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Neurosurgery Rotation and Application Changes Due to COVID-19: A Medical Student Perspective (Part I)

By COVID-19, GME, MedEdNo Comments

The COVID-19 pandemic has resulted in many changes in the neurosurgery residency application process. Early decisions by the Society of Neurological Surgeons led to the canceling of away rotations, installation of virtual interviews, and a required eight-week home rotation in lieu of visiting rotations. Despite being disappointed that I would be unable to visit programs physically, the neurosurgical response to the challenges as a result of COVID-19 was very proactive, and it was a relief to have a definitive idea of the process early on.

Standing out during the home rotation became essential. Letters of recommendation could only come from home programs, so I used the eight weeks to form stronger relationships with key faculty members. During my rotation, I went to clinic with two of my anticipated letter writers, which proved to be an excellent opportunity to prepare and showcase history-taking, physical exam and imaging interpretation skills. Standing out in the operating room did not change much, but the added time of the rotation allowed me to see a wider variety of cases than I would have on a four-week rotation. I have become more familiar with the inner workings of my home health system. As the eight weeks progressed, I was able to take on more and more tasks associated with running the clinical service. The wider breadth of these experiences helped me learn much more about how to function as a neurosurgical resident than I would on a shorter, four-week rotation.

Many neurosurgical programs have started webinars or meet-and-greet sessions, where applicants can learn about the program directly from faculty and residents. Some programs — my home institution included — have organized lecture series, where faculty and residents give didactic sessions about various neurosurgical topics. These are great opportunities for students to get to know both the logistical aspects of the program, such as rotation schedules, research emphases and to get a feel for the all-important “fit.”As the time to submit applications approached, I reached out to friends who applied last year, current residents and faculty members to better understand the programs and compile my list. While the process has certainly been different from years past, some positive things have come from these changes, including the longer home rotation, webinars and lecture series. To say that the virtual interview dramatically affected the ability of programs and applicants to gauge “fit” may be an overstatement, and the real drawback is likely from loss of longitudinal exposure during in-person rotations. Nevertheless, this year has been exciting for both programs and applicants, and I enjoyed seeing how programs showcased themselves through virtual interviews.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtags #Match2021 and #NeurosurgeryMatch.

Sean Neifert
Medical Student
Icahn School of Medicine at Mount Sinai Hospital
New York, N.Y.

Connecting with the Neurosurgery Community in the COVID-19 Era: Lessons Learned at the University of Miami

By COVID-19, GME, MedEdNo Comments

The COVID-19 pandemic has challenged the neurosurgery community to utilize new technologies to create and maintain connections. With social distancing guidelines in place, much attention has turned to the virtual space to accomplish this. At the University of Miami, we have trialed several virtual initiatives to connect with the neurosurgery community across the country and the world — from medical students interested in our residency training program to attending neurosurgeons interested in hearing from the world-leading experts in various neurosurgical subspecialties. We report the lessons we have learned during these unprecedented and challenging times.

Virtual Sub-Internship

Typically, sub-internships represent the culmination of medical school studies where interested final year medical students rotate in our department to gauge interest in both neurosurgery and our residency program. However, given concerns for student safety with travel, the various travel restrictions in place, and differing hospital policies on rotating medical students, the Society of Neurosurgical Surgeons opted for a unified policy for programs and students to afford all applicants the same opportunities. In 2020, away sub-internships were eliminated, and the University of Miami created a 1-day virtual sub-internship. In these, attendees were exposed to different subspecialties via attending presentations, resident life via resident presentations and applying to our program via a question and answer session with the program director, Ricardo J. Komotar, MD, FAANS, FACS. The lessons we learned are:

  • We can host more attendees than we would be able to with in-person sub-internships;
  • Compared to before, attendees of the virtual sub-internship are objectively more familiar with the residency program, faculty, residents and daily life within the program; and
  • All prospective attendees agreed that a virtual sub-internship before in-person sub-internship applications would be of great use after the pandemic.

The Resident Hour

A challenge facing medical students learning about our residency program is getting to know the current residents when they cannot rotate in the department. Given how vital inter-resident personality fit is when planning applications, we sought to increase the exposure of our residents by introducing a monthly resident-run virtual initiative called The Resident Hour. In it, we had residents present on various neurosurgery- and residency-related topics, but in a more conversational manner. The lessons we learned here are:

  • There is interest in hearing from neurosurgery residents from both within the U.S. and overseas;
  • Interactive sessions that encourage conversations greatly facilitates getting to know residents; and
  • Residents enjoy the opportunity to share with the neurosurgery community their knowledge and opinions.

Online Symposia

In the current pandemic, multiple neurosurgical conferences have been canceled. Without these, the neurosurgery community has lost exposure to experts in the field and the most up-to-date didactics. In response, our department has been able to organize our lecture series utilizing virtual symposia, nicknamed Zoomposiums. In it, we can bring in world-renowned experts virtually to discuss in real-time many pertinent and contemporary topics — including brain tumors via the Miami Global Brain Tumor Symposium organized by Michael E. Ivan, MD, FAANS, and Cerebrovascular and Skull Base Symposium organized by Jacques J. Morcos, MD, FAANS, FACS. Attendance is free and open to anyone interested, and all of the recordings (including The Resident Hour) are available on YouTube. From these symposia, we learned:

  • Virtual symposia increase the breadth of neurosurgical experts’ ability to present their work, as well as the neurosurgery community able to attend;
  • There is great interest in these symposiums across the world, with attendees from over 50 countries registering for each symposium; and
  • Being able to store these symposia online, at no cost, dramatically increases the longevity and reach of their impact.

The COVID-19 pandemic has challenged the neurosurgery community to innovate new ways to become and stay connected. Here in the Department of Neurological Surgery at the University of Miami, we have embraced virtual technology and created initiatives to increase exposure and maintain a connection to our program, our residents and our expertise. We have learned several lessons with the overarching goal of increased accessibility at the forefront of our experience. We can implement these virtual endeavors within the neurosurgery community to become more connected than ever.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtags #Match2021 and #NeurosurgeryMatch.

Victor M. Lu, MD, PhD
University of Miami School of Medicine
Miami, Fla.



Ingrid Menendez
University of Miami School of Medicine
Miami, Fla.



Ricardo J. Komotar, MD, FAANS, FACS
University of Miami School of Medicine
Miami, Fla.

Virtual Sub-internships and Remote Interviews: A Sudden Paradigm Shift in the Neurosurgical Residency Application Process Due to COVID-19

By COVID-19, GME, MedEdNo Comments

The year 2020 required constant adaptation to a rapidly changing environment in many facets of life. Few would have guessed that national travel would be severely restricted or that surgeons would be wearing face masks to the supermarket. As impactful as the COVID-19 pandemic has been on life in general, the effect on the neurosurgical practice has been similarly profound —  from shifting outpatient care towards a more remote, telehealth presence to restricting non-urgent surgical case volume. Perhaps the most significant, potentially long-lasting effect of the pandemic on the neurosurgical profession has been with the transition from medical student to resident physician.

Matching into a neurosurgical residency position in the United States has traditionally been an extensive process spanning months and costing applicants upwards of $10,000. Traditionally, students drawn to the field would rotate at a neurosurgical department associated with their medical school before embarking on sub-internship rotations in other neurosurgical departments across the country. This typically benefits the applicant by allowing him or her to observe the diverse practice of neurosurgery across different institutions. Furthermore, it allows the applicant to demonstrate his or her commitment and passion to the field to residents and faculty at these institutions. Moreover, this process is integral to generating letters of recommendation from respected members of the neurosurgical community. While applying for visiting sub-internship positions occurs in the fall to winter of the prior year, these rotations typically happen in the summer to fall of the application year. Once the Electronic Residency Application Service (ERAS) opens, usually in September, residency candidates submit applications to neurosurgery programs nationwide. Based on various selection criteria, applicants are subsequently invited for in-person interviews.

When the COVID-19 pandemic hit the U.S. in March 2020, health care providers nationwide, including neurosurgeons, began focusing all efforts and resources on treating critical patients affected by the SARS-CoV-2 virus. Furthermore, health policies were enacted in various hotspots to limit viral transmission, including stay-at-home quarantine orders, travel restrictions, and strict limitations on hospital visitors. Taken together, these had a noticeable impact on the ability of medical students to participate in visiting sub-internships.

Recognizing that these away rotations are a critical portion of a student’s application for neurosurgery residency, in late April 2020, the Society of Neurological Surgeons (SNS) released its official guidance on external medical student rotations during the COVID-19 pandemic. The SNS recommended deferring all visiting medical student rotations for the 2020 application cycle.  Instead, the SNS recommended that students rotate internally with their home institution for eight weeks. For students enrolled in medical schools without a neurosurgery program, the SNS recommended rotating at the nearest Accreditation Council for Graduate Medical Education-accredited program. Regarding students’ letters of recommendation, the SNS recommended obtaining two letters from neurosurgery faculty and one additional letter from a general surgeon faculty member. Lastly, to further discourage traveling rotations, the SNS recommended against letters from faculty at external neurosurgery programs. Overall, these recommendations served to level the playing field for applicants in regions harder hit by the pandemic (e.g., those with more significant travel restrictions) and students without a home neurosurgery residency program.

In early May 2020, a coalition comprised of the American Association of Medical Colleges, Accreditation Council for Graduate Medical Education (ACGME), American Medical Association and others released a set of recommendations for external rotations and in-person interviews during the COVID-19 pandemic. First, the group discouraged away rotations among all specialties, except for medical students without an ACGME-accredited program at their home institution. Regarding interviews, the coalition recommended that programs commit to virtual interviews and site visits for all applicants, including local students. Lastly, the standard timeline for the ERAS was delayed to account for students’ missing or delaying rotations.

Given that much of the neurosurgery residency match has traditionally depended heavily on interpersonal interaction, letters of recommendation and in-person interviews, these changes to the application process were quite unique. Anyone familiar with the neurosurgery Twitter-sphere can attest to the growing interest in virtual sub-internships and residency program information sessions. As a community, we continue to adapt to the challenges posed by the COVID-19 pandemic. In many cases, we are finding more efficient ways to educate students and promote residency programs, which may be a transition point away from the traditional — and expensive — model of rotating, applying and interviewing for residency. In this series of blog posts, we highlight the challenges in the application process experienced by neurosurgical programs, medical students and others in organized neurosurgery and showcase their innovative responses during this critical time.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtags #Match2021 and #NeurosurgeryMatch.

Krystal L. Tomei, MD, MPH, FAANS, FACS, FAAP
Rainbow Babies and Children’s Hospital
Cleveland, Ohio




Kurt A. Yaeger, MD
Mount Sinai Medical Center
New York, N.Y.

AANS Neurosurgeon Spotlight: Winter 2020 – The Mind of a Neurosurgeon Part II

By AANS Spotlight, MedEd, Medical Liability, MentoringNo Comments

Articles in the latest issue of AANS Neurosurgeon: “The Mind of a Neurosurgeon” take on the daunting task of better understanding what makes us tick! Many of the best and brightest have graciously considered aspects of this question and shared their poignant thoughts:

The Case for Mindfulness and Compassion

James R. Doty, MD, FAANS

  • Focus Lost. Every moment in surgery can be critical, right to the very end.
  • Focus Regained. I am working blind, so I open my heart to a possibility beyond reason, beyond skill and I begin to do what I was taught decades ago, not in residency, not in medical school, but in the back room of a small magic shop in the California desert.
  • For some it manifests as forgetfulness. Others experience compassion fatigue. Some experience moral injury and completely lose their motivation to serve their patients. In the worst cases, as defined by the ICD-10, physician’s burnout results in a state of vital exhaustion.
  • Being able to apply mindfulness training and a self-compassionate attitude to my profession gave me permission to attend to my own health and well-being.

The Impact of Medical Review Panels

Jennifer Kosty, MD; Bowen Jiang, MD; Devon LeFever; Jared R. Broughman; Frederick White, MD; Katie O. Orrico, JD; Bharat Guthikonda, MD, FAANS

  • Between 1990 and 2010, the National Practitioner Data Bank estimated malpractice and liability claims from adverse surgical events to be over $1.3 billion.
  • The Medical Review Panel (MRP) and Patient’s Compensation Fund are completely self-funded by physician participants, filing fees and investment income.
  • Once initiated, the panel has a 180-day period to render a decision with three possible outcomes: (1) Evidence demonstrates breach of the standard of care; (2) Evidence does not demonstrate breach of the standard of care; or (3) A question of fact exists bearing on the issue of liability which does not require expert opinion and therefore the MRP cannot render a decision.
  • Although the MRP has largely been beneficial for Louisiana, not all states have had similar experiences.

Inspiring Diverse Minds: The Value of Online Mentorship

Tiffany Ejikeme; Jennifer A. Sweet, MD, FAANS

  • Mentoring has been shown to be the most important factor for medical students in their choice of a specialty.
  • One specific challenge to mentorship relates to diversity. I have not come across many neurosurgeons who look like me, a black woman.
  • Staff physicians must relate to their students beyond the academic scope to form more authentic and effective relationships.
  • Further complicating the mentorship equation is how the medical student experience has evolved with the advent of technology.
  • Supporting efforts like WINS’ online mentorship portal, will help foster and develop mentorship relationships for students around the world.

Alternative Mind: How Non-traditional Experiences Enrich Neurosurgical Training Part 2

Juliana C. Rotter, MD; Avital Perry, MD; Christopher S. Graffeo, MD

  • Advanced communication skills and training are a crucial skill brought to neurosurgery by those coming in with background in business, administration or leadership.
  • The military mindset has a number of enriching elements including discipline to prioritize mission first as well as creating routinized procedures for debriefing, preparation and review.
  • Taken together, the less-traveled pathways have the potential to improve communication, diversify the collective skillset, enhance leadership and maintain the essential focus on the needs of the patient.


AANS Neurosurgeon Spotlight: Winter 2020 – The Mind of a Neurosurgeon

By AANS Spotlight, GME, Loss of Life, MedEd, Voices of Neurosurgery DepartmentsNo Comments

In The Mind of a Neurosurgeon, join authors as they discuss navigating life as a neurosurgeon. From work-life balance to processing loss, pursuing creative outlets to the responsibility of training the next generation, neurosurgeons have a unique calling that leads to a special life serving others. Browse the articles and step into the mind of a neurosurgeon for stimulating conversations about the alternate mind, retirement, mindfulness, the outsider’s perspective, music and much more.

Check back later in January and February for more on The Mind of a Neurosurgeon. Here are just a few articles out now:

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