Neurosurgical Residency Programs Research Articles

Effect of neurosurgical residency programs on neurosurgical patient outcomes in a single health care system: a cohort study.

The evidence on the benefits and drawbacks of involving neurosurgical residents in the care of patients who undergo neurosurgical procedures is heterogeneous. We assessed the effect of neurosurgical residency programs on the outcomes of such patients in a large single-payer public health care system. Ten population-based cohorts of adult patients in Ontario who received neurosurgical care from 2013 to 2017 were identified on the basis of procedural codes, and the cohorts were followed in administrative health data sources. Patient outcomes by the status of the treating hospital (with or without a neurosurgical residency program) within each cohort were compared with models adjusted for a priori confounders and with adjusted multilevel models (MLMs) to also account for hospital-level factors. A total of 46 608 neurosurgical procedures were included. Operative time was 8%-30% longer in hospitals with neurosurgical residency programs in 9 out of 10 cohorts. Thirty-day mortality was lower in hospitals with neurosurgical residency programs for aneurysm repair (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.20-0.44), cerebrospinal fluid shunting (OR 0.52, 95% CI 0.34-0.79), intracerebral hemorrhage evacuation (OR 0.66, 95% CI 0.52-0.84), and posterior lumbar decompression (OR 0.32, 95% CI 0.15-0.65) in adjusted models. The mortality rates remained significantly different only for aneurysm repair (OR 0.19, 95% CI 0.05-0.69) and cerebrospinal shunting (OR 0.42, 95% CI 0.21-0.85) in MLMs. Length of stay was mostly shorter in hospitals with neurosurgical residents, but this finding did not persist in MLMs. Thirty-day reoperation rates did not differ between hospital types in MLMs. For 30-day readmission rates, only extracerebral hematoma decompression was significant in MLMs (OR 1.41, 95% CI 1.07-1.87). Hospitals with neurosurgical residents had longer operative times with similar to better outcomes. Most, but not all, of the differences between hospitals with and without residency programs were explained by hospital-level variables rather than direct effects of residents.

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.

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 < 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.

Factors Influencing the Medical Student’s Interest and Career Choice in Neurosurgery

Objective: To determine the factors influencing interest and a career choice in neurosurgery among final year medical students. Methodology: A mixed method study was conducted where primary data was collected from 120 final year medical students and three neurosurgery consultants in the University of Ghana Medical School, using quantitative cross-sectional study and qualitative Delphi panel study methods, respectively. The main study outcome was the choice of Neurosurgery as a specialty. Results: About 90% of the students expressed interest in neurosurgery. Interest in neurosurgery (70%) and the will to make an impact in the specialty (75%) were the top factors for the 13.8% of students who said they would apply for neurosurgical residency, while the long duration of training deterred 63% of respondents. The students had poor exposure to the clinical aspects of the specialty. Practicing neurosurgeons placed a high premium on student interest in the field. Conclusion: To build interest among medical students to enter neurosurgical residency programs, students should be given more contact hours during their neurosurgery rotations, and neurosurgical mentorship programmes should be established in medical schools to give medical students insight into the typical life of practicing neurosurgeons.

Perception and Representation of LGBTQ+ Individuals in U.S. Neurosurgical Training

ObjectiveThe aim of this study is to gauge the current social climate in neurosurgical residency training and attitudes regarding sexual orientation and gender identity. MethodsWe conducted a cross-sectional study through a 35-question questionnaire distributed to roughly 1,700 residents at all U.S. neurosurgical residency programs. ResultsA total of 107 responses were obtained. 17 residents (16%) identified as being an LGBTQ+ individual. 76% of LGBTQ+ residents were concerned about how their sexual orientation would be perceived while applying to programs and 47% endorsed purposefully concealing sexual orientation at work for fear of rejection or reprisal. 56% of those surveyed have witnessed homophobic/transphobic remarks by patients. While at work, 29% of LGBTQ+ individuals stated they are uncomfortable being open with their sexual orientation, and three LGBTQ+ individuals endorsed being the target of direct homophobic/transphobic comments. ConclusionsThis is the first study to our knowledge that has been conducted assessing the presence, perception, and treatment of LGBTQ+ trainees in neurosurgical residency. Our study outlines the challenges LGBTQ+ individuals face when applying to neurosurgical programs, which involves the perception of their sexual orientation, their witnessed instances of homophobic and transphobic comments by coworkers and patients, and their hesitation with discussing their social lives compared to their non-LGBTQ+ peers at work for fear of judgement or reprisal. Ongoing research is needed to address these issues to obtain workplace respect and fairness in this population, and thus create an accepting atmosphere and achieve social justice in neurosurgery training.

Women in neurosurgery: a cross-sectional demographic study of female neurosurgery residents in the United States.

Over the past several decades, the number of women applying to medical school has increased significantly. However, parallel recruitment and retention of women in the field of neurosurgery continues to lag. The aim of this study was to identify the ratio and trend of female neurosurgery residents to the total number of residents during the past 7 years across all US neurosurgery residency programs. The authors conducted a cross-sectional demographic study investigating the ratio of female neurosurgery residents to the total number of neurosurgery residents across US neurosurgical programs from 2016 to 2022. Using the Fellowship and Residency Electronic Interactive Database, all neurosurgical residency programs in the US were collected. Data were further divided into postgraduate years 1-7 to dissect the data collection per residency year. One hundred fourteen programs were included in the study. The number of female neurosurgery residents was 71 (29.8%) in 2022, 58 (25.2%) in 2021, 65 (27.9%) in 2020, 62 (27.3%) in 2019, 46 (21.4%) in 2018, 33 (15.2%) in 2017, and 34 (15.9%) in 2016. The trend line showed a significant increase using the Mann-Kendall test (p = 0.035). The total number of international medical graduate (IMG) female neurosurgery residents was 3 (4.2%) in 2022, 4 (6.9%) in 2021, 3 (4.6%) in 2020, 1 (1.6%) in 2019, 1 (2.2%) in 2018, 1 (3%) in 2017, and 2 (5.9%) in 2016. The number of women matching into neurosurgery residency programs is modestly increasing, especially for IMG women. Future steps toward fewer gender disparities should focus on career advancement and leadership diversification in organized and academic neurosurgery.

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.

Abstract 240: Factors Affecting Selection of TraineE for Neurointervention (FASTEN)

Introduction Neurointervention has become one of the most competitive specialties in the United States due to the limited number of training spots, and a larger pool of applicants from different backgrounds: neurosurgery, neurology, and radiology. The training standards are continuously updated to ensure solid learning experiences, which ultimately factors in better outcomes and fewer complications. There is a move towards a structured competency assessment of training requirements via collaboration among several professional societies. However, the substantial drivers of candidate selection by program directors (PDs) have not been fully established yet. The goal of our study is to investigate the factors influencing the selection of fellowship candidates. Methods We distributed a 52‐question electronic survey via REDCap to 93 PDs. The questionnaire was divided into 5 categories: program characteristics; candidate demographics; educational credentials; personal traits; and research and extracurricular activities. The PDs were then asked to rank 5 pre‐selected factors from across all 5 categories. Each category included a subset of multiple‐choice questions to be graded as indicated for each category. Characteristics for these categories were scored from a range of 1 through 10 and means with standard deviations (SD) were calculated for each characteristic. Results Of the 93 PDs surveyed, 55 PDs filled the survey with a response rate of 59.1%. As per the programs’ characteristics, Neurosurgery was the most involved specialty in running the training programs (69.1%), followed by neurology (38.2%), and radiology (30.9%). Most programs were based in academic hospitals (87.3%, n=48/55). The most important criterion for candidate’s demographic characteristics was the need for visa sponsorship, followed by career gap and number of years from graduation from residency program, as summarized in Figure 1A. The most important criteria for educational credentials were being a graduate from a neurosurgical residency program (5.4 ± 2.9), and the institution where the candidate’s residency training is/was based (5.4 ± 2.5). Regarding the candidate’s personal traits, assessment by faculty members at the interview had the highest score (8.9 ± 1). In terms of research and extracurricular activities, fluency in English had the highest score (7.2 ± 1.9), followed by the number of peer‐reviewed/PubMed‐indexed publications (6.4 ± 2.2). Ranking of a final set of 5 characteristics from across all categories is summarized in Figure 1B, with knowledge of the candidate being the single most important contributing factor. Conclusion Neurointerventional training is open to candidates in neurosurgery, neurology, and radiology. To our knowledge, our survey is the first to investigate the factors that might be implicated in the final decision made by PDs when choosing the future neurointerventional trainee, including demographic, educational, research and extracurricular activities.

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.

P.117 Quantitative evaluation in competency-based medical education – a nationwide survey of the spinal surgical training landscape

Background: The competency-based medical education (CBME) model has been recently implemented in spinal neurosurgical and orthopedic residencies. This model is grounded on entrustable professional activities (EPAs) that allow the assessment of clinical milestones. Integrating quantitative metrics to evaluate procedural competencies could refine the assessment’s scope. This survey, administered to program directors (PDs), aims to evaluate the current state and anticipated needs for quantitative evaluation to develop innovative assessment techniques. Methods: We surveyed 32 PDs of neurosurgical (N=14) and orthopedics (N=16) programs with a spine service via RedCap. We collected information on the programs’ characteristics. We inquired about existing assessment methods and the perceived values of developing quantitative metrics to assess spinal technical competencies using thirteen questions. Results: The response rate was 53%. All programs use EPAs to assess procedural competencies through direct observation in the operation room. One surgical program employed quantitative metrics for examination. Four PD valued the profitability of quantitative evaluation methods in a clinical or simulatory context. Conclusions: The use of quantitative metrics to assess spinal surgical competencies in Canadian neurosurgical and orthopedic residency programs is seldom. Despite its underutilization, PDs acknowledge the potential for quantitation to improve the accuracy and reliability of CBME assessments in both simulated and clinical settings.

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.

746 PGY-6 Versus PGY-7 Neurosurgical Chief Year: A Survey of Residents and Program Directors

INTRODUCTION: Recently, more neurosurgical residency programs have transitioned from a post-graduate year (PGY)-7 to a PGY-6 chief year. There has not been a national analysis of resident and program director perceptions regarding the timing of chief year conductance and its influence on overall program satisfaction. METHODS: An online survey was distributed via individual institution program coordinators to all North American PGY 4-7 residents and program directors. Data regarding program size, protected research timing, chief year timing (PGY-6 vs PGY-7) and resident and program director perceptions of the influence of neurosurgical chief year timing on program satisfaction and ability of residents to practice were recorded. Survey results were summarized descriptively. RESULTS: A total of 134 respondents completed the survey. Thirty-five percent of respondents reported a recent program transition from a PGY-7 to PGY-6 chief year while 44% of respondents at programs conducting a PGY-7 chief year reported they were interested in transitioning to a PGY-6 chief year. The large majority of residents (76%) and program directors (80%) at PGY-6 chief year programs stated they were overall satisfied with this. A greater percentage of residents (54%) reported a positive impact of PGY-6 chief year on patient care and preparation to practice when compared to program directors (8%). A large percentage (&gt;80%) of all respondents reported that a PGY-6 chief year provided increased opportunity for subspecialty focus, enfolded fellowships and career planning. CONCLUSIONS: Program directors and residents at PGY-6 chief year program s report a high level of satisfaction with many of those at PGY-7 programs desiring to make this transition. A PGY-6 chief year may allows for greater sub-specialty focus and career planning during the PGY-7 year and its impact on programs should be investigated further.

Letter: Integration of Veterans Affairs Medical Centers Into Neurosurgical Residency Programs.

To the Editor: We read with great interest the recent article published by Yearly et al1 highlighting the integration of Veterans Affairs (VA) Medical Center rotation into neurosurgery residency programs across the United States. The authors summarize succinctly the current state of affairs. At the University of Miami training program, our postgraduate year 3 (PGY3) residents rotate at the Bruce W. Carter VA Medical Center for 4 months. The VA rotation at our program has become known for its breadth through the wide skillset of contracted attendings, its innovation through the robust VA infrastructure, and its flexibility to continue training opportunities at the primary teaching site through its manageable clinical obligations. All these elements add to the findings of Yearly et al,1 affirming the formative nature of a VA rotation within neurosurgery training programs when possible. BREADTH There are 3 contracted attendings at our VA center, who specialize in complex spine, functional, tumor, and general cranial. Through this range of interests, the VA resident is exposed to these areas on a one-to-one basis with the attending because they are the sole resident on service. Our VA service make-up mirrors much of what Yearly et al1 report, in that spine surgeries are the most common, but within that, the complexities range from single-level laminectomy to multilevel cervical laminoplasties and lumbar fusions. Outside spine, a variety of procedures are also performed—a recent week's example includes spinal cord stimulator placement for pain, radiofrequency ablation for spinal metastasis, and endoscopic transsphenoidal resection for pituitary tumor. By having attendings who specialize in different areas, the VA rotation can provide the rotating resident exposure to a large breadth of surgical techniques. INNOVATION The infrastructure at the VA allows our department to incorporate new concepts and materials for the better of our patients. So much so that the invested interest from our anesthesia colleagues, operating room staff, and hospital managers has allowed the VA rotation to become known for better exposure to particular techniques than some of the other teaching sites within our program. This includes navigated single-position corpectomies and fusions and percutaneous spinal cord stimulator placements (Supplemental Figure 1,https://links.lww.com/NEU/D758). Furthermore, on the horizon for approval includes robotic spine surgery and stereotactic deep brain stimulation. Our experience therefore demonstrates the potential for the VA rotation within training programs to not only expose residents to standard operative techniques but also new and emerging ones too. FLEXIBILITY A normal week at the VA for our resident includes 2 operative days and 2 clinic days. Outside these clinical obligations, the vicinity of the primary teaching hospital allows the VA resident to participate in other clinical activities at the primary site. This can include further operative time and pursuing research interests which are both encouraged pending the resident's preference. A unique aspect of our VA center is its close proximity to the primary teaching hospital of our program—across the road. This location allows the VA resident to participate in all primary site learning activities (both in the morning and in the evening), as well as talk in-house overnight call at the primary site. Although not all VA centers are located so close to the primary teaching sites, our experience demonstrates that within a flexible set of obligations, a VA rotation is not a compromise in operative and academic opportunities if appropriate arrangements and schedules can be made ahead of time. At the University of Miami training program, the VA rotation has become a key and much looked forward to rotation among the residents. This is because of both the reasons Yearly et al1 highlight, as well as the elements we detail above. The VA rotation can be a pivotal experience for neurosurgery residents in their training, and maximizing where possible its breadth, innovation, and flexibility is highly encouraged.

Words matter: using natural language processing to predict neurosurgical residency match outcomes.

Narrative letters of recommendation (NLORs) are considered by neurosurgical program directors to be among the most important parts of the residency application. However, the utility of these NLORs in predicting match outcomes compared to objective measures has not been determined. In this study, the authors compare the performance of machine learning models trained on applicant NLORs and demographic data to predict match outcomes and investigate whether narrative language is predictive of standardized letter of recommendation (SLOR) rankings. This study analyzed 1498 NLORs from 391 applications submitted to a single neurosurgery residency program over the 2020-2021 cycle. Applicant demographics and match outcomes were extracted from Electronic Residency Application Service applications and training program websites. Logistic regression models using least absolute shrinkage and selection operator were trained to predict match outcomes using applicant NLOR text and demographics. Another model was trained on NLOR text to predict SLOR rankings. Model performance was estimated using area under the curve (AUC). Both the NLOR and demographics models were able to discriminate similarly between match outcomes (AUCs 0.75 and 0.80; p = 0.13). Words including "outstanding," "seamlessly," and "AOA" (Alpha Omega Alpha) were predictive of match success. This model was able to predict SLORs ranked in the top 5%. Words including "highest," "outstanding," and "best" were predictive of the top 5% SLORs. NLORs and demographic data similarly discriminate whether applicants will or will not match into a neurosurgical residency program. However, NLORs potentially provide further insight regarding applicant fit. Because words used in NLORs are predictive of both match outcomes and SLOR rankings, continuing to include narrative evaluations may be invaluable to the match process.

Integration of Veterans Affairs Medical Centers Into Neurosurgical Residency Programs.

Veterans Affairs (VA) medical centers serve as a unique training environment for US residency programs. In this study, we aim to explore the scope and details of VA integration into neurosurgery resident training. We used data from the Accreditation Council for Graduate Medical Education database to provide an overview of neurosurgery training programs with an active VA affiliation and developed a multi-institutional survey to gather information related to rotation design, operative volume, expectations, and core training values. Of the 116 neurosurgery residency programs, 40 have an active affiliation with a VA medical center (34%). Residents most frequently rotated at the VA during their third postgraduate year, with an average rotation length of 7.5 months (range 2-21). Nearly all programs reported a weekly mix of clinic and operative days (96%), with residents longitudinally following patients throughout their rotations. Attending neurosurgeons from VA-affiliated programs reported operative experience (100%), independent decision-making (89%), and continuity of care (81%) as core values of VA neurosurgery rotations. Surgical volume varied between programs with an average of 13.4 ± 6.4 (SD) cases per month per rotating resident. A significant portion of neurosurgery residency programs in the United States incorporate VA rotations into resident training. Although rotation details vary from program-to-program, shared values include a strong operative experience, independent decision-making, and continuity of care. This analysis provides a comprehensive assessment of VA rotation structure across the country, which is valuable for programs considering implementing a VA rotation into their training program or modifying an existing rotation.

The use of advanced technology for preoperative planning in cranial surgery – A survey by the EANS Young Neurosurgeons Committee

IntroductionTechnological advancements provided several preoperative tools allowing for precise preoperative planning in cranial neurosurgery, aiming to increase the efficacy and safety of surgery. However, little data are available regarding if and how young neurosurgeons are trained in using such technologies, how often they use them in clinical practice, and how valuable they consider these technologies. Research questionHow frequently these technologies are used during training and clinical practice as well as to how their perceived value can be qualitatively assessed. Materials and methodsThe Young Neurosurgeons’ Committee (YNC) of the European Association of Neurosurgical Societies (EANS) distributed a 14-items survey among young neurosurgeons between June 1st and August 31st, 2022. ResultsA total of 441 responses were collected. Most responders (42.34%) received “formal” training during their residency. Planning techniques were used mainly in neuro-oncology (90.86%), and 3D visualization of patients' DICOM dataset using open-source software was the most frequently used (>20 times/month, 20.34% of responders). Software for 3D visualization of patients’ DICOM dataset was the most valuable technology, especially for planning surgical approach (42.03%). Conversely, simulation based on augmented/mixed/virtual reality was considered the less valuable tool, being rated below sufficiency by 39.7% of responders. Discussion and conclusionTraining for using preoperative planning technologies in cranial neurosurgery is provided by neurosurgical residency programs. Software for 3D visualization of DICOM datasets is the most valuable and used tool, especially in neuro-oncology. Interestingly, simulation tools based on augmented/virtual/mixed reality are considered less valuable and, therefore, less used than other technologies.

Postgraduate Year 6 Versus Postgraduate Year 7 Neurosurgical Chief Year: A Survey of Residents and Program Directors

Recently, more neurosurgical residency programs have transitioned from a postgraduate year (PGY)-7 to a PGY-6 chief year. There has not been a national analysis of resident and program director perceptions regarding the timing of chief year conductance and its influence on overall program satisfaction. An online survey was distributed to all North American PGY 4-7 residents and program directors. Data regarding program size, protected research timing, chief year timing (PGY-6 vs. PGY-7), and resident and program director perceptions of the influence of neurosurgical chief year timing on program satisfaction and ability of residents to practice were recorded. Survey results were summarized descriptively. A total of 134 respondents completed the survey. Thirty-five percent of respondents reported a recent program transition from a PGY-7 to PGY-6 chief year while 44% of respondents at programs conducting a PGY-7 chief year reported they were interested in transitioning to a PGY-6 chief year. The large majority (76%) of respondents at PGY-6 chief year programs stated they were overall satisfied with this. A large percentage of all respondents reported that a PGY-6 chief year provided increased opportunity for subspecialty focus, enfolded fellowships and career planning. Program directors and residents at PGY-6 chief year programs report a high level of satisfaction with close to half of those at PGY-7 programs desiring to make this transition. Most PGY-6 chief year respondents report that this model allows for greater subspecialty focus and career planning during the PGY-7year.

Social Media Presence Across U.S. Neurosurgical Residency Programs and Subspecialties

U.S. Neurosurgery programs are increasingly utilizing social media accounts. We performed a search and analysis of social media accounts across all U.S. neurosurgical training programs with an attempt at understanding the relative utilization by various sub-specialties. We compiled a list of all ACGME accredited U.S. neurosurgery programs and the faculty. Each faculty member was classified based upon their subspecialty. Next, the Twitter, Facebook, and Instagram profiles were extensively searched for the number of followers and posts. We analyzed 110 programs with 1829 clinical faculty. Programs with a larger number of faculty (p = .035;χ2=13.528) and residents (p = .003; χ2= 11.865) were more likely to have a social media account. Likewise, faculty and resident number had a positive correlation to Twitter (p = .037 for faculty size; p = .008 for residents' size) and Instagram followers (p = .003 for faculty size; p < .001 for residents size). We additionally found a significant association between subspecialty type and the presence of a Twitter and Instagram account (p = .001; p = .028) and the number of followers (p = 0.004; p = 0.013), especially the vascular and oncology subspecialties. Many U.S. neurosurgical programs have social media accounts with larger programs likely to have a social media accounts. While there is a larger percentage of spine faculty within individual departments, vascular and oncology subspecialties are more likely to have a Twitter account. We suggest the need for increased engagement amongst spine faculty across social media platforms.

Continued underrepresentation of historically excluded groups in the neurosurgery pipeline: an analysis of racial and ethnic trends across stages of medical training from 2012 to 2020.

US allopathic medical schools have experienced improvements in racial and ethnic diversity among matriculants in the past decade. It is not clear, however, whether better representation of historically excluded racial and ethnic groups at medical school entry impacts subsequent stages of the medical training pipeline leading into a specific field. The aim of this study was to examine these trends as they relate to the neurosurgical medical education pipeline and consider the drivers that sustain barriers for underrepresented groups. Race and ethnicity reports from the American Association of Medical Colleges were obtained on allopathic medical school applicants, acceptees, and graduates and applicants to US neurosurgical residency programs from 2012 to 2020. The representation of groups categorized by self-reported race and ethnicity was compared with their US population counterparts to determine the representation quotient (RQ) for each group. Annual racial composition differences and changes in representation over time at each stage of medical training were evaluated by estimating incidence rate ratios (IRRs) and 95% confidence intervals (CIs) using non-Hispanic Whites as the reference group. On average, Asian and White individuals most frequently applied and were accepted to medical school, had the highest graduation rates, and applied to neurosurgery residency programs more often than other racial groups. The medical school application and acceptance rates for Black individuals increased from 2012 to 2020 relative to Whites by 30% (95% CI 1.23-1.36) and 42% (95% CI 1.31-1.53), respectively. During this same period, however, inequities in neurosurgical residency applications grew across all non-Asian racialized groups relative to Whites. While the incidence of active Black neurosurgery residents increased from 2012 to 2020 (0.6 to 0.7/100,000 Black US inhabitants), the prevalence of White neurosurgery residents grew in the active neurosurgery resident population by 16% more. The increased racial diversity of medical school students in recent years is not yet reflected in racial representation among neurosurgery applicants. Disproportionately fewer Black relative to White US medical students apply to neurosurgery residency, which contributes to declining racial representation among all active neurosurgery resident physicians. Hispanic individuals are becoming increasingly represented in neurosurgery residency but continue to remain underrepresented relative to the US population. Ongoing efforts to recruit medical students into neurosurgery who more accurately reflect the diversity of the general US population are necessary to ensure equitable patient care.

Targeting the Future: Developing a Training Curriculum for Robotic Assisted Neurosurgery

Technological advances have significantly fostered the use of robotics in neurosurgery. Due to their novelty, there is a need to develop training methods within neurosurgical residency programs that provide trainees the skills to utilize these systems in their future practices safely and effectively. We describe a detailed curriculum for trainees with significant responsibilities in the operating room, as well as hands-on and theoretical didactics. The curriculum for robot-assisted stereotactic electroencephalography (SEEG) and deep brain stimulation (DBS) electrode implantation technique and assessment tool has been designed based on Accreditation Council for Graduate Medical Education's (ACGME's) milestone requirement for surgical treatment of epilepsy and movement disorders. Residents were surveyed to assess their use of robotics in their surgical training. Since 2019, more than 100 patients have undergone robot-assisted SEEG and DBS depth electrode implantations at our institution. Residents and fellows were involved in all aspects of surgical planning and execution and were encouraged to take an active role during procedures. Didactic sessions led by experienced faculty are emphasized as important learning tools prior to hands-on experience in the operating room. The results of the survey show that residents receive more training intraoperatively as compared to training sessions, yet trainees would benefit from more instruction on informative cadaveric simulation sessions. Our curriculum was developed to become a structured tool for assessment of robotic education in neurosurgical training. This curriculum based on ACGME milestone requirements serve as a template for resident and fellow education in robotics in neurosurgery.