Cataloging Educational Curricula of Neurosurgical Preliminary and Preresidency Clinical Positions in the US

Introduction: The neurosurgery match was highly competitive in 2023, with only 65% of U.S. applicants matching, compared to 93% across all specialties. With fewer than 30% of reapplicants succeeding, preresidency and preliminary programs emerged to provide rigorous training in neurosurgical care, neuroanatomy, neurophysiology, and neuroradiology. Although these programs do not guarantee residency placement, they offer invaluable clinical experience networking opportunities, and occasionally led to filling PGY1/2 attrition positions. This study aimed to catalog the curricula and characteristics of these clinical programs in the U.S.

Methods: Using ACGME’s 2023-2024 Neurological Surgery Accreditation data, a manual search of 118 program websites and social media was conducted to identify clinical preresidency positions. A10-item survey, following AAPOR guidelines, was distributed to program coordinators. The survey collected data on program characteristics, clinical responsibilities, educational exposure, admission processes, and support systems. Data was analyzed using StataCorp16.1.

Results: Nine preresidency programs were identified. Preliminary responses from four programs indicated that these positions spanned one year, were non-ACGME accredited, and recruited through departmental websites and social media, with admissions taking place between March and May. Compensation aligned with PGY1 salaries, though academic stipends were frequently not included. The programs featured rotations across multiple hospitals, provided NP support, and followed Q1 home call and Q3 in-house call schedules. Trainee responsibilities combined administrative tasks with clinical duties comparable to those of PGY1/2 residents. The number of monthly consults varied significantly, ranging from 29-133, with a median of 61. Bedside procedures ranged from 1-4 per month, with a median of 2, while involvement in operative cases had a median of 16, ranging from 9-41.

Conclusion : Preresidency programs provided clinical experience outside of the Match but differed significantly from general surgery preliminaries in scope and responsibilities. Further studies were needed to assess program directors' perspectives and the impact of these programs on Match success for neurosurgical applicants.