Neurosurgery Residents Research Articles

Neurosurgical Practice, Training, and Research Capacity Assessment in Nigeria: A Methodological Approach

There has been a progressive growth of neurosurgery in Nigeria over the past 6 nulldecades. This study aims to comprehensively evaluate the state of neurosurgical practice, training, and research in the country. We used a mixed-methods approach that combined a survey of neurosurgery providers and a systematic review of the neurosurgical literature in Nigeria. The 83-question online survey had 3 core sections for assessing capacity, training, and gender issues. The systematic review involved a search of 4 global databases and gray literature over a 60-year period. One hundred and forty-nine respondents (95% male) completed the survey (65.4%). Their age ranged from 20 to 68years, with a mean of 41.8 (±6.9) years. Majority were from institutions in the nation's South-West region; 82 (55.0%) had completed neurosurgery residency training, with 76 (51%) employed as consultants; 64 (43%) identified as residents in training, 56 (37.6%) being senior residents, and 15 (10.1%) each held academic appointments as lecturers or senior lecturers. The literature review involved 1,023 peer-reviewed journal publications: 254 articles yielding data on 45,763 neurotrauma patients, 196 on 12,295 pediatric neurosurgery patients, and 127 on 8,425 spinal neurosurgery patients. Additionally, 147 papers provided data on 5,760 neuro-oncology patients, and 56 on 3,203 patients with neuro-vascular lesions. Our mixed-methods approach provided significant insights into the historical, contemporary, and future trends of neurosurgery in Nigeria. The results could form the foundation for policy improvement; health-system strengthening; better resource-planning, prioritization, and allocation; and more purposive collaborative engagement in Nigeria and other low- and middle-income countries.

Availability and utilization of molecular testing for primary central nervous system tumors among US hospitals.

Advanced molecular testing has increasingly become an integral component for accurate diagnosis of central nervous system (CNS) tumors. We sought to establish the current state of molecular testing availability and approaches for the diagnosis of CNS tumors in US hospitals that conduct high volumes of CNS tumor resections. We distributed a 16-item survey inquiring about molecular testing approaches for CNS tumors to 115 neuropathologists at US hospitals with neurosurgery residency programs. Thirty-five neuropathologists (30.4%) responded to the survey, all of whom indicated their institutions perform molecular testing on CNS tumor tissue. The most commonly offered tests were MGMT methylation profiling and next-generation sequencing. Fourteen respondents (40%) indicated that their institution is able to test for and report all of the molecular alterations included in our survey. Nine (25.7%) respondents indicated that molecular testing is performed as standard of care for all patients with resected CNS tumors. Our results suggest that even in academic hospitals with a high volume of CNS tumor resections, molecular testing for these tumors is limited. Continued initiatives are necessary to expand the availability of molecular testing for CNS tumors to ensure diagnostic accuracy and guide targeted therapy.

Quantitative assessment and objective improvement of the accuracy of neurosurgical planning through digital patient-specific 3D models.

Neurosurgical patient-specific 3D models have been shown to facilitate learning, enhance planning skills and improve surgical results. However, there is limited data on the objective validation of these models. Here, we aim to investigate their potential for improving the accuracy of surgical planning process of the neurosurgery residents and their usage as a surgical planning skill assessment tool. A patient-specific 3D digital model of parasagittal meningioma case was constructed. Participants were invited to plan the incision and craniotomy first after the conventional planning session with MRI, and then with 3D model. A feedback survey was performed at the end of the session. Quantitative metrics were used to assess the performance of the participants in a double-blind fashion. A total of 38 neurosurgical residents and interns participated in this study. For estimated tumor projection on scalp, percent tumor coverage increased (66.4 ± 26.2%-77.2 ± 17.4%, p = 0.026), excess coverage decreased (2,232 ± 1,322 mm2-1,662 ± 956 mm2, p = 0.019); and craniotomy margin deviation from acceptable the standard was reduced (57.3 ± 24.0 mm-47.2 ± 19.8 mm, p = 0.024) after training with 3D model. For linear skin incision, deviation from tumor epicenter significantly reduced from 16.3 ± 9.6 mm-8.3 ± 7.9 mm after training with 3D model only in residents (p = 0.02). The participants scored realism, performance, usefulness, and practicality of the digital 3D models very highly. This study provides evidence that patient-specific digital 3D models can be used as educational materials to objectively improve the surgical planning accuracy of neurosurgical residents and to quantitatively assess their surgical planning skills through various surgical scenarios.

Simulation-based Training for Neurology and Neurosurgery Residents in ICU Procedures (P4-7.002)

Simulation-based Training for Neurology and Neurosurgery Residents in ICU Procedures (P4-7.002)

A realistic aneurysm clipping simulation combining 3D-printed and placenta-based models-how I do it.

Neurovascular surgery, particularly aneurysm clipping, is a critical skill for aspiring neurosurgeons. However, hands-on training opportunities are limited, especially with the growing popularity of endovascular techniques. To address this challenge, we present a novel neurovascular surgical training station that combines synthetic 3D-printed models with placental vascular structures to create a semi-realistic surgical field. Our model consists of three components: a 3D-printed skull replica with anatomical landmarks, a malleable silicone parenchyma with a Sylvian fissure, and vascular layers (placenta). The placental vascular layer is catheterized and perfused to replicate pulsatile flow, offering a realistic aneurysm simulation. This innovative training station provides a cost-effective solution (approximately 200 USD once) without ethical constraints. Surgeons can practice essential skills such as Sylvian fissure dissection, managing anatomical constraints like bone, and achieving proximal vascular control. The model's realism allows for training in various scenarios, including clipping with different hand orientations and handling ruptures realistically. Our neurovascular surgical station bridges the gap between existing training models, offering affordability, ecological considerations, and minimal ethical concerns. It empowers neurosurgery residents to refine their skills in handling both emergencies and elective cases under close-to-real surgical conditions, with the potential for independent practice and senior supervision.

The effect of surgeon’s pose and duration of operation on movement accuracy and level of microsurgical hand tremor

Background. Physiological hand tremor is one of significant problems in microsurgical technique. One careless movement can cause damage to the neighboring structures and consequently worsen a patient’s condition. Therefore, the problem of reducing hand tremor remains relevant.Aim. To determine the effect of microsurgeon’s pose, duration of operation on the accuracy of surgical action and level of microsurgical hand tremor.Materials and methods. The study included 14 neurosurgery residents satisfying inclusion criteria. For evaluation and simulation of microsurgical action, validated and developed by the study authors devices for testing and surgical microscope Carl Zeiss were used. The experimental results were compared using univariate analysis. The differences were considered statistically significant at p <0.05.Results. Surgeon’s pose standing / sitting did not affect spatial accuracy of surgical action and the level of microsurgical hand tremor. However, statistically significant changes in hand tremor were observed both in standing and sitting positions with increased time of microsurgical action.Conclusion. The choice between sitting or standing pose for microsurgical operation is not a factor significantly affecting microsurgeon’s spatial accuracy of movement and hand tremor. Duration of surgical intervention affects the level of microsurgical hand tremor.

421 GPT-4 Artificial Intelligence Model Outperforms ChatGPT, Medical Students, and Neurosurgery Residents on Neurosurgery Written Board-Like Questions

INTRODUCTION: Artificial intelligence (AI) and machine learning (ML) have transformed healthcare, with applications in various specialized medical fields. Neurosugery can benefit from AI in surgical planning, predicting patient outcomes, and analyzing neuroimaging data. GPT-4, an updated advanced language model by OpenAI with additional training parameters, has exhibited exceptional performance on standardized exams. METHODS: GPT-4's performance was examined on 643 Congress of Neurological Suregons (CNS) Self-Assessment Neurosurgery Exam (SANS) board-style questions from various neurosurgery subspecialities. Of those, 477 were text-based and 166 contained images. GPT-4 refused to answer 52 questions that contained no text. The remaining 591 questions were inputted into GPT-4, and its performance was evaluated based on first-time responses. Raw scores were analyzed across subspecialties and questions types, then compared to previous findings on ChatGPT performance against SANS users, medical students, and neurosurgery residents. RESULTS: GPT-4 attempted 91.9% of CNS SANS questions and achieved 76.6% accuracy. The model's accuracy increased to 79.0% for text-only questions. GPT-4 outperformed ChatGPT across all neurosurgery categories, scoring highest in Pain/Peripheral Nerve (84%) and lowest in Spine (73%). The model exceeded the performance of medical students (26.3%), neurosurgery residents (61.5%), and the national average of SANS users (69.3%) across all categories. CONCLUSIONS: GPT-4 outperformed medical students, neurosurgery residents, and the national average of SANS users. The model's notable accuracy suggests potential applications in educational settings and clinical decision-making, enhancing provider efficicency, and improving patient care.

818 Prevalence of and Risk Factors for Depression, Anxiety, and Burnout in U.S. Neurosurgical Residents

INTRODUCTION: Rates of mental illness are disproportionately higher among medical residents. Neurosurgical trainees are no exception and may be more likely to suffer from depression, anxiety, and/or burnout than other residents. An assessment of the prevalence of mental illness in U.S. neurosurgical residents in the post-COVID-19 era is lacking in the literature and understanding the risk factors is vital to combating these mental health disorders. METHODS: Cross-sectional study analyzing responses to a 28-question survey from March-May 2023 distributed to U.S. neurosurgery residents. The survey included demographic and program-specific information, as well as Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) screening questions. PHQ-9 and GAD-7 scores >5 represent at least mild depression and anxiety, respectively. RESULTS: Forty-eight responses were included in the analysis, which consisted of 35 males (74%), 36 married respondents (77%), and 27 junior residents (56%, PGY-1 to 4). Twenty-four residents (50%) screened positive for depression, 19 residents (40%) screened positive for anxiety, and 26 residents (54%) reported feeling burned out. Depressed residents were highly more likely to also suffer from anxiety (70%, p < 0.0001) and burnout (79%, p = 0.001). Further, junior residents (63%, p = 0.042), female residents (83%, p = 0.008), and residents on a neurosurgical rotation (60%, p = 0.036) were more likely to screen positive for depression. However, being married (p = 0.318), practicing in one’s home state (p = 0.724), having a 24-hour call system (0.188), having formal didactic time (p = 0.125), and having program-led wellness initiatives (p = 0.069) were not protective. CONCLUSIONS: Half of U.S. neurosurgery residents who responded screened positive for depression, 40% screened positive for anxiety, and 54% felt burned out. Depression was strongly correlated with both anxiety and burnout. Neurosurgery residents who were female, in their junior years, and on-service were at particularly high risk for depression.

815 Gender Parity in Neurosurgery Residencies: An Analysis

INTRODUCTION: The number of women graduating from U.S. medical schools has reached parity with that of men. However, persistent inequalities and barriers have made the pace towards equity in application and representation in neurosurgery residency slow despite initiatives to increase female representation. METHODS: Data on the number of active female neurosurgery residents and female applicants to neurosurgery was collected from the American Council of Graduation Medical Education Data Resource Book from 2007 to 2021 and Electronic Residency Application Service from 2014 to 2022, respectively. Bivariate linear regression analysis was used to predict percent of active female residents based on academic year (AY). Pearson Chi-squared was conducted to determine the odds ratio of a female applicant to neurosurgery. RESULTS: The percent of active female residents in neurosurgery increased from 11.0% in 2007 to 21.8% in 2021. Bivariate linear regression analysis using AY as predictor of percent of active females was statistically significant. On average, the percent of active female residents increases by 0.65% per year. If trends persist, parity in neurosurgery will not be reached until 2069. Linear regression analysis of the overall rate of attrition in neurosurgery as a predictor of percent of active female residents revealed that for every 1% increase in rate of attrition the percent of active female residents decreases between 1.4% to 4.4%. The percent of female applicants to neurosurgery increased from 19.6% in 2014 to 29.8% in 2022, yet the odds of a female applying to neurosurgery remains low. CONCLUSIONS: Neurosurgery continues to struggle with recruitment of female medical students, despite achievement of parity for female medical school matriculants. Greater effort is needed to recruit and retain female applicants to neurosurgery, including increased transparency in match and attrition metrics.

Creating a neuroanatomy education model with augmented reality and virtual reality simulations of white matter tracts.

The utilization of digital technologies has experienced a notable surge, particularly in cases where access to cadavers is constrained, within the context of practical neuroanatomy training. This study evaluates augmented reality (AR)- and virtual reality (VR)-based educational models for neuroanatomy education. Three-dimensional models were created using advanced photogrammetry. VR- and AR-based educational models were developed by arranging these 3D models to align with the learning objectives of neurosurgery residents and second-year medical students whose cadaveric training was disrupted due to an earthquake in Turkey. Participants engaged with and evaluated the VR- and AR-based educational models, followed by the completion of a 20-item graded user experience survey. A 10-question mini-test was given to assess the baseline knowledge level prior to training and to measure the achievement of learning objectives after training. Forty neurosurgery residents were trained with a VR-based educational model using VR headsets. An AR-based educational model was provided online to 200 second-year medical students for their practical neuroanatomy lesson. The average correct answer rates before the training were 7.5/10 for residents and 4.8/10 for students. These rates were significantly improved after the training to 9.7/10 for residents and to 8.7/10 for students (p < 0.001). Feedback from the users concurred that VR- and AR-based training could significantly enhance the learning experience in the field of neuroanatomy. VR/AR-based educational models have the potential to improve education. VR/AR-based training systems can serve as an auxiliary tool in neuroanatomy training, offering a realistic alternative to traditional learning tools.

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.

Letter to the Editor Regarding: "GPT-4 Artificial Intelligence Model Outperforms ChatGPT, Medical Students, and Neurosurgery Residents on Neurosurgery Written Board-Like Questions"

Letter to the Editor Regarding: "GPT-4 Artificial Intelligence Model Outperforms ChatGPT, Medical Students, and Neurosurgery Residents on Neurosurgery Written Board-Like Questions"

724 Population Per State Served by a Neurosurgery Resident: A National Review

INTRODUCTION: Neurosurgery residency remains challenging, with 7-years of post-graduate training offered at only 116 locations. It's typically the longest route to board certification of all surgical and medical specialties, yet its programs often consist of the smallest cohorts. Furthermore, the breadth of pathology and populations served by each neurological residency varies significantly. METHODS: Doximity residency “navigator” was used to query total residency programs that entered the 2022-2023 match cycle. U.S. state populations were collected from World Population Review Census January 2023. States were arranged from highest to lowest by census population. Each state population was divided by the NS resident positions in that state. The population per resident (PPR) were compared. RESULTS: California and Wyoming contained the largest and smallest state populations, respectively at 40,223,504 and 580,817. Vermont was the smallest state to contain a NS program with a population of 648,279 and 7 residency positions or roughly 92,611 PPR. California comparatively contained 151 positions or 266,381 PPR. Interestingly, New York and Florida each contain roughly 21 million people, yet they respectively contained 115,527 and 354,909 PPR. In total 65% of residents served between 127,920 to 306,528 people depending on the state. CONCLUSIONS: There is a wide range in the number of people served by each NS resident throughout the USA. Neurological Surgery residencies are not located uniformly by population and patients are free to travel across state boundaries. Currently the ACGME determines program expansion and creation by uniform specialty specific standards. Our data presents a new lens for discussing maximization of training opportunities across the continental United States.

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.

334 Resident Salary Compared to Living Wages at US Training Institutions

INTRODUCTION: Resident physician salaries vary by region, though it is unknown how these variations compare to differences in living wages across the United States or what factors drive residency salary discrepancies. METHODS: Publicly available resident salary information was obtained from full-service training centers containing a neurosurgical residency program via institution-specific websites in February 2023 with information on post-graduate year (PGY)-1 through PGY-7 resident compensation for 2022-2023. Living wage calculations by city were generated via the Massachusetts Institute of Technology (MIT) Living-Wage Calculator. Resident salary to living-wage ratios were calculated using PGY-4 salary for each family composition living-wage. Univariate and multivariable analysis of PGY-4 resident salary on affordability was performed, accounting for proportion of expected living wages to taxes, transportation, housing, medical costs, childcare, and food as well as unionization and state income-tax status. RESULTS: 118 neurosurgery residency programs were included, 21 (17.9%) of which were unionized. Residents without children earned a salary greater than living-wage during all years, while single-parent families were unable to earn a living-wage until PGY-7. Residents with 1 child in in 2-adult (single-income) and 2-adult (double-income) families were unable to earn a living-wage until PGY-5 and PGY-3 respectively. Residents with more than 1 child failed to earn a living-wage. Multivariate regression analysis using PGY-4 salary:living-wage ratios in single-child, 2-parent homes showed food expenses and unionization status were always significant. On multivariate regression, unionization was significantly associated with lower living-wage ratios pre-stipend, improved post-stipend, and was again significantly lower after factoring in union dues. CONCLUSIONS: Current resident salaries often preclude a resident from earning a living-wage, especially among junior residents and those with children. Unionization is significantly associated with lower resident income to living-wage ratios.

Industry payments to academic neurosurgeons in 2021: an open payments cross-sectional analysis.

The Open Payments Program (OPP) was a database started in 2013 by the US government to report payments made by the medical device and pharmaceutical industry to physicians. Neurosurgery is a technologically advanced field that relies heavily on the latest innovations for complex treatment of its patient population. This study sought to explore the financial relationship between academic neurosurgeons and the industry. OPP data were reviewed for the year 2021 of all faculty neurosurgeons affiliated with a neurosurgery residency program. Trends related to general payments, research payments, associated research funding, ownership and investment interest, name of the companies making payments, monetary amount of payments per company, and number of payments per company were analyzed. Industry payments to 1151 US academic neurosurgeons were reviewed. These neurosurgeons received $121.4 million in payments. Three hundred thirty-two companies made 18,466 payments. The average payment per neurosurgeon was approximately six-fold higher than that of all other physicians. Vascular and spine subspecialties received the highest payments. A higher proportion of research money was allocated to the Pacific division, while all other categories (including total amount) were higher in the Eastern US. Most financial contributions were made by a small number of companies. Neurosurgery has been rated by many as a field fueled by research, innovation, and technology. In 2021, academic neurosurgeons had a strong relationship with the medical device and pharmaceutical industry as reflected in the OPP data. While the true impact on patient care cannot be directly measured, the advancement of the field relies heavily on these collaborations.

814 Results and Opinions on the Implementation of a Preference Signaling System in Neurosurgical Residency Applications

INTRODUCTION: The 2022-2023 neurosurgery residency application cycle employed an optional preference signaling system that indicated a focused interest in a particular program. During this first iteration, applicants could signal interest in up to eight participating programs. METHODS: A survey consisting of 28 questions pertaining to the signaling process was distributed via email to all neurosurgery applicants participating in the 2022-2023 cycle. Results were compiled, and descriptive statistics were used to generate results. RESULTS: Of the 361 total applicants, 82 (22.7%) completed the survey; 84.1% attend a US MD program, 1.2% a DO program, 12.2% are international medical graduates, and 2.4% are post-graduates. The mean number of programs applied to was 78 (range 21-116 (all). The median number of interviews received was 17 (range 0 to 57). Notably, 14.6% of individuals signaled their home programs, and 63.4% signaled at least one externship program. 90.2% of applicants utilized all eight signals. Applicants averaged 3.5 interviews from programs they signaled, and 15.6% of applicants matched at a program they signaled. Sixty-five percent of applicants were unsatisfied with the application process, but 53.1% indicated preference signaling should continue. Regarding the number of available signals, 43.75% felt eight was appropriate, 32.5% felt it was too few, 13.75% thought it was too many, and 10% were indifferent. CONCLUSIONS: Preference signaling was implemented in the 2022-2023 applicant cycle to improve interview efficiency and equity. Applicant opinions were mixed about this first iteration. Two consistently noted themes were the desire for improved home and away rotation signaling standardization and the perceived lack of impact on match outcome.

Sanford Larson, MD, PhD: a pioneering neurosurgeon, scientist, and educator.

Dr. Sanford Larson, MD, PhD (1929-2012), was an influential figure in spinal neurosurgery. Dr. Larson played a pivotal role in establishing neurosurgery's foothold in spinal surgery by serving as the inaugural chair of the Joint Section on Disorders of the Spine and Peripheral Nerves and as a president of the Cervical Spine Research Society. He made many advances in spine care, most notably the modification and popularization of the lateral extracavitary approach to the thoracolumbar spine. Dr. Larson established the neurosurgery residency program at the Medical College of Wisconsin; he also instituted the program's spine fellowship, the first in the United States for neurological surgeons. His mentorship produced numerous leaders in organized neurosurgery and neurosurgical education, including Edward Benzel, MD, Dennis Maiman, MD, PhD, Joseph Cheng, MD, Shekar Kurpad, MD, PhD, and Christopher Wolfla, MD. Dr. Larson was a prominent leader in spinal neurosurgery and his legacy carries on today through his contributions to research, education, and surgical technique.

Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons.

This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery. We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed. Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained. RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.

Post-COVID Analysis of Which U.S. Medical Schools Produce the Most Neurosurgery Residents: 2021–2023 in Review

ObjectiveThe process surrounding application to the national residency matching program changed drastically because of COVID. Virtual interviews, pre-interview zoom socials, and limitations on sub-internships are major changes that applicants worldwide have had to overcome. The available literature does not reflect the impact of major changes to the interview process. Here, we examine the neurosurgery resident cohort from 2021-2023 to investigate differences between United States medical schools pre- and post-COVID. MethodsA database was constructed reporting the number of students matched to neurosurgery for U.S. medical schools (MD and DO) from 2021-2023. Percentage of total graduates matched to neurosurgery was calculated and institutions were ranked by this metric. This rank was compared to the rank reported by Antar et al in 2021. Variables were compared across the pre- and post-COVID cohorts. ResultsCase Western, Johns Hopkins, Mayo Clinic, Vanderbilt, University of Illinois and University of California San Francisco produced the most neurosurgical residents as a percentage of total graduates. There was a statistically significant difference in the post-COVID cohort between medical schools with a home program vs those without. For the top 20 ranked U.S. News medical schools, there was a statistically insignificant increase in the number of graduates matched to neurosurgery ConclusionsWith the data provided, there have not been many significant changes in which medical schools produce the most neurosurgery residents since COVID changes were implemented. The playing field has remained relatively the same in the setting of major changes that were made.