Original ArticleElectronic Residency Application Service Application Characteristics Associated with Successful Residency Matching in Neurosurgery in 2009–2016
Introduction
The path to becoming a neurosurgeon is arduous with high standards for neurosurgery applicants. For example, the mean United States Medical Licensing Examination (USMLE) Step 1 score in 2016 was 233 for all applicants who successfully matched in all specialties (SD 17.4). For neurosurgery, the average score was 249. For comparison, a passing score is 192.1 In addition, applicants averaged a score of 251 on USMLE Step 2 and 4.8 research projects.
For individuals who aspire to match into neurosurgery, preparation begins early in medical school and often during undergraduate education. The American Academy of Neurologic Surgeons reiterates this idea on their website, stating that neurosurgery “strives to attract the best and brightest candidates graduating from accredited medical schools” and emphasizes the need for the very best of medical school credentials in no uncertain terms.2 Potential applicants in the United States and abroad anecdotally rely on available information sources such as local faculty mentors, program directors, chairmen, residents, websites, and other medical students. However, much of this advice is based on individualized experience alone. Objective data can be difficult to find. Faculty mentorship is valuable but often is aided by general observational trends at best. Initial information-gathering attempts may even compound confusion, as various forums may easily propagate misinformation. Students who are interested in neurosurgery residency need more clarity regarding the baseline objective factors that influence match success.
About every other year, Charting Outcomes in the Match, a publication of the National Residency Match Program (NRMP) and Association of American Medical Colleges, reports data pertaining to the characteristics of applicants who match into various specialties. Neurosurgery joined the NRMP in 2009, and Charting Outcomes in the Match has been published for neurosurgery for the years 2009, 2011, 2014, and 2016.1, 3, 4, 5, 6 This study used data published by the NRMP for 2009–2016 to examine components of the Electronic Residency Application Service application that were associated with successful residency matching into neurosurgery. This information can aid potential applicants in determining which factors increase the likelihood of matching and can offer insight into elements of the process applicants may be able to control. This is the first study to analyze NRMP data for predictors of success in the neurosurgical match.
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Materials and Methods
Aggregate data were collected from the NRMP publication Charting Outcomes in the Match from all the years neurosurgery data were available (2009, 2011, 2014, and 2016). Although deidentified individual-level data were requested, these data were not available from the NRMP. Therefore, only univariate statistical analysis was performed, as multivariate analysis was not possible. Given the disparity in match outcomes, graduating seniors from the United States were analyzed separately from
Results
Data included 899 U.S. seniors and 275 independent applicants. For U.S. seniors applying to neurosurgery, number of contiguous ranks, USMLE Step 1 and 2 scores, research projects, AOA status, and medical school top 40 NIH funding were significantly associated with a greater proportion of applicants successfully matching. Number of volunteer experiences was nearly statistically significant. For independent applicants, only USMLE Step 1 and 2 scores and number of research projects were
Discussion
Neurosurgery continues to prove to be a competitive specialty. In 2016, 216 positions were offered for 342 total applicants for a 63% match proportion.1 Individuals who aspire to become neurosurgeons should be well versed in the potentially modifiable factors that increase the likelihood of matching. Although various nontraditional routes to neurosurgery exist, this analysis highlights the factors that likely influence a successful match into a neurosurgery residency program. For U.S. medical
Conclusions
Students pursuing and applying to neurosurgery residency as well as their mentors should be aware of which factors are meaningfully associated with success in the match. This analysis emphasizes the importance of number of contiguous ranks, USMLE Step 1 and 2 scores, research projects, AOA status, and medical school top 40 NIH funding, all of which reached statistical significance in our analysis for U.S. graduates. USMLE Step 1 and 2 scores and number of research projects reached significance
Acknowledgments
We thank Stephen J. Haines for his support and advice. We also thank the National Resident Matching Program and Mei Liang, Director of Research, for her input.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.