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Neurosurgery

Introduction

Neurosurgery is a wonderful field that incorporates rapidly evolving technology, high-level surgical skills, and patients with highly acute illnesses. Unlike most other surgical specialties, the fully trained neurosurgeon performs a variety of procedures in any given day. The breadth of the field is incredible as neurosurgeons treat everything from aneurysms, spinal cord tumors, scoliosis, brain tumors, peripheral nerve injuries, and Parkinson’s Disease. The technology utilized includes everything from research in brain-computer interfaces to advanced imaging to minimally invasive and non-invasive techniques.

Yet, neurosurgery training still has the unfortunate reputation of being in the ‘Dark Ages.’ However the 80hr/wk limit and inclusion of significant research time has improved the quality of life over prior generations of residents, yielding more applicants than ever.

The size of the field is also small, and many of the faces you meet on “the trail” will be become close friends and your colleagues that you’ll see again at meetings throughout your career.

Neurosurgery is truly a unique field that continues to evolve.

General Information About Applying

Neurosurgery participates in the Electronic Residency Application Service (ERAS). All programs are now 7 years in length with 1-2 years of incorporated research/elective time.

In general, at this point, a few things should be completed, or should be in the process of being completed:

  1. Taken and passed Step I
  2. Establishing connections/research with the Neurosurgery Department at Maryland.
  3. Thinking about away rotations and applying for them.
  4. Thinking about the appropriate time to take Step II CK and CS.

Selection Factors

  1. Board Scores
  2. (Most applicants will have >230; a score >240 will be required by top programs, and 250+ will give you a competitive edge; please note that these numbers are just generalizations, not rules!)
  3. Research
  4. (Research in the field of neurosurgery is most valuable. Bench-work is preferred, but clinical research is also useful)
  5. Letters of Recommendation
  6. Med School reputation/AOA status
  7. Away electives/Away Elective LORs
  8. Clinical Grades and Comments.

Specific Information about applying

    • Attend neurosurgery conferences Thursday mornings.
    • Start to work on your CV and Personal Statement.
    1. Dr. Eisenberg will review and give advice about your personal statement if you ask him. It is also helpful to get advice from the other faculty members.
    • Start to think about scheduling 4th year and away Sub-I’s
    1. Sub-I’s: The process of choosing and applying to sub-Is can be stressful and daunting. Many of the programs that host sub-I’s schedule through VSLO, an online application service dedicated to the scheduling away rotations. However, many also do not, and require their own application. The best method is to go on VSLO and see which programs are available, then research program websites that you don’t find.

      Many away rotations require many supplemental forms and LOR’s to even apply, so it is important to get these things completed now rather than running around later.

      Things you should absolutely, positively, undoubtedly do after you read this, if you haven’t done so: 

      1. Go to student health and make sure all of your vaccines are up to date. This includes influenza, td, hep B. Many programs even want you to have vaccines such as polio again. Print out the required immunization forms for each institution on VSLO and turn into Student Health.
      2. Go to student health and get immunization titers! Many programs don't want documented shots but actually want titers.
      3. Get a 10-12 panel drug test at student health.
      4. Get a federal and state background check along with fingerprints. Official certification from the VA won’t be sufficient. Go to a company to get this done. A list of available locations that provide this service is located at this website.
      5. http://www.dpscs.state.md.us/publicservs/fingerprint.shtml
      6. Start asking for LORs to submit to programs at which you want to rotate.

      Scheduling: Schedule a home Sub-I’s and two away sub-I’s. The Sub-I months are generally July, August, and September of 4th year. This allows sufficient time to upload and receive LORs in time for the ERAS application opening in mid-September. Deciding on which programs to rotate can be difficult, and some strategies to consider are listed below:

      • Strategy #1: Schedule aways at very competitive programs to get your foot in the door (ie. UCSF, Barrow, MGH, Columbia, Mayo, Hopkins, NYU etc).
      • Strategy #2: Schedule aways at institutions with influential and well-known chairs/faculty who if you impress can write you a good LOR (ie. UVA – Dr. Mark E. Shaffrey, Wisconsin – Dr. Robert Dempsey/Daniel Resnick)
      • Strategy #3: Schedule aways at lesser rotated programs with fewer sub-Is. This allows you to be the only sub-I many times, and allows you to interact with the faculty and residents on a more intimate level.
      • Strategy #4: Mix and match

      In the end, the strategy of deciding which sub-I’s to schedule varies depending on the person to whom you speak as well as your own preferences and goals. If you are an average candidate it may be better for you to rotate at “mid-tier” programs rather than a “top-tier” institution that hosts 20 or more sub-Is in a season. Also consider that many programs tend to be inbred as well so this may be a factor in considering where to go. In the end, do not rotate in a location where you have no interest in going.

      Additional Sub-I info: Many places require you to give a short talk on a subject of your choosing, whether your research or another topic. Some common sense things that are worth mentioning: Be kind, professional, courteous, hard working, and respect everyone including your fellow sub-I’s. In the end it doesn't matter how smart or talented you are; people want to know, can we work with this person? Similarly, you want to know if your personality meshes with a particular program.

      Sample Schedule:

      • July – Home NS Sub-I
      • August – Away NS Sub-I #1
      • September – Away NS Sub-I #2
      • October – Off for Step II CK and beginning of Interviews
      • November – Neuroradiology
      • December – Off for interviews
      • January – Home Sub-I (other than NS)
      • Feb – AHEC
      • March – NS Research Elective
      • April – Elective
      • May – Off
    • Start thinking of residency programs to which you want to apply.
    1. Your list depends on many factors: the competitiveness of your application, if you’re couples matching, your geographic constraints etc. It’s best to get a variety of opinions from faculty and junior residents. Helpful faculty include Dr. Sansur, Dr. Woodworth, and Dr. Crandall who are all young and not too far removed from residency.

    • Plan research with the Neurosurgery Department
    1. This may be difficult depending on time and rotation constraints but it is not only helpful, but almost required when applying to competitive programs. Laboratory papers are valued more than clinical but clinical papers and case reports are also very useful. This gives you something to talk about during interviews and people will ask about your research. There are many clinical projects going on at Maryland.

  • Phase II: Implementation
    • Finish CV and Personal Statement by the end of August.
    1. Get help from Dr. Eisenberg to read your personal statement. Don't be afraid to ask for help from different faculty members.
    • Solidify a list of potential programs.
    1. Be open-minded and realistic. Again, ask the faculty; Eisenberg is a good source of information as well as the residents when it comes to being realistic.
    • Schedule an appointment with Dr. Eisenberg, in July (bring CV, statement, & list - be prepared)
    1. Keep in contact with him
    • Complete Sub-I and externships early.
    1. Ask for letters. Make sure you follow-up on your letters! This is really important! If you don’t have a letter from an institution it can look suspicious.
    • Get LOR’s
    1. You can have a total of 4 for each application on ERAS. The traditional letters are as follows and all should be from Neurosurgeons. LOR #1: Dr. Eisenberg LOR #2: Another faculty member at Maryland that can speak well of your abilities and is influential. (Possibly Dr. Simard) LOR #3: Chair (or highly influential faculty member) from Away #1 LOR #4: Chair (or highly influential faculty member) from Away #2
    • Register for the NRMP.
    • Once you get your ERAS token from OSA, begin to fill out the application early. Submitting early is key!
    • Scheduling and Attending Interviews
    1. Interviews run from October – early February with the bulk being in November, December, and early January. Try to schedule programs that are close together geographically, close together temporally. This can be difficult, but can save money. You can also use budget websites such as priceline to reserve hotels. Many programs will offer “discounts” and participating hotels and encourage you to stay at a particular hotel that is within walking distance from the medical center. If you don't mind a cab in the morning, you can save a significant amount by staying at a more distant but cheaper location. Interviews are time consuming, and traveling can get exhausting but attempt to retain morale.

      The criteria to select candidates to interview are complex and program dependent. You will receive some interviews you didn't think you would get, and you won’t get some you thought you would no-doubt get. In the end, if there is a program you really wanted and didn't get, send an email. This applies for couples matching as well: if your significant other received an interview it’s a good reason to contact a program.

      Try to research the faculty and program as much as possible. This is easier at the beginning of the season when your enthusiasm is up. But, there are many Maryland grads out there and it’s a nice way to spark up conversation. Also, people frankly like talking about themselves. When it comes time to ask questions, if you ask someone about their background and show you have researched them, it will make your life easier.

      During interviews talk to residents as much as possible and take good notes if you can. Don't be afraid to ask questions, as you are interviewing them as much as the other way around. Ultimately, be yourself. You want to go to a program that fits who you are and a program where you will be happy for 7 years with people you will see more than your own family, wife, kids, etc.

      Thank you letters:
      This can be difficult to know when to send them and to whom etc. and you will receive differing opinions on the matter. I personally chose to send a thank you email to the program coordinators who contacted me to schedule interviews. Additionally, I wrote thank you emails to the chair and the program director toward the end of interview season to “remind” them of my interest.

      Second Looks:
      This should be done on an individual program basis. Some programs will tell you to come back if you’re interested. Others will say it isn’t required. Use your discretion and visit places you truly are interested in getting a better picture.

  • Phase III Decision Making
    • Finalize and submit your rank list in early February - get advice from trusted, informed, and reliable sources. Rank programs according to how they fit your specific needs and how happy you can see yourself at a particular place. Do not worry about gaming the system etc. There is no penalty for ranking “reach” programs highly. Also, the best predictor of your being happy with a program is the happiness of the current residents. Be true to yourself. If location is important, it’s important! If being close to your family is important, then factor that into your decision-making. This goes the same for research or fellowship opportunities etc.
  • Phase IV: Matching
    • Ultimately, matching is random. 

Resources: 

Helpful Websites 

Neurosurgery://On-Call
American Association for Neurological Surgeons
Congress of Neurological Surgeons
Neurosurgic.com
 

DO NOT HESISTATE TO ASK THE RESIDENTS AND ATTENDINGS QUESTIONS ABOUT THE PROCESS!!! THE MORE INVOLVED YOU ARE, THE MORE THE FACULTY RECOGNIZES YOUR INTEREST IN THIS HIGHLY COMPETITIVE SPECIALTY AND WILL HENCE BE REFLECTED ON YOUR LETTERS OF RECOMMENDATION!

For more information please contact:
Joshua Olexa 

Last Revision: May 2, 2018