Neurological Surgery Residency Research Articles

Match rate of neurosurgery residents in the United States at their home institution: A comparative analysis of Pre COVID-19, During COVID-19 and Post COVID-19 pandemic

ObjectiveLimitations to medical student clinical rotation opportunities brought on by the pandemic has the potential to exacerbate differences in access to clinical experience between medical schools, and thus impact the distribution of graduates matching into neurosurgical programs nationwide. The utilization of virtual interviews that started after the pandemic are likely here to stay. In this study we seek to evaluate match rates for American (AMGs) and international medical graduates (IMGs) across the 6 most recent academic years, examining specifically the rate of home-institution matching before, during, and after the COVID-19 pandemic. MethodsAll neurological surgery residents for the years 2018–2024 were included in this analysis, with basic information about each resident being collected using publicly available online resources. For any remaining programs where information was not publicly available, program directors were contacted. Statistical analysis was performed using SPSS version 26.0 with a level of significance p<0.05. ResultsOf the total of 1271 AMGs, 1005 (79.1 %) matched away from their home institution. When dividing the 6 academic years into 3 subgroups (pre, intra, and post COVID-19), there was no significant variation between the rates of home institution matching (pre=21.0 %, during=20.4 %, post=21.3 %, p=0.740). Similar results were found while assessing IMGs (pre=28.6 %, during=30.8 %, post=32.3 %, p=0.777). Our analysis found no variation in match rates when isolating for gender across the 6 years studied either for AMGs or IMGs. However, overall institute-specific variations were found where some programs showed increased likelihood of home program match (p<0.001). ConclusionPreliminary data analysis suggests that contrary to the broader trends seen in other specialties, neurosurgery applicants do not exhibit a significant shift towards matching in closer proximity to their home institutions post COVID-19 pandemic and during the virtual interviews era.

819 Pre-residency Research Output Amongst U.S. Neurological Surgery Residents

INTRODUCTION: Research productivity is often used in evaluating candidates for neurosurgery residency. Official Match data report successful candidates have on average ∼25 pre-residency research products; however, average number of indexed publications, the highest-valued research product, is not reported separate from other research products. METHODS: A list of all US neurosurgery residents who successfully matched between 2017-2021 was generated and narrowed to US MD seniors who applied to the authors’ institution. Each resident’s pre-residency publication quantity was extracted using Scopus. Additional variables were extracted from residency applications. RESULTS: 93.2% of all matched neurosurgery applicants from 2017 through 2021 were captured. Distribution of publication quantity was right skewed. Mean ± SD total, neuroscience-specific, and first-author pre-residency publications for applicants who matched in 2021 were 8.1 ± 10.0, 6.6 ± 8.7, and 2.3 ± 3.8 respectively. Median (IQR) total, neuroscience-specific, and first-author pre-residency publications were 5.0 (2.0, 11.0), 4.0 (1.5, 9.0), and 1.0 (0.0, 3.0) respectively. There was a statistically significant increase in average total, neuroscience-specific, and first-author publications from 2017 to 2021 (p &lt; 0.001). Multivariable analysis demonstrated an independent, positive association between class year and publication quantity (1.07 (0.71-1.42), p &lt; 0.001). CONCLUSIONS: Indexed publications constitute a small portion of total research products successful neurosurgery candidates apply with. A high number of publications is not necessary to match with approximately 50% of all applicants who successfully matched having fewer than five publications and 25% having fewer than two. That said, average pre-residency publication quantity is increasing over time at a rate of approximately one publication per year.

816 Comparing Match Data for Neurological and Orthopaedic Surgery Applicants From 2016-2022: Is There a Point of Diminishing Return for Research Experiences and Publications?

INTRODUCTION: The application process for neurological surgery (NSGY) and orthopaedic surgery (Ortho) residency positions is highly competitive. Prior work has characterized variables associated with improved match rates; however, limited analyses have been published in recent years. METHODS: Data on the characteristics of NSGY and Ortho applicants was obtained from the National Residency Matching Program Interactive Charting Outcomes in the Match tool from 2016 to 2022. The POM was computed for each subgroup classification available for applicant characteristics. RESULTS: Applicant characteristics that correlated with an improved POM into both NSGY and Ortho included increasing USMLE Step 1 and Step 2 scores, being a US MD Senior, number (#) of contiguous ranks (a proxy for # of interviews), # of volunteer experiences, and being a member of AOA. An increasing # of publications correlated with an increased POM until 25+ were reported for NSGY applicants but only until more than 11-15 were reported for Ortho applicants. A PhD correlated positively with the POM for NSGY applicants but negatively for Ortho applicants. Non-PhD graduate degrees correlated negatively with the POM for both NSGY and Ortho applicants. An increasing # of work experiences correlated negatively with the POM for NSGY applicants at all levels, and correlated negatively with the POM for Ortho applicants after 3-5 were reported. CONCLUSIONS: There appeared to be a point of diminishing return where an increasing number of publications no longer increased the probability of matching for both NSGY and Ortho applicants. Non-PhD graduate degrees did not improve the POM. Ranking more programs was associated with a higher POM for both NSGY and Ortho applicants, suggesting an incentive to take as many interviews as possible if not otherwise restricted.

430 Academic Productivity of Neurosurgical Trainees Is Associated With Productivity of Gender Concordant Faculty

INTRODUCTION: Mentorship disparity is a commonly cited barrier to female neurosurgery trainees. The extent to which gender concordance with faculty impacts trainees’ academic productivity is underexplored. METHODS: The website of each ACGME accredited neurological surgery residency program was queried to identify the name and gender of all current (2022-2023) neurosurgical residents and academic faculty. Academic productivity, defined as the number of publications per person between 2021-2023 in 15 neurosurgery journals, was compiled into an original database. For each program, the average number of publications per female and male faculty and resident were recorded. Pearson correlation coefficients were calculated. RESULTS: A total of 959 faculty (female: 121, 12.6%) and 790 residents (female: 179, 22.7%) across 112 programs were identified. Forty (38%) programs had no female faculty; 32% had no female residents. The absence of female faculty was not statistically associated with the absence of female residents. In programs with only male faculty, academic productivity of male attendings was negatively associated with that of female residents (-0.47, p 0.0104). CONCLUSIONS: Academic productivity of male faculty correlates with productivity of male residents in their program; this relationship is not observed between faculty and residents of opposite genders. In programs with only male faculty, faculty productivity is inversely correlated with productivity of female residents. These findings reveal limited collaboration between residents and faculty of the opposite gender as a potential barrier to academic productivity. Furthermore, efforts to promote effective cross-sex collaboration could increase productivity for all members of neurosurgery divisions.

322 A Cost Analysis of Medical Students Applying to Neurological Surgery Residency: An Analysis of the Texas STAR Database

INTRODUCTION: Medical Students applying to competitive residencies such as neurosurgery incur substantial costs associated with interviews, away rotations, and application fees. Researchers in the past have examined the sources of expenses during the residency application cycle, but few studies have compared the expenses prior to and during the COVID-19 pandemic. METHODS: The TEXAS STAR database was surveyed for applicants of neurosurgical residency programs during the COVID-19 pandemic (2021) and post-pandemic (2022). In total, 66 applicants for the 2021 application cycle and 50 applicants for the 2022 application cycle completed the survey. We compared the application fees, away rotations cost, interview cost, and total expenses as reported by the neurosurgery applicants of the 2021 and 2022 application cycle. A Shapiro-Wilk test was used to test for data normality, and a Mann-Whitney U-Test was used to compare costs during the 2021 and 2022 neurosurgery application cycle. RESULTS: There was a statistically significant reduction in total expenses in 2021 vs 2022 ($3,934 vs $9,860). Interview expenses and away rotation expenses were also decreased in 2021 vs 2022 (interview expenses $786 vs $4511, away rotation $1,083 vs $3,000, p &lt; 0.001). Application fee expenses were not different between the 2021 and 2022 application cycle. Regional stratification revealed the greatest reduction in cost, an $11,908 savings, in the South region for the year of 2021. CONCLUSIONS: Our study revealed that the COVID-19 pandemic caused a significant reduction in the total fees associated with the neurosurgical residency application. The use of virtual platforms in place of in-person interviews could lessen the financial burden on applicants and alleviate socioeconomic barriers in the neurosurgical application process even after COVID-19.

Preresidency research output among US neurological surgery residents.

Research productivity is often used to evaluate candidates for neurosurgery residency. Official annual reports describe the mean total number of research products of successful applicants for each match cycle; however, the average number of indexed publications, the highest-valued research product, is not reported separately from other research products. The primary objectives of this study were to describe the distribution of preresidency indexed publication quantity among successful neurosurgery applicants from 2017 to 2021 and determine whether any change in publication quantity across application cycles existed. Secondary objectives included determining the rate at which the average publication quantity is increasing across application cycles, whether this increase is driven by high-output applicants alone, and if a performance ceiling has been reached. US doctor of medicine seniors applying to the senior author's institution between 2017 and 2021 and who successfully matched into any US neurosurgery program were included. Publication quantities were extracted using Scopus. Additional variables were extracted from residency applications. Mean (SD) and median (IQR) publication quantities were used to describe the distribution and compare across years. Applicants were ranked by descending publication count and divided into quartiles. Averages within each quartile were compared with respective quartiles across years. Averages of the top 10% most productive applicants were compared across years to determine if a performance ceiling existed. Overall, 93.2% of matched applicants were captured. The mean and median total numbers of publications for applicants who matched from 2017 to 2021 were 5.6 ± 8.3 and 3.0 (1.0, 7.0), respectively. The mean and median numbers of publications increased from 3.7 ± 5.3 and 2.0 (0.0, 5.0) in 2016-2017 to 8.1 ± 10.0 and 5.0 (2.0, 11.0) in 2020-2021 (p < 0.001). The distribution of publication quantity was right-skewed. Multivariable analysis determined the application year to be independently and positively correlated with publication quantity (β 1.07 [95% CI 0.71-1.42], p < 0.001). All quartiles observed an increased average number of publications across years (p < 0.001). The mean and median numbers for the top 10% increased from 15.8 ± 8.7 and 13.0 (10.8, 15.5) in 2016-2017, respectively, to 31.3 ± 16.0 and 25.0 (21.0, 35.5) in 2020-2021 (p < 0.001). Indexed publications account for a small portion of the total research products that successful neurosurgery candidates list on applications. A high number of publications is not necessary for candidates to match, with approximately 50% of all applicants who successfully matched having ≤ 5 publications and 25% having ≤ 2 publications. The average preresidency publication quantity has been increasing yearly among neurosurgery applicants. This increase was present across the applicant pool. Additionally, no performance ceiling was observed.

Factors impacting neurosurgery residents' operative case volume: a nationwide survey.

Neurological surgery residency remains one of the most competitive and longest specialties in terms of training in medicine. The Accreditation Council for Graduate Medical Education uses residents' case volume throughout residency as one of its measures for the quality of surgical training. The objective was to study the variability of residency case volume among US training programs and to analyze the factors that potentially influence that case volume. In line with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines, an online survey regarding department size, case volume, number of residents per year, number of dedicated research years, presence of fellows, and resident case volume by the time of graduation was created using Google Forms and distributed to all neurosurgery residency program directors and coordinators in the US. A total of 97 of the 115 programs (84.3%) responded to the survey. Fifteen programs were excluded due to missing data or incomplete resident cohort at the time of the survey, and a total of 82 programs were included in the analysis. The average number of cases performed by residents as lead or senior surgeons by the time of graduation ranged from 900 to 2250 (median 1600 cases). The resident case volume did not have a significant correlation with the program case volume, number of operating attending neurosurgeons, number of residents, number of research years, or presence of fellows. The only factor that impacted the resident case volume was the number of cases performed per faculty. The number of cases performed by residents throughout residency varied significantly between programs. Although other factors play important roles in the quality of training, including autonomy, variation, and complexity of cases, the resident case volume is one of the only measurable factors. This study sheds some light on the factors that potentially influence neurosurgical resident case volume.

Innovative growth and development of a neurological surgery residency cadaveric spine-simulation training program: a single-institution experience.

Cadaveric and dry 3D model-based simulation training is a valuable educational tool for neurosurgical residents. Such simulation training is an opportunity for residents to hone technical skills and decision-making and enhance their neuroanatomy knowledge. The authors describe the growth and development of the Oregon Health & Science University Department of Neurological Surgery resident-focused, hands-on, spine-simulation surgery courses and provide details of course evaluations, layout, and setup. A four-part spine surgical simulation series, including two human cadaveric and two dry 3D model-based courses, was created to provide resident spine procedure training. Residents participated in the spine simulation series (2017-2021) and completed annual course curriculum and anonymous post-course evaluations. Evaluations included both Likert scale items and free-text responses. Responses to Likert scale items were analyzed in Python. Free-text responses were quantified using the Valence Aware Dictionary for Sentiment Reasoner. Descriptive statistics were calculated and plotted using Python's seaborn and matplotlib library modules. The analysis included 129 spine (occipitocervical, thoracolumbar, and spine model fusion I and II) simulation course evaluations. Likert responses demonstrated high average responses for evaluation questions (4.67 ± 0.90 and above). The average compound sentiment value was 0.58 ± 0.28. This is the first time Likert responses and sentiment analysis have been used to demonstrate how neurosurgical residents positively value a hands-on spine simulation training. Simulation is an essential component of neurosurgical resident education training. The authors encourage other neurosurgical education programs to develop and leverage spine simulation as a teaching tool.

In Reply: The Evolving Role of Postgraduate Year 7 in Neurological Surgery Residency.

In Reply: The Evolving Role of Postgraduate Year 7 in Neurological Surgery Residency.

Effect of online public domain representation in neurosurgical resident recruitment and decision-making

OBJECTIVE Over the past 20 years, female representation in neurosurgical residency programs has steadily increased. Still, the number of Black women and Black neurosurgical residents overall has remained stagnant. The authors aimed to understand the factors that led to this stagnation and how online public domain representation informs current and upcoming resident recruitment and decision-making. METHODS The authors performed a retrospective study using the following public domain sources: Doximity, neurosurgical residency program websites, and LinkedIn. The authors collected data from all neurosurgery residents who matriculated into a US neurosurgical residency program from 2015 to 2022. Variables, including name, race, gender, year of matriculation, medical school, and undergraduate institution, were recorded. RESULTS The authors analyzed resident data from 110/113 (97.3%) US neurological surgery residency programs. Of these programs, 106 (96.4%) matriculated and retained ≥ 1 female resident over the study period. There were 408 (22.6%) female neurosurgical residents, with 37 (33.6%) programs accounting for 57.8% of all female neurosurgical residents. For those states with a female resident, the lowest percentage of female residents by state was in Iowa (6.25%) and the highest was in New Hampshire (50%). Of all programs, 60 (54.5%) matriculated and retained ≥ 1 Black resident over the study period. There were 88 (4.9%) Black neurosurgical residents, with 19 (17.3%) programs accounting for 55.7% of all Black neurosurgical residents. For those states with a Black resident, the lowest percentage of Black residents by state was in Maryland (2.0%) and the highest was in Arkansas (23.1%). CONCLUSIONS Recruiting and retaining female and Black residents has increasingly become a focus of neurosurgical programs across the country. The authors’ data show that female and Black residents overwhelmingly choose to apply to and matriculate into programs that demonstrate a commitment to diversity via their online presence. Programs wishing to recruit more diverse residents should make efforts to relay their dedication to diversity, inclusion, and performance through their online presence.

Surgical Specialty Impacts Quality of Operative Training in Carotid Endarterectomy

Carotid endarterectomy (CEA) is currently performed by multiple surgical specialties. The impact of surgical specialty and operative volume on post-CEA outcomes has been well described. However, it is unclear whether trainees of different surgical specialties have similar quality of operative training. Data from Accreditation Council for Graduate Medical Education annual reports were collected and compared between graduating vascular surgery (VS) residents, VS fellows, and neurological surgery (NS) residents. Only cases reported as chief/senior/lead resident, surgeon junior, or surgeon fellow were included in analysis. Linear regression analysis was utilized to evaluate trends in case-mix and volume. From 2013 to 2022, total CEA case volume was higher among VS residents and fellows, compared to NS residents (52.8±0.8 vs. 44.3±1.4 vs. 12.9±0.6, P<0.0001). Additionally, VS residents and fellows performed other carotid operations including transfemoral or transcarotid artery stenting (11.1±0.9 vs. 11.2±0.8 vs. 0), carotid body tumor resection (0.7±0.1 vs. 0.7±0.0 vs. 0), and extracranial cervical bypass (6.7±0.3 vs. 6.3±0.3 vs. 0) that were not reported by the NS resident cohort (P<0.0001 each). On linear regression analysis, total CEA procedures did not change for VS residents (R2=0.03, P=0.62), decreased for VS fellows (-1.29 cases/yr, R2=0.75, P<0.0001), and decreased among NS residents (-0.41 cases/yr, R2=0.44, P=0.01) over the study period. Although residents of multiple surgical specialties are trained in CEA, vascular training offers significantly greater numbers and diversity of extracranial carotid cases. It also appears that CEA volume is decreasing among neurosurgical trainees. In light of recent reports on the volume-outcome effect in carotid surgery, these data may have implications for future practice patterns in the domain of extracranial carotid artery disease.

A cost analysis of medical students applying to neurological surgery residency: An analysis of the Texas STAR database

IntroductionMedical Students applying to neurosurgery residency programs incur substantial costs associated with interviews, away rotations, and application fees. However, few studies have compared expenses prior to and during the COVID-19 pandemic. This study evaluates the financial impact of COVID-19 on the neurosurgery residency application and identifies strategies that may alleviate the financial burden of prospective neurosurgery residents. MethodsThe TEXAS STAR database was surveyed for applicants of neurosurgical residency programs during the COVID-19 pandemic (2021) and post-pandemic (2022). 66 applicants for the 2021 application cycle and 50 applicants for the 2022 application cycle completed the survey. We compared application fees, away rotations cost, interview cost, and total expenses as reported by the neurosurgery applicants of the 2021 and 2022 application cycle. A Shapiro-Wilk test was used to test for data normality, and a Mann-Whitney U-Test was used to compare costs during the 2021 and 2022 neurosurgery application cycle. ResultsThere was a statistically significant reduction in total expenses in 2021 vs 2022 ($3,934 vs $9,860). Interview and away rotation expenses decreased in 2021 vs 2022 (interview expenses $786 vs $4511, away rotation $1,083 vs $3,000, p < 0.001). Application fee expenses were not different between 2021 and 2022. The greatest reduction in application cost ($11,908) was seen in the South for 2021. ConclusionsThe COVID-19 pandemic significantly reduced total fees associated with the neurosurgical residency application. Virtual platforms in place of in-person interviews could lessen the financial burden on applicants and alleviate socioeconomic barriers in the neurosurgical application process after COVID-19.

Neurological Surgery Residency Programs in the United States: A National Cross-Sectional Survey.

The Accreditation Council for Graduate Medical Education has approved 117 neurological surgery residency programs which develop and educate neurosurgical trainees. We present the current landscape of neurosurgical training in the United States by examining multiple aspects of neurological surgery residencies in the 2022-2023 academic year and investigate the impact of program structure on resident academic productivity. Demographic data were collected from publicly available websites and reports from the National Resident Match Program. A 34-question survey was circulated by e-mail to program directors to assess multiple features of neurological surgery residency programs, including curricular structure, fellowship availability, recent program changes, graduation requirements, and resources supporting career development. Mean resident productivity by program was collected from the literature. Across all 117 programs, there was a median of 2.0 (range 1.0-4.0) resident positions per year and 1.0 (range 0.0-2.0) research/elective years. Programs offered a median of 1.0 (range 0.0-7.0) Committee on Advanced Subspecialty Training-accredited fellowships, with endovascular fellowships being most frequently offered (53.8%). The survey response rate was 75/117 (64.1%). Of survey respondents, the median number of clinical sites was 3.0 (range 1.0-6.0). Almost half of programs surveyed (46.7%) reported funding mechanisms for residents, including R25, T32, and other in-house grants. Residents received a median academic stipend of $1000 (range $0-$10 000) per year. Nearly all programs (93.3%) supported wellness activities for residents, which most frequently occurred quarterly (46.7%). Annual academic stipend size was the only significant predictor of resident academic productivity (R 2 = 0.17, P = .002). Neurological surgery residency programs successfully train the next generation of neurosurgeons focusing on education, clinical training, case numbers, and milestones. These programs offer trainees the chance to tailor their career trajectories within residency, creating a rewarding and personalized experience that aligns with their career aspirations.

The Evolving Role of Postgraduate Year 7 in Neurological Surgery Residency.

In 2013, all neurosurgery programs were mandated to adopt a 7-year structure. We sought to characterize how programs use the seventh year of training (postgraduate year 7 [PGY7]). We surveyed all accredited neurosurgery programs in the United States regarding the PGY7 residents' primary role and the availability of enfolded fellowships. We compiled responses from different individuals in each program: chair, program director, program coordinator, and current chiefs. Of 120 accredited neurological surgery residency programs within the United States, 91 (76%) submitted responses. At these programs, the primary roles of the PGY7 were chief of service (COS, 71%), enfolded fellowships (EFF, 18%), transition to practice (10%), and elective time (1%). Most residencies have been 7-year programs for >10 years (52, 57%). Sixty-seven programs stated that they offer some form of EFF (73.6%). The most common EFFs were endovascular (57, 62.6%), spine (49, 53.9%), critical care (41, 45.1%), and functional (37, 40.7%). These were also the most common specialties listed as Committee on Advanced Subspecialty Training accredited by survey respondents. Spine and endovascular EFFs were most likely to be restricted to PGY7 (24.2% and 23.1%, respectively), followed by neuro-oncology (12, 13.2%). The most common EFFs reported as Committee on Advanced Subspecialty Training accredited but not restricted to PGY7 were endovascular (24, 26.4%) and critical care (23, 25.3%). Most accredited neurological surgery training programs use the COS as the primary PGY7 role. Programs younger in their PGY7 structure seem to maintain the traditional COS role. Those more established seem to be experimenting with various roles the PGY7 year can fill, including enfolded fellowships and transition-to-practice years, predominantly. Most programs offer some form of enfolded fellowship. This serves as a basis for characterization of how neurological surgery training may develop in years to come.

Neurosurgery residency rankings: An assessment of Doximity’s survey-based data and objective program characteristics

BackgroundMedical students often consult residency program reputation rankings whilst creating residency program rank lists. Accurate assessment of a residency program remains a cumbersome task, primarily due to varying degrees of interpretation and bias. The Doximity Residency Navigator (DRN) is a tool used to assist medical students in making informed residency decisions whilst simultaneously increasing transparency in the residency match process. DRN is comprised of data that assist applicants research prospective training programs, including reputation rankings across specialties, resident and alumni satisfaction surveys, and objective statistics such as training program size and research output. ObjectiveThis study aims to evaluate the correlation between different Doximity rankings across neurosurgical residency programs. MethodsRankings and the relevant criteria (reputation, research output, and percentage of graduates that subspecialize) and program size for all neurological surgery residency programs in the United States were obtained from the 2020–2021 Doximity Residency Navigator. Independent correlation analyses were run to ascertain the relationship between reputation ranking and 1) program size, 2) research output ranking and 3) ranking of the percentage of graduates who subspecialize. ResultsThe reputation rankings of neurosurgical residency programs are determined, in part, by nomination surveys completed by board-certified physicians. A statistically significant correlation was observed between reputation ranking and 1) program size and 2) research output ranking. ConclusionReputation rankings of neurosurgical residency programs put forth by Doximity Inc. incorporate reputational data and other objective outcome criteria. A nuanced understanding of the Doximity rankings will facilitate its use by medical students and healthcare professionals.

Impact of Specialty on Cases Performed During Spine Surgery Training in the United States

Two general pathways exist for spine surgery training in the United States: orthopedic surgery and neurological surgery. Previous studies have not quantified the impact of fellowship training when comparing case volumes between these 2 training pathways. This study compares reported spine surgery case volume upon graduation from orthopedic surgery and neurological surgery training. This was a retrospective cohort study of recent graduates from orthopedic surgery and neurological Surgery training programs in the United States (2018-2021). The Accreditation Council for Graduate Medical Education provided case logs for residents in neurological surgery and orthopedic surgery as well as fellows in orthopedic spine surgery. Case volumes were compared for adult and pediatric spine surgery cases using parametric tests. Case logs from 3146 orthopedic surgery residents, 107 orthopedic spine surgery fellows, and 766 neurological surgery residents were included in this study. Across each cohort, neurological surgery trainees reported more total adult spine surgery cases than orthopedic surgery trainees (514±206 vs. 383±171, P < 0.001). Orthopedic surgery trainees reported more total pediatric spine surgery cases (21±14 vs. 17±12, P= 0.006). Neurological surgery training affords a greater volume of adult spine surgery cases, but orthopedic surgery affords more pediatric spine surgery cases. Identification of relative strengths and weaknesses can help facilitate multidisciplinary training experiences in spine surgery.

414 Competitive Advantage: An Analysis of Matched and Unmatched United States Neurological Surgery Residency Applicants From 2009-2021

INTRODUCTION: National Resident Matching Program releases a detailed report of residency match statistics for each specialty. Securing a training position in a United States neurological surgery residency program is notoriously competitive, and the subspecialty has long maintained a match rate much lower than other specialties. There remains a paucity of recently studied longitudinal trends in academic and extracurricular characteristics of successfully matched neurological surgery residency applicants. METHODS: Residency applicant self-reported data, obtained from the American Association of Medical Colleges Electronic Residency Application Service, were collected from yearly “Results and Data: Main Residency Match” (2009-2021) and biennial “Charting Outcomes in the Match” (2009-2020) National Residency Match Program summary reports. RESULTS: From 2009-2021, the number of neurological surgery residency programs and positions increased from 97 to 115 and 191 to 234, respectively. Matched applicants’ average United States Medical Licensing Exam (USMLE) Step 1 scores significantly increased (239 to 248; p = 0.01332), while average USMLE Step 2 Clinical Knowledge scores rose (237 to 252; p = 0.05682) during the study period. Average number of distinct research experiences among matched applicants increased (3.3 to 6.1; p = 0.5398), while the average number of abstracts, presentations, and publications increased from 7.8 to 23.4 (p = 0.0746). Lastly, Alpha Omega Alpha (AOA) membership (p = 0.00077) and percentage graduating from a top National Institutes of Health-funded medical school (p = 0.00396) significantly differed between matched and unmatched neurological surgery residency applicants. CONCLUSIONS: Matched neurological surgery residency applicants had significantly fewer average number of distinct specialties ranked, higher USMLE Step 1 scores, greater AOA membership, and more frequently graduated from top 40 NIH-funded medical schools than their unmatched counterparts. Additional research considering applicant-level intersectional data is warranted to further understand the match process.

Analysis of Current Neurological Surgery Residents and Prior Medical Education: Do Medical School Attributes Matter?

With the recent changes to the U.S. Medical Licensing Examination grading system, an understanding of the factors that influence the neurological surgery residency match process is crucial for residency directors. The aim of the present retrospective study was to explore the associations of medical school location, ranking, private school status, size, and presence of an American Association of Neurological Surgeons (AANS) chapter or neurological surgery interest group (NSIG) with the neurosurgery match outcomes. An enrollment list of all accredited U.S. neurosurgery residency programs was compiled on June 28, 2021. For the included residents, the residency program, degree, and previously attended medical school were retrieved. The geographic location, ranking, private school status, and size were collected for the residency programs and medical schools attended by the residents at each program. A total of 1437 residents from 101 neurosurgery residency programs (89%) were included. Graduates from the top 25 medical schools were more likely to match into their home residency programs (P < 0.001) and highly ranked residency programs (P < 0.001). Students from larger medical schools were also more likely to match into larger (P < 0.001) and highly ranked (P < 0.001) programs than were applicants from smaller schools. Students from medical schools with an AANS chapter or NSIG were also more likely to match into top ranked programs (P < 0.001 for both). Medical students from the top 25 medical schools, private medical schools, medical schools with an AANS chapter, and medical schools with an NSIG were more likely to match into a prestigious residency program. These findings suggest that underlying biases might be present for program directors to consider in the resident selection process.

Innovative growth and development of a neurological surgery residency cadaveric skull base simulation training program: A single institution experience

ObjectiveNeurosurgical cadaveric and simulation training is a valuable opportunity for residents and fellows to develop as neurosurgeons, further neuroanatomy knowledge, and develop decision-making and technical expertise. The authors describe the growth and development of Oregon Health & Science University (OHSU) Department of Neurological Surgery (NSG) resident hands-on simulation skull base course and provide details of course layout and setup. MethodsA three-part surgical simulation series was created to provide training in cadaveric skull base procedures. Course objectives were outlined for participants. Residents participated in NSG hands-on simulation courses (years 2015–2020) and completed annual course curriculum and anonymous course evaluations, which included free text reviews. Courses were evaluated by Likert scale analysis within Python, and free text was quantified using Valence Aware Dictionary for sEntiment Reasoning (VADER). Descriptive statistics were calculated and plotted using Python’s Seaborn and Matplotlib library modules. ResultsAnalysis included 162 skull base (anterior fossa, middle fossa and lateral, and endoscopic endonasal-based) simulation course evaluations. Resident responses were overwhelmingly positive. Likert responses demonstrated high average responses for each question (4.62 ± 0.56 and above). A positive attitude about simulation courses is supported by an average compound sentiment value of 0.558 ± 0.285. ConclusionThis is the first time Likert responses and sentiment analysis have been used to demonstrate how neurosurgical residents view a comprehensive, multi-year hands-on simulation training program. We hope the information presented serves as a guide for other institutions to develop their own residency educational curriculum in cadaveric skull base procedures.

An Operating Room, Transformed.

An Operating Room, Transformed.