The Path to the Top: Factors Associated With Matching into Top-Tier Neurosurgical Residencies in the U.S.

Introduction: Neurosurgery remains highly competitive for United States medical graduates (USMGs). With USMLE Step 1 now pass/fail, understanding factors contributing to matching into prestigious programs is crucial. This study aims to identify characteristics associated with successfully matching into "top-ranked" neurosurgery residency programs.

Methods: We analyzed American Association of Neurological Surgeons data for graduates between 2007-2017. The primary outcome was matching into a "top residency program," defined using three ranking systems: Top-40 NIH-funded institutions, Blue Ridge Institute for Medical Research ranking, and Doximity ranking.

Results: Among 1,692 neurosurgery residents that began residency between 2007-2017, majority were male (82%) with a mean age of 31.9 years. Of these, 26.7% attended US News top 25 medical schools. Median H-index was 1, with a mean of 2 pre-residency publications. 78% took a gap year prior to entering residency, and 1.4% participated in pre-residency fellowships or preliminary year. The vast majority (98.6%) held an MD degree, and 8.4% had PhDs. Our results showed that attending a US News top medical school (p < 0.001) and higher pre-residency H-index (p < 0.001) were associated with matching into top programs across all ranking systems. Other factors such as PhD (p=0.001) and Master's degrees (p=0.03) correlated with matching into NIH Top-40 programs. Conversely, taking gap years (p=0.01) and DO degrees (p=0.006) were associated with lower top program match rates.

Conclusion : Even though numerous intangibles are important for matching at “top-tier” neurosurgical residencies, our study reveals important factors for matching into top-tier neurosurgery residencies: attendance at highly ranked medical schools, higher h-indices, publication count, research fellowships, and advanced degrees. These findings are especially relevant now that USMLE Step 1 is pass/fail, emphasizing the importance of these alternative metrics in residency applications.