but who will also serve as a longitudinal career mentor for students interested in neurology, throughout the four years of medical school.
“We know from surveys that about one-quarter to one-third of entering medical students have some interest in neuroscience, but only a small percentage become neurologists,” Dr. Safdieh says. “Are we turning students off or teaching them the wrong way? I hope that providing this support can boost those numbers.”
Even in his “down time,” it's hard to get Dr. Safdieh to stop learning and teaching. Wandering the streets of his beloved New York with his 14-year-old daughter and ten-year-old son and his soon-to-be husband, he indulges in his passion for urban design. (Dr. Safdieh married young in the Orthodox tradition, and he and his ex-wife divorced amicably and now share custody.)
“I'm very interested in the history of how cities and transportation systems developed,” he explained. “I love walking around the city and looking at a building, closing my eyes and imagining who lived in that building 150 years ago.”
On his nightstand at the moment are Power Broker, Robert Caro's Pulitzer Prize-winning book about urban planner Robert Moses and his influence on New York, and the famous Ron Chernow biography Alexander Hamilton.
Dr. Safdieh also travels annually to Weill Cornell's branch medical school in Qatar to teach medical students. “It's a fabulous experience to see how people practice medicine in other countries and look at it from an international perspective.”
He sees Neurology Today as a way to pursue his educational goals on a national level. “We're focusing on high-level science and clinical advances, synthesized in a way that a neurologist, who's already in love with the field, can access, digest, and apply them to patients without having to scour the literature to find all that stuff. To me, Neurology Today is about education.”