The Neurosurgery Applicant’s “Arms Race”
Neurosurgery is incredibly selective, and for good reason. Neurosurgeons require the fortitude to complete seven years of intensive training, operate in high-risk corridors, and endure the emotional and physical aspects of patient care. Beyond that, they also need to be innovative and intellectually curious. Many program directors view research productivity, before and during medical school, as a reflection of these important characteristics necessary to be successful. As a result, current medical students interested in the field are feeling an increasing pressure to participate in research; this has resulted in an unparalleled growth in student research output.
The pressure is particularly apparent for students who model their application strategies using research productivity data published by the National Resident Match Program (NRMP). Every few years, NRMP releases a report titled “Charting Outcomes in the Match”, which compares various metrics between matched and unmatched candidates by specialty. For neurosurgery, in 2009, the average number of abstracts, presentations, and peer-reviewed publications documented was 7.8 per matched applicant (5.5 per unmatched applicant); by 2018, this number had grown to 18.3 (8.9 in unmatched), the highest of any field represented in the Match.1-2
The conclusion many applicants arrive at is that research improves the chances of matching in neurosurgery. Research is, after all, a gateway to building relationships, experience, and a fund of knowledge. However, it is daunting to hear stories—especially on online neurosurgery forums—of how other students can have hundreds of research products.3 With this information, the perceived number needed to be exceptional rises. This only perpetuates the neurosurgery applicant’s research “arms race”. We are left wondering if these astronomical numbers are reflective of the involvement students have in their research. Are students really publishing countless papers, or is the rise in research productivity explained elsewhere?
Understanding the steady increase in research numbers over the last decade was the rationale for our recent Journal of Neurosurgery article in which we provided a comprehensive analysis of the matched applicant’s research productivity. The goal was to determine the number of peer-reviewed publications successfully matched applicants produce, since this information is usually anecdotal. The NRMP combines abstracts, presentations, and peer-reviewed publications together into a “research products” metric. We found that matched applicants from the 2018-2019 cycle published a mean 5.5 journal articles.4 As such, the majority of the 18.3 research products reported by the NRMP in 2018 were abstracts and presentations, not peer-reviewed papers.
The current culture, in which some students perceive research as a means to distinguish themselves from the applicant pool, may be undermining the attempt to attract the best students to neurosurgery. Candidates from diverse backgrounds and medical schools may be discouraged from applying to neurosurgery if they feel their research portfolio is not competitive.
One analysis found almost half of neurosurgical applicants engage in some form of research misrepresentation, purposeful or not.5 Misrepresentation was defined in this study as anything from listing a research in the wrong section of the application (i.e. an abstract listed in the peer-reviewed publication section) to falsifying entire publications. It may be that the recent conversion of the USMLE Step 1 to pass/fail may only serve to place more emphasis on the applicant’s research portfolio.
The onus to ensure academic honesty and to balance research quantity with quality of experience lies with both applicants and research mentors. Whether that means the role of medical students in research needs to be updated or if application reform is needed to better assess quality is yet to be determined. Students should not, by any means, stop pursuing numerous research experiences. Contributions to multiple projects has its advantages; unfortunately, sometimes it comes at the price of superficial involvement. Students should instead use their time and resources to develop substantial, impactful projects and develop fundamental research skills. Brainstorming ideas, submitting IRB proposals, collecting data, learning statistical analysis techniques, writing manuscripts, creating figures, and ultimately publishing a paper from start to finish are what make for meaningful student experiences. With the continuous redistribution of emphasis on what is important for neurosurgery, it will be interesting to see if the applicant’s “arms race” propels students to become better researchers in residency.
1. National Resident Matching Program (NRMP): Charting Outcomes in the Match. Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2009 Main Residency Match. Washington, DC: NRMP2009 (https://www.nrmp.org/wp-content/uploads/2013/08/chartingoutcomes2009v3.pdf) [Accessed March 10 2020].
2. National Resident Matching Program (NRMP): Charting Outcomes in the Match: U.S. Allopathic Seniors. Characteristics of U.S. Allopathic Seniors Who Matched to Their Preferred Specialty in the 2018 Main Residency Match. Washington, DC: NRMP2018 (https://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-Seniors.pdf) [Accessed March 10 2020].
3. “Neurosurgery Hub.” Neurosurgery Hub, www.neurosurgeryhub.org/.
4. Wadhwa H, Shah SS, Shan J, et al. The neurosurgery applicant’s “arms race”: analysis of medical student publication in the Neurosurgery Residency Match. J Neurosurg. 2019 Nov 1:1-9. [Epub ahead of print].
5. Kistka HM, Nayeri A, Wang L, et al.Publication misrepresentation among neurosurgery residency applicants: an increasing problem. J Neurosurg 124:193–198, 2016.
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