Complete Guide to Neurosurgery Residency

List of Neurosurgery Residencies in US

Here’s a list of the top 10 neurological surgery residency programs from the American Medical Association (AMA).

1. Mayo Clinic College of Medicine and Science (Phoenix) Program
2.  University of Alabama Medical Center Program
3.  University of California (San Diego) Medical Center Program
4.  Barrow Neurological Institute at St Joseph's Hospital and Medical Center Program
5.  Johns Hopkins University Program
6.  University of California (San Francisco) Program
7.  University of Arizona College of Medicine-Tucson Program
8.  Mayo Clinic College of Medicine and Science (Jacksonville) Program
9.  Yale-New Haven Medical Center Program
10.  University of Arkansas for Medical Sciences (UAMS) College of Medicine Program

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List of Neurosurgery Residencies in Canada

1. McGill University
2. University of Montreal
3. Dalhousie University
4. Université de Sherbrooke
5. University of Ottawa
6. University of Toronto
7. McMaster University
8. Western University
9. University of Manitoba
10. University of Saskatchewan
11. University of Alberta
12. University of Calgary
13. University of British Columbia

What is Neurosurgery Residency?

Neurological surgery, or neurosurgery residency for short, is one of the most competitive residencies out there. It is also one of the longest residencies, too, as it is one of the more complex, innovative, intriguing and demanding medical specialties out there.

Neurosurgery deals with one of the most complicated and mysterious organs we have: the brain. Neurosurgery is literally brain surgery, but it’s so much more than that. Neurosurgery encompasses the treatment of a huge variety of neurological diseases, but it’s focus is on the central nervous system and peripheral nervous system.

Within the discipline of neurosurgery, residents can explore a variety of procedures including but not limited to: cranial surgery, spinal surgery, peripheral nerve surgery and trauma surgery.

Neurosurgery residency is one of the most demanding residencies out there, both physically and emotionally. The stakes and pressure to perform are incredibly high—neurosurgeons are literally saving lives. Like trauma or emergency medicine residency, neurosurgeons are often dealing with the most emergent, serious medical situations.

The hours are long and unpredictable and the journey to become a fully trained neurosurgeon takes a great deal of stamina and commitment. Neurosurgeons are among the highest paid doctors, and this extends to how much residents make in this specialty, too. This comes at the cost of lifestyle, since neurosurgery notoriously has one of the most challenging doctor lifestyles.

On the other hand, neurosurgery can be an incredibly fulfilling, exciting and rewarding career. For those who are drawn to the specialty tend to be intellectually curious and enjoy the innovative and evolving nature of the discipline. Neurosurgery is one of the “newest” surgical specialties, having first developed in the early 1900s, and it is an area of medicine we still don’t know a lot about. It is a highly academic specialty, drawing residents who enjoy research and being on the forefront of developing medical knowledge and technology.

Neurosurgery has traditionally been a male-dominated field, but this has been slowly shifting in recent years as more women enter into the discipline of neurosurgery. There has been an increase in the number of neurosurgery residency positions in recent years, too, making it a growing field among resident doctors.

Neurosurgery Residency: Structure

Neurosurgery residency is one of the longest residencies of all the specialties, taking between 7-8 years. Even longer for residents who opt to take a medical fellowship!

Neurosurgery residencies can be either categorical or advanced residencies, meaning they will sometimes require a transitional year residency or preliminary residency year. In other words, some neurosurgery residencies require an “intern” year or two in general surgery or neurology residency before you really begin training in neurosurgery. Categorical neurosurgery residencies cover your internship years under the same program and get you right into the study of neurosurgery.

In general, neurosurgery residency covers clinical rotations in general surgery, critical care, trauma surgery, ICU and neurology. Some programs are more expansive than others, offering more electives or additional rotations in neuroradiology or neuro-ophthalmology.

Neurological Surgery Residency in the US

Neurosurgery residency programs in the US are accredited by Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Neurological Surgery (ABNS) also sets out neurosurgery residency training requirements and guidelines. Neurosurgery residents must complete 7 years (84 months) of neurosurgical residency training in an ACGME-accredited program under the direction of a program director.

The training requirements to become board-certified also dictate at least 4.5 years (54 months) of core clinical neurosurgery, including:

Neurological Surgery Residency in Canada

Neurosurgery residency programs in Canada are accredited by the Royal College of Physicians and Surgeons in Canada (RCPSC), and follow structural guidelines set out by the organization. The requirements include six years of residency training with a minimum of 42 blocks of neurosurgery, so slightly less than the requirements for US neurosurgery residency programs.

Requirements also include:

Here are the easiest and hardest residencies to match to!

Neurosurgery Residency: Fellowships

Within neurosurgery, there are several subspecialties you can explore during your residency years. Most neurosurgery residents explore a medical fellowship in their PGY-5 year and beyond. Neurosurgery fellowships are typically focused on a specific neurological surgery procedure, such as skull base neurosurgery, or they make encompass neurosurgery for a subgroup of patients, like pediatric neurosurgery.

• Pediatric Neurosurgery
• Cerebrovascular Neurosurgery
• Skull Base Neurosurgery
• Spine Neurosurgery
• Neurosurgical Oncology Fellowship
• Peripheral nerve neurosurgery
• Functional neurosurgery
• Neurocritical care

You can find a list of neurosurgery fellowships in the US and Canada through the American Association of Neurological Surgeons.

Neurosurgery Residency Match Rates

Neurosurgery is one of the most competitive residencies, and can be one of the toughest to match to. This is partly because there are fewer neurosurgery residency programs out there. There are only 115 programs in the US and 13 in Canada. Some of those programs only admit 1 or 2 graduates every match, so the open positions are severely limited.

Not only that, but the competition is fierce. Neurosurgery residency tends to attract the best and brightest, and program directors are looking for the top medical students with some of the highest USMLE Step 1 and USMLE Step 2 CK scores.

Neurosurgery Match Rate for MD Seniors

The average match rate for neurosurgery residency is 77.8% for MD seniors in the US. The specialty can be very competitive for DO graduates and international medical graduates, with match rates of 25% and 6.25%, respectively.

In the latest US match data, there was only 243 positions offered in neurological surgery residencies. Of those positions, MDs had a fill rate of 86.8% and DOs had a fill rate of just 1.2%.

Matching to Neurosurgery Residency Programs

To apply to neurosurgery residency programs, US applicants will need to use the ERAS application system and apply to enter the National Resident Matching Program (NRMP). Canadian applicants can apply through the CaRMS match service and submit their application at the same time.

Both application systems are very similar, requiring a residency personal statement, reference letters, residency CV and attending the residency interview. You will also need to complete a residency rank order list, which includes the programs you’re interested in matching to and the order of preference. If you’re not sure how many residency programs to apply to, keep in mind with a competitive specialty like this, it helps to apply a little broadly and not just to the top 10 programs. Aim for a list between 20-30 programs in various locations.

While many neurosurgery residency program directors are looking for the top med school graduates, excellent grades and a stand-out MSPE are not enough. Be ready to answer neurosurgery residency interview questions and write a stellar neurosurgery residency personal statement if you want to match!

Next, we’ll look at our top tips on how to ace your neurosurgery residency application and how to match to this challenging specialty!

How to Match Neurosurgery Residency Programs

To get into a neurosurgery residency program, you need to be the best of the best. Often, program directors are looking for the top students for their programs, but this isn’t the only determining factor. Neurosurgery requires extremely hard work, intellectual curiosity, physical and emotional resilience and a fair amount of passion and commitment. It demands a balance of academic spirit, technical competence and emotional fortitude.

In this section, we’ll cover some of the ways you can make your residency application stand out and increase your chances of matching to a neurosurgery residency!

#1 Achieve High Exam Scores

Top neurosurgery residency programs are looking for students with top exam scores. To put it in perspective, successful applicants to top programs have a USMLE Step 1 mean score of 240. If your score is close to the mean, you have a reasonable chance of matching to the best programs. You can also submit USMLE Step 2 scores as a way to boost or offset a lower USMLE Step 1 score. But keep in mind that your exam scores aren’t everything; you will still need a strong residency application to show for it.

#2 Participate in Research

Neurosurgery is a very academic field, and many programs have a significant portion dedicated to medical research. Most applicants will have significant research experience, but it does not necessarily need to be within the scope of neurosurgery. In your application, outline any publications and presentations you have that speak to your research ability and dedication. It’s recommended that you include at least 2-5 quality publications in your application.

#3 Build Strong Relationships

Gaining some exposure to the field of neurosurgery or networking with programs early on is an excellent way to get your foot in the door. Neurosurgery residency programs are few and small, so you can make a great first impression and begin building critical relationships by participating in away rotations, sub internships and finding a mentor within neurosurgery. Not only will you advance your knowledge and experience, but you can get some early exposure to residency programs you might want to match to. When it comes time for the match, these programs will already know you and be familiar with your work ethic. Show up to any away rotations or internships eager to learn and ready to participate as a team player.

#4 Ace Your Clinical Rotations

A strong MSPE is always a great addition to your residency application, especially if you aced those clinical rotations most closely related to neurosurgery. If you’re applying for a prelim year or transitional year in general surgery, getting excellent reviews from the best residency programs for surgery program directors will certainly be a bonus when you move on to an advanced neurosurgery residency program.

#5 Nail the Primary Application

Writing a strong ERAS or CaRMS application will be time-consuming, but it will help your chances of matching. Every piece of your application, from your personal statement to your experiences and achievements to your ERAS recommendation letters, will form a complete picture of who you are and help you stand out from the many other qualified and high-achieving students applying for the same position. Take the time to go through each and every section of your application materials and fill them out.

#6 Submit a Supplemental Application

A majority of neurosurgery residency programs are now participating in the ERAS supplemental application. This is an optional application, but it can help further distinguish you from other applicants, and residency program directors are interested in learning more about you! The supplemental app gives you an opportunity to share meaningful experiences and impactful moments you have you did not share in your primary application. It is an extra step, but it may be worth using your supplemental app essays to your advantage, especially if you are applying to a top program.

#7 Prep for Your Residency Interview

As always, residency interview prep is a must. Get familiar with some of the hardest residency interview questions, and practice for your interview until you are confident in delivering a strong performance. Especially if a residency program hasn’t met you before, the interview is a critical time to make a strong, positive first impression and secure one of those coveted spots. Be sure to check out some ERAS interview prep tips or CaRMS interview prep, depending on where you’re applying!

#8 Go the Extra Mile

Finally, going the extra mile can be the thing that tips the odds of matching in your favor. For instance, sending thank you notes to program directors after your interviews or sending a residency letter of intent to your top-choice program. Since you’ve come this far and you’re dedicated to getting into a neurosurgery residency program, take every little step possible to ensure you match successfully!

Conclusion

Neurosurgery residency programs are among the longest, most demanding and grueling residency specialties out there. There are some many benefits and rewards that come from entering a career in neurosurgery, but it is also a huge commitment in many ways. Medical school graduates who choose neurosurgery as their specialty are often highly motivated to pursue the specialty and have given significant thought to their choice of residency.

If you’re still unsure of what medical specialty you should choose, or you’re weighing your chances of matching to a neurosurgery residency program, you can talk with a residency application consultant for guidance and advice on crafting an excellent application!

FAQs

To your success,

Your friends at BeMo

BeMo Academic Consulting

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