It has been a pleasure to serve as the chair of the Society of Neurological Surgeons (SNS) Medical Student Committee. This group of neurosurgical leaders is deeply engaged in finding better approaches to training future neurosurgeons. Our responsibilities include enhancing exposure to the field for students exploring future careers, providing a framework of mentorship for those considering a neurosurgical residency, and ensuring that The Match® is fair and efficient for both applicants and programs. It has been clear that forces are making this last goal more challenging for some time.
First, objective evaluation metrics have been eroded in U.S. medical schools. This situation began with grades but has gone on to involve eliminating the United States Medical Licensing Examination® Step 1 scores and many academic honor society chapters. Evaluating an applicant’s clinical knowledge and relative success in medical school coursework on a transcript has become much more difficult. Perhaps in response to these forces, applicants have thrown energy into research activity and increasing numbers of neurosurgery rotations in the hopes of setting themselves apart. While these activities are undoubtedly helpful, there is surely a “ceiling” beyond which more research focus or neurosurgery rotations negatively impact a student’s overall medical education and/or create excess and unnecessary financial burdens.
Finally, we have seen the median number of applications per applicant rise year after year until reaching a point where the median applicant now applies to >80% of all programs. “Application fever” compounds costs and makes holistic review even more difficult for programs to execute efficiently. The SNS Medical Student Committee has carefully reviewed these areas of concern and has produced several new strategies to promote a more efficient match system.
- Standardized Letters of Recommendation
This evidence-based approach is used in other specialties to reduce implicit bias and provide more objective evaluations of a candidate’s suitability for the field. Our neurosurgery-specific template focuses on measuring key traits critical to trainee success. While “grade inflation” remains an issue, repeated use of the template has demonstrated more normalized distributions of candidate scores, especially when focusing on recommendations written by more prolific and experienced letter writers. - Cap on Neurosurgery Externships
We released guidelines advising students to spend no more than three months of their 4th year on neurosurgical externships between home and away programs. This guidance draws on the experience of many neurosurgical educators who understand the need to balance in-depth exposure to the field with other important factors. Capping these rotations helps to create a level playing field, control costs and provide students time to round out their medical education on other important subjects. - Standardized Release Date for Interview Offers
The stress of rapidly managing interview offers repeatedly became a significant concern in our surveys of neurosurgery applicants. The current system allows offers to be released on the four Fridays in October in the afternoon, with all offers held for at least 48 hours. This will enable programs flexibility about when they would like to begin offering interviews. It also means that applicants can predict when offers will arrive and can focus on their other clinical activities during the rest of the week. In line with National Resident Matching Program® rules, we have also emphasized that programs cannot offer more interview slots than they will schedule, eliminating the need for immediate responses to avoid ending up on a waitlist. - Preference Signaling
“Signaling” is the newest innovation to hit neurosurgery, and we are quickly learning how to optimize its use. In 2022-23, we participated in an optional program allowing applicants up to eight “signals” to send to programs indicating particular interest. Building from the data from that cycle, we have moved to a system of 25 signals for the 2023-24 season. Models suggest that this approach will improve the process for both applicants and programs, facilitating a holistic review of the most interested candidates and distributing interview offers evenly across the applicant pool.
The Match has undergone a remarkable evolution in the last few years alone. There are clearly ongoing challenges related to cost, stress and identifying the best candidate-program fit. I believe that the innovative efforts of the SNS Medical Student Committee reflect our commitment to ensuring that the process of applying to a neurosurgery residency remains applicant-centric, with the well-being of our applicants our top priority.
Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.
Lola B. Chambless, MD, FAANS
Vanderbilt University Medical Center
Nashville, Tenn.