American Board Of Neurological Surgery Research Articles

Educational Limitations of ChatGPT in Neurosurgery Board Preparation.

Objective This study evaluated the potential of Chat Generative Pre-trained Transformer (ChatGPT) as an educational tool for neurosurgery residents preparing for the American Board of Neurological Surgery (ABNS) primary examination. Methods Non-imaging questions from the Congress of Neurological Surgeons (CNS) Self-Assessment in Neurological Surgery(SANS) online question bank were input into ChatGPT. Accuracy was evaluated and compared to human performance across subcategories. To quantify ChatGPT's educational potential, the concordance and insight of explanations were assessed by multiple neurosurgical faculty. Associations among these metrics as well as question length were evaluated. Results ChatGPT had an accuracy of 50.4% (1,068/2,120), with the highest and lowest accuracies in the pharmacology (81.2%, 13/16) and vascular (32.9%, 91/277) subcategories, respectively. ChatGPT performed worse than humans overall, as well as in the functional, other, peripheral, radiology, spine, trauma, tumor, and vascular subcategories. There were no subjects in which ChatGPT performed better than humans and its accuracy was below that required to pass the exam. The mean concordance was 93.4% (198/212) and the mean insight score was 2.7. Accuracy was negatively associated with question length (R2=0.29, p=0.03) but positively associated with both concordance (p<0.001, q<0.001) and insight (p<0.001, q<0.001). Conclusions The current study provides the largest and most comprehensive assessment of the accuracy and explanatory quality of ChatGPT in answering ABNS primary exam questions. The findings demonstrate shortcomings regarding ChatGPT's ability to pass, let alone teach, the neurosurgical boards.

Maxine Deborrah Hyde: First Female Graduate of Case Western Reserve University's Neurologic Surgery Residency Program and Second Black Female Neurosurgeon in the United States

The historical diversity gap in the neurosurgical workforce persists to this day. Women, despite constituting over half of the yearly total of medical school graduates, comprise only 6% of certified practicing neurosurgeons in the United States. Furthermore, Black Americans make up under 4% of U.S. neurosurgeons, despite making up around 14% of the national population. The purpose of this account is to highlight the life and career of Dr. Maxine Deborrah Hyde and illustrate the importance and necessity of diversity and inclusivity in advancing the field of neurosurgery. Through this paper, we aspire to encourage the development of new diversity initiatives. Original scientific and bibliographic materials of Hyde were examined, and an extensive analysis of her life was compiled. Despite growing up during the era of Jim Crow, Dr. Hyde persevered and became the valedictorian of Oak Park High School. As a first-generation college student at Tougaloo College, she later earned her MS from Cleveland State University. Dr. Hyde graduated with honors from Case Western Reserve University School of Medicine in 1977. Thereafter, she became the first female and first Black graduate of Case Western's neurosurgery residency and the second Black woman to receive certification from the American Board of Neurological Surgery. Later in life, Dr. Hyde established the Beacon of Hope Scholarship Foundation to assist disadvantaged students in overcoming educational barriers. Dr. Hyde was a trailblazer who overcame systematic barriers and paved the way for future generations of aspiring neurosurgeons.

In Memoriam: Hamit Ziya Gökalp, 1929 to 2022.

In Memoriam: Hamit Ziya Gökalp, 1929 to 2022.

Neurosurgery residency and fellowship education in the United States: 2 decades of system development by the One Neurosurgery Summit organizations.

The purpose of this report is to chronicle a 2-decade period of educational innovation and improvement, as well as governance reform, across the specialty of neurological surgery. Neurological surgery educational and professional governance systems have evolved substantially over the past 2 decades with the goal of improving training outcomes, patient safety, and the quality of US neurosurgical care. Innovations during this period have included the following: creating a consensus national curriculum; standardizing the length and structure of neurosurgical training; introducing educational outcomes milestones and required case minimums; establishing national skills, safety, and professionalism courses; systematically accrediting subspecialty fellowships; expanding professional development for educators; promoting training in research; and coordinating policy and strategy through the cooperation of national stakeholder organizations. A series of education summits held between 2007 and 2009 restructured some aspects of neurosurgical residency training. Since 2010, ongoing meetings of the One Neurosurgery Summit have provided strategic coordination for specialty definition, neurosurgical education, public policy, and governance. The Summit now includes leadership representatives from the Society of Neurological Surgeons, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the American Board of Neurological Surgery, the Review Committee for Neurological Surgery of the Accreditation Council for Graduate Medical Education, the American Academy of Neurological Surgery, and the AANS/CNS Joint Washington Committee. Together, these organizations have increased the effectiveness and efficiency of the specialty of neurosurgery in advancing educational best practices, aligning policymaking, and coordinating strategic planning in order to meet the highest standards of professionalism and promote public health.

Correlation Between Neurosurgical Residency Written Board Scores and Case Logs

There are few objective measures for evaluating individual performance throughout surgical residency. Two commonly used objective measures are the case log numbers and written board examination scores. The objective of this study was to investigate possible correlations between these measures. We conducted a retrospective review of the American Board of Neurological Surgery (ABNS) written board scores and the Accreditation Council for Graduate Medical Education case logs of 27 recent alumni from neurologic surgery residency training programs at The Ohio State Wexner Medical Center and the University of Nebraska Medical Center. The number of spine cases logged was significantly correlated with the ABNS written examination performance in univariate linear regression (r2= 0.182, P= 0.0265). However, case numbers from all other neurosurgical subspecialties did not significantly correlate with ABNS written board performance (P > 0.1). Identifying which objective measures correlate most closely with resident education could help optimize the structure of residency training programs. We believe that early exposure to focused aspects of neurosurgery helps the young resident learn quickly and efficiently and ultimately score highly on standardized examinations. Therefore program directors may want to ensure focused exposure during the early years of residency, with particular attention to worthwhile rotations in spine neurosurgery.

Slow progress in the visibility of women in neurosurgery in the United States: opportunity for improvement.

The goal of this study was to analyze the visibility of women within organized neurosurgery, including leadership positions, lectureships, and honored guest/award recipients at neurosurgical conferences. A cross-sectional study was used to analyze the gender demographics within the five major national neurosurgical societies (Congress of Neurological Surgeons [CNS], American Association of Neurological Surgeons [AANS], Society of Neurological Surgeons [SNS], American Board of Neurological Surgery [ABNS], and Council of State Neurosurgical Societies [CSNS]) from 2000 to 2020. Data for top leadership positions, keynote speakers, honored guests, and invited lectureships at these neurosurgical societies were reviewed. Additionally, national neurosurgical residency match data from 2018 to 2020 were collected. For each aforementioned data point, gender was determined and confirmed via publicly available data. Data from the US News and World Report best hospitals publication for 2020 were applied for analyzing gender trends within neurosurgical residencies specifically. In the past 2 decades (2000-2020), top leadership positions across the neurosurgical organizations were held by 45 individuals, of whom 5 (11.1%) were women. Spanning from 2000 to 2018, just 8.1% (50 of 618) of guests/honored speakers on the national neurosurgical stage of the CNS, AANS, SNS, and CSNS meetings have been female. Excluding the Louise Eisenhardt Lecture (honoring women), the percentage of female guests/honored speakers at the AANS meeting was just 5% (17 of 367). For the CNS annual meetings, 13.4% (20 of 149) of the speakers were women from 2000 to 2018, whereas the CSNS annual meeting data from 2001 to 2018 found that 11.9% (7 of 59) of speakers were women. From 1952 to the present, there have been no female honored guests at the CNS annual meeting. Across the residency match cycles from 2018 to 2020, the percentages of matched applicants identifying as female have been 22.7%, 28.1%, and, most recently, 25.3%. The percentage of female residents is 28.5% (top 20 program) versus 24.3% (non-top 20 program) (p = 0.267). This study found that for all the data points surveyed, including leadership positions, invited lectureships at national neurosurgical meetings, and successful neurosurgical residency applicants, disproportionate female underrepresentation was evident. Consistent lack of visibility leads to a negative impact on progress in the recruitment and retention of women in neurosurgery. Visibility, mentorship, role models, and sponsorship are highly interrelated processes and are essential for meaningful progress.

Resiliency of a perpetual optimist: neurosurgeon Dr. Linda Liau.

It is not possible to capture all the depth that composes Dr. Linda Liau: chair of the Neurosurgery Department at the University of California, Los Angeles; second woman to chair a neurosurgery program in the United States; first woman to chair the American Board of Neurological Surgery; first woman president of the Western Neurosurgical Society; and one of only a handful of neurosurgeons elected to the National Academy of Medicine. Her childhood and family history alone could fascinate several chapters of her life's biography. Nonetheless, this brief biography hopes to capture the challenges, triumphs, cultural norms, and spirit that have shaped Dr. Liau's experience as a successful leader, scientist, and neurosurgeon. This is a rare story. It describes the rise of not only an immigrant within neurosurgery-not unlike other giants in the field, Drs. Robert Spetzler, Jacques Marcos, Ossama Al-Mefty, and a handful of other contemporaries-but also another type of minority in neurosurgery: a woman.

Continuous improvement in patient safety and quality in neurological surgery: the American Board of Neurological Surgery in the past, present, and future.

The American Board of Neurological Surgery (ABNS) was incorporated in 1940 in recognition of the need for detailed training in and special qualifications for the practice of neurological surgery and for self-regulation of quality and safety in the field. The ABNS believes it is the duty of neurosurgeons to place a patient's welfare and rights above all other considerations and to provide care with compassion, respect for human dignity, honesty, and integrity. At its inception, the ABNS was the 13th member board of the American Board of Medical Specialties (ABMS), which itself was founded in 1933. Today, the ABNS is one of the 24 member boards of the ABMS.To better serve public health and safety in a rapidly changing healthcare environment, the ABNS continues to evolve in order to elevate standards for the practice of neurological surgery. In connection with its activities, including initial certification, recognition of focused practice, and continuous certification, the ABNS actively seeks and incorporates input from the public and the physicians it serves. The ABNS board certification processes are designed to evaluate both real-life subspecialty neurosurgical practice and overall neurosurgical knowledge, since most neurosurgeons provide call coverage for hospitals and thus must be competent to care for the full spectrum of neurosurgery.The purpose of this report is to describe the history, current state, and anticipated future direction of ABNS certification in the US.

Ross C. Puffer: Neurosurgery primary board review

Ross C. Puffer presents “Neurosurgery Primary Board Review,” a contemporary question and answer book of 170 pages (paperback), primarily intended for residents preparing their neurosurgical board examination. The book is divided into seven chapters, according to the structure of the American Board of Neurological Surgery (ABNS) primary written exam, as follows: neurosurgery, neurology, neuroanatomy, neurobiology, neuropathology, neuroimaging, and fundamental skills. The book’s key feature is the abundant and up-to-date question bank, comprising 1500 multidisciplinary questions. Of those, 600 multiple-choice questions can be found in the book, accompanied by corresponding answer keys that include short explanations for each answer. Those questions are also enriched by 217 illustrations, which are suitably placed within the text. The remaining 900 questions can be accessed online.

Snapshot: Socioeconomic Competence in US Neurosurgery Residents

Socioeconomic topics such as federal mandates/regulations, conflict of interest, and practice management have become increasingly important for all neurosurgeons. Graduating residents immediately need a host of skills to successfully navigate neurosurgical practice. Surgical and medical skills are closely evaluated through the American Board of Neurological Surgery, and a formal socioeconomic curriculum has been developed with defined milestones. Nevertheless, little has been done to evaluate neurosurgery resident competence in socioeconomic and medicolegal principles. The purpose of this study was to assess the competence of Accreditation Council for Graduate Medical Education neurosurgical residents in socioeconomic knowledge. Neurosurgery resident members of the American Association of Neurological Surgeons (N=1385) were sent a Survey Monkey of 10 questions. The survey covered the most basic of socioeconomic principles. Initial survey responses were collected across a 1-month period from April to May2018. The response rate was 14% (194/1385). Overall, neurosurgery residents would have received a grade of D, with an average score of 67% on the survey. For 7 of the 10 questions, the majority (>50%) of neurosurgery residents answered correctly. Furthermore, for 3 questions, more than 90% of residents selected the correct answer. However, for one-half of all questions, residents averaged a score of less than 65%. Residents tended to answer questions correctly for physician compensation and compensation models, but incorrectly for topics of informed consent, Controlled Substances Act, and conflicts of interest. With the increasing complexity of neurosurgery practice, solid knowledge of socioeconomic topics is essential. The study confirms suspected deficiencies in socioeconomic proficiency among neurosurgery residents, despite the availability of a validated curriculum. This knowledge gap will likely affect career success and satisfaction. Nevertheless, this survey had a significantly low response rate, and it may be an incomplete representation of the neurosurgical resident mind. Focused educational initiatives through the neurosurgical Residency Review Committee and individual training programs must facilitate an action plan that ensures the effective implementation of socioeconomic curricula.

United States Medical Licensing Exam Step I Score as a Predictor of Neurosurgical Career Beyond Residency.

United States Medical Licensing Exam (USMLE) Step I score is cited as one of the most important factors when for applying to neurosurgery residencies. No studies have documented a correlation between USMLE Step I score and metrics of neurosurgical career trajectory beyond residency. To determine whether USMLE Step I exam scores are predictive of neurosurgical career beyond residency, as defined by American Board of Neurological Surgery (ABNS) certification status, practice type, academic rank, and research productivity. A database of neurosurgery residency applicants who matched into neurosurgery from 1997 to 2007 was utilized that included USMLE Step I score. Online databases were used to determine h-index, National Institutes of Health (NIH) grant funding, academic rank, practice type, and ABNS certification status of each applicant. Linear regression and nonparametric testing determined associations between USMLE Step I scores and these variables. USMLE Step I scores were higher for neurosurgeons in academic positions (237) when compared to community practice (234) and non-neurosurgeons (233, P<.01). USMLE Step I score was not different between neurosurgeons of different academic rank (P=.21) or ABNS certification status (P=.78). USMLE Step I score was not correlated with h-index for academic neurosurgeons (R2=0.002, P=.36). USMLE Step I score has little utility in predicting the future careers of neurosurgery resident applicants. A career in academic neurosurgery is associated with a slightly higher USMLE Step I score. However, USMLE Step I score does not predict academic rank or productivity (h-index or NIH funding) nor does USMLE Step I score predict ABNS certification status.

Recent trends in North American pediatric neurosurgical fellowship training.

OBJECTIVE The goal of this study was to evaluate trends in pediatric neurosurgical fellowship training in North America. METHODS From a database maintained by the Accreditation Council for Pediatric Neurosurgery Fellowships (ACPNF), all graduates of ACPNF-accredited pediatric neurosurgery fellowships were identified, and an Internet search was conducted to determine sex, undergraduate and graduate degrees, location and dates of residency and fellowship training, current practice/employment environment, American Board of Neurological Surgery (ABNS) or Fellowship of the Royal College of Surgeons certification status, American Board of Pediatric Neurological Surgery (ABPNS) certification status, and extent of current pediatric-focused practice. The graduates were further studied to determine whether they had completed a neurosurgical residency at a program with an affiliated ACPNF-accredited pediatric neurosurgery fellowship program, and their residency training programs were further classified by whether the program was ranked in the top 50 by NIH funding awards. Each fellowship graduate’s current practice was also ranked in a similar fashion. RESULTS There were 391 graduates of ACPNF-accredited pediatric neurosurgery fellowship programs from 1993 to 2018. The number of graduates per year has grown steadily over time, as has the percentage of women, now over 40% compared to zero in the first 3 years of fellowship accreditation in the mid-1990s. Approximately 71% of graduating fellows have a pediatric-focused practice, but only 63% went on to attain ABPNS certification. Of all graduates practicing in the United States, 68% practice in academic settings. Ninety-five percent of graduating fellows who were ABNS board eligible were ABNS certified. CONCLUSIONS A study of the graduates of accredited pediatric neurosurgical fellowships from 1993 to 2018 has revealed a growth in the number of graduates from ACPNF-accredited fellowship programs over time. A substantial portion of graduates will practice at least some adult neurosurgery and not go on to obtain ABPNS board certification.

Maintenance of Certification: Perceptions and Attitudes of Neurosurgeons.

Assuring clinical competence throughout the career of a neurosurgeon is of paramount importance for patient safety. We present the first comprehensive survey of all neurosurgeons board certified through the American Board of Neurological Surgery (ABNS) to evaluate perceptions of Maintenance of Certification (MOC). We administered a validated, online, confidential survey to 4899 neurosurgeons (2435 ABNS diplomates participating in MOC, 1440 diplomates certified prior to 1999 [time-unlimited certificates], and 1024 retired diplomates). We received 1449 responses overall (30% response rate). Our study found that most respondents believe that neurosurgeons should be required to participate in continuing professional improvement following initial board certification (75%). Most believe that specialty boards, working in conjunction with specialty societies, should require diplomates to participate in programs meant to promote continuous professional development (73%). The majority of respondents (76%) believed that self-assessment tests constituted a meaningful professional development activity, in addition to periodic case log reviews (33%) or quality improvement projects (32.6%). A plurality of respondents (44%) do not feel that the MOC process as currently structured provides them with value. There were no differences between those who were "grandfathered" and those who actively participate in MOC and no differences between those in private practice versus those in academics. The ABNS is cognizant of diplomate concerns and is actively developing new MOC paradigms to ensure that the process achieves both the goals of meeting the public interest and assuring that the quality of American neurosurgery remains exemplary.

Tracking Career Paths of Women in Neurosurgery.

Women represent a growing cohort of US neurosurgeons. To describe postresidency fellowship, practice environment, and updated academic rank among female neurosurgeons. Databases from the American Association of Neurological Surgeons (AANS) and the American Board of Neurological Surgery (ABNS) from 1964 to 2013 were reviewed for female neurosurgery residency graduates. Data on postresidency fellowships, practice environment (private vs academic), academic rank, board certification, and AANS/CNS (Congress of Neurological Surgeons) Joint Section on Women in Neurosurgery (WINS) membership were collected in 2016. Academic rank was verified from program websites and electronic correspondence. Faculty members were asked to report directorships and tenure. The AANS/CNS Joint Section on Women in Neurosurgery verified WINS membership. A total of 379 female neurosurgery residency graduates were identified in this 50-yr span. Of these, 70% became ABNS certified, and 2.1% left neurosurgery. Twenty-seven percent of women (n = 103) pursued fellowships, with pediatric neurosurgery (33%) the most common. Regarding practice environment, 26% entered academic medicine (n = 91), with 42 at the rank of assistant professor, 33 at the rank of associate professor, and 16 reaching the rank of full professor. Upon completion of training, 27% of women pursue fellowships. The distribution of women in private vs academic practice environments is proportionate to male neurosurgeons; however, the number women in academic leadership positions remains exceedingly low, with disproportionate representation in higher academic ranks. Women in national organized neurosurgery are increasing. Tracking the career paths of women in neurosurgery is a necessary step to identifying current achievements and opportunities for future progress.

John C. Vangilder (1935-2007): Neurosurgical Leader and Founder of the Department of Neurosurgery at the University of Iowa.

John C. VanGilder, the former professor and chairman of neurosurgery at The University of Iowa died on August 27, 2007 after making a lasting impact to the field of neurosurgery both in the United States and abroad. In this manuscript, we review VanGilder's life and achievements. VanGilder was born in 1935 in West Virginia and received his undergraduate education at West Virginia University in Morgantown. He studied medicine at the University of West Virginia, completing his final 2 years at the University of Pittsburgh, and after serving in the U.S. military, completed his neurosurgical training at Washington University in St. Louis. He was appointed to faculty positions first at Yale University and later at The University of Iowa, where he became professor and later chairman of the Division of Neurosurgery. VanGilder also served as president of the Society of Neurological Surgeons (1997-1998), president of the Neurosurgical Society of America (1998-1999), chairman of the American Board of Neurological Surgery (1997-1998), and vice president of the American Academy of Neurological Surgery. At The University of Iowa, VanGilder played a key role in the transition of the Division of Neurosurgery to a Department of Neurosurgery and mentored several neurosurgeons who would go on to become department chairmen or make other important neurosurgical contributions at other medical schools in the United States.

Recognized focused practice: Does sub-specialty designation offer value to the neurosurgeon?

Vehicles for life-long assessment such as Maintenance of Certification tend to focus on generalist neurosurgical knowledge. However, as neurosurgeons advance in their careers, they tend to narrow their practice and increase volumes in certain specific types of operations. Failing to test the type of procedures most relevant to the practitioner is a lost opportunity to improve the knowledge and practice of the individual neurosurgeon. In this study, we assess the neurosurgical community’s appetite for designations of board-recognized Recognized Focused Practice (RFP). We administered a validated, online, confidential survey to 4,899 neurosurgeons (2,435 American Board of Neurological Surgery (ABNS) Diplomates participating in MOC, 1,440 Diplomates certified prior to 1999 (grandfathered), and 1,024 retired Diplomates). We received 1,449 responses overall (30% response rate). A plurality of respondents were in practice 11–15 years (18.5%), in private practice (40%) and participate in MOC (61%). 49% of respondents felt that a RFP designation would not be helpful. For the 30% who felt that RFP would be helpful, 61.3% felt that it would support recognition by their hospital or practice, it would motivate them to stay current on medical knowledge (53.4%), or it would help attract patients (46.4%;). The most popular suggestions for RFP were Spine (56.2%), Cerebrovascular (62.9%), Pediatrics (64.1%), and Functional/Stereotactic (52%). A plurality of neurosurgeons (35.7%) felt that RFP should recognize neurosurgeons with accredited and non-accredited fellowship experience and sub-specialty experience. Ultimately, Recognized Focused Practice may provide value to individual neurosurgeons, but the neurosurgical community shows tepid interest for pursuing this designation.

The Aging Neurosurgeon: When Is Enough, Enough? Attitudes Toward Ceasing Practice and Testing in Late Career

ObjectiveTo present the first wide-scale survey to assess perceptions of testing the aging neurosurgeon. Patients and MethodsThis study included 4899 neurosurgeons, 2435 American Board of Neurological Surgery Diplomates participating in Maintenance of Certification (MOC), 1440 Diplomates certified before 1999 (grandfathered), and 1024 retired Diplomates. We developed an online confidential survey conducted from March 1, 2016, to May 31, 2016. We received 1449 responses overall (30% response rate). ResultsMost respondents (938; 65%) were aged 50 years and older. Overall, most respondents (718; 50%) believe that the aging neurosurgeon (65 years and older) should undergo additional testing, including cognitive assessment or a review of cases, in addition to a standard (MOC) examination. Nine hundred fifty-six (67%) respondents believed that there should be no absolute age cutoff at which neurosurgical practice is forced to end. Six hundred six (42%) respondents believed that MOC should be tailored to accommodate the aging neurosurgeon. Most respondents (766; 59%) believed that MOC should consist of a review individual case logs and patient outcomes for the aging neurosurgeon. ConclusionAppropriately assessing the aging neurosurgeon is important to protect patient safety and also maximize the capacity of an aging neurosurgical workforce. This first of its kind survey of neurosurgeon diplomates of the American Board of Neurological Surgery provides important information as to what mechanisms can be created to fairly evaluate aging neurosurgeons. Although this is a study of neurosurgeons, the implications of these findings are widely applicable across specialties, and additional research on testing for aging and competency is needed across specialties.

Does the Open Payments Database Provide Sunshine on Neurosurgery?

The Open Payments Database (OPD) was launched by the Centers for Medicare & Medicaid Services in 2014. Through this online searchable database, the public can explore physician-industry interactions. To date, there is no published literature on the accuracy of the database for neurosurgeons or any physician specialty. To study the accuracy of published records and scope of industry-neurosurgeon relationships between neurosurgeons and industry within the OPD. We searched 4.3 million records in 2013 and 11.41 million records in 2014 in the OPD for board-certified neurosurgeons verified by the American Board of Neurological Surgery. Delimit software was used to condense these data, Microsoft Access for database queries, and STATA to perform descriptive analyses. Of the 3240 neurosurgeons in the OPD in 2013, 2020 were identified correctly as neurosurgeons within the database (62%). Of the 3593 neurosurgeons in the OPD in 2014, 2433 were identified correctly as neurosurgeons (68%). Within the OPD in 2013, there were 72 066 attributed records for neurosurgeons; within the 2014 OPD, there were 160 563 attributed records for neurosurgeons. Total payments to neurosurgeons in 2013 (for the 9 months published in OPD): $61 802 659.37; in 2014: $117 127 824.00. The OPD details physician interactions with industry and has multiple inaccuracies. Publicly availing inaccurate information through a searchable governmental website that can be accessed by patients and journalists alike has the potential to tarnish individual neurosurgeons and undermine professional credibility. CMS, Centers for Medicare & Medicaid ServicesOPD, Open Payments Database.

United States Medical Licensing Examination Step 1 Scores Directly Correlate with American Board of Neurological Surgery Scores: A Single-Institution Experience

Neurosurgery residency is becoming an increasingly competitive match. The process of screening and ranking applicants is a multifactorial process that lacks uniformity across residency programs. A significant factor is the applicant's performance on the United States Medical Licensing Examination (USMLE) Step 1. USMLE Step 1 scores are often used to project future success in residency and performance on specialty boards like the American Board of Neurological Surgery (ABNS) examination. The authors of this study investigate the strength of correlations between USMLE Step 1 and ABNS scores. Data were extracted from records of graduating residents from the neurosurgery residency program at the University of California, Los Angeles, between 2003 and 2010. Twenty-one residents were selected. USMLE Step 1 scores were deidentified and paired with ABNS scores. Correlation and regression analyses were performed. Higher USMLE Step 1 scores significantly correlated with higher ABNS scores (P= 0.01; Spearman correlation coefficient, 0.7). USMLE Step 1 and ABNS scores are directly correlated. USMLE Step 1 scores will continue to be a valuable measure of projected success on ABNS written examinations, but more sophisticated measures are needed.

325 Maintenance of Certification and the Aging Neurosurgeon

INTRODUCTION: Assuring clinical competence in the aging neurosurgeon is of paramount importance for patient safety. The American College of Surgeons and the American Medical Association have both developed position statements on the aging surgeon. Cognition, technical dexterity, and physical status vary greatly among individuals. Determining how educational methods can optimally be delivered to senior neurosurgeons, and understanding neurosurgeon perceptions, will help create the most appropriate resources. We present the first wide-scale survey of neurosurgeons to evaluate perceptions of Maintenance of Certification (MOC) and testing of the aging neurosurgeon. METHODS: We developed a validated, online, confidential survey and administered it to 4899 neurosurgeons (2435 American Board of Neurological Surgery (ABNS) Diplomates participating in MOC, 1440 Diplomates certified prior to 1999 (grandfathered), and 1024 retired Diplomates). We received 1247 responses overall (25% response rate). RESULTS: Most respondents (65%) were aged 50 and older. Overall, the majority of respondents (62%) believed that the aging neurosurgeon (defined as 65 years of age and older) should undergo additional testing, including cognitive assessment or a review of cases, in addition to a standard MOC examination. Sixty-seven percent of respondents believed there should be no absolute age cutoff at which neurosurgical practice is forced to end. If asked to select an age at which neurosurgical practice should cease, 29% recommended 70 years of age. Forty-two percent of respondents believed that MOC should be tailored to accommodate the aging neurosurgeon. The majority of respondents (59%) believed that MOC should consist of a review of individual case logs and patient outcomes for the aging neurosurgeon. CONCLUSION: Appropriately assessing the aging neurosurgeon is important to protect patient safety and also maximize the capacity of an aging neurosurgical workforce. This first of its kind comprehensive survey of neurosurgeon diplomates of the ABNS provides important information as to what evaluation mechanisms can be created to fairly evaluate aging neurosurgeons.