Neurosurgery Residency Program Directors' Perspectives: A Scoping Review of Program Director Survey Responses

Entrance to neurological surgery residency is highly competitive due to the large number of applicants vying for a limited number of spots. The process has become even more competitive in recent years, with a significant increase in applicants but a consistent number of available residency positions. Program director (PD) surveys offer valuable insights into the selection process and expectations for neurosurgical residency, guiding prospective candidates to navigate the challenging training path. We conducted a three-database scoping review confined to the last 20 years to compile all available PD survey results, excluding those released through the official National Resident Matching Program (NRMP) data. Studies were screened and selected according to specific inclusion and exclusion criteria. The selected articles were evaluated for survey year, distribution method, response rate, question type, number of items, and content. Most importantly, survey responses were detailed and summarized. Nineteen PD survey studies were eligible for inclusion in the present review. These revealed substantial diversity in survey structure and topics addressed over the past 20 years, with response rates averaging 54%. Studies focused on PD perspectives on applicant evaluation criteria, residency training factors, and the impact of COVID-19 on the application process. Key findings included the importance of the interview process, United States Medical Licensing Exam (USMLE) Step 2 scores, and letters of recommendation in resident selection, concerns about the impact of the USMLE Step 1 transitioning to pass/fail, and the need for enhanced research opportunities and mentorship to increase interest in neurosurgery. Residency training studies highlighted challenges related to duty hour restrictions, the importance of surgical simulation for resident education, and variations in subspecialty training experiences. The impact of COVID-19 on residency applications posed challenges for certain applicant groups during virtual interviews, and barriers remain in the post-pandemic era. Recent studies provide an in-depth look at PD perspectives on essential factors in the neurosurgery residency match, the impact of COVID-19 on recruitment, and the current state of training. Selection criteria still heavily rely on USMLE scoring, letters of recommendation, and interviews, with debates arising from the shift to pass/fail Step 1 scoring. Challenges in evaluating candidates, concerns about training quality, and the effects of the 80-hour workweek mandate are ongoing issues, while research participation is encouraged to enhance academic productivity. The pandemic has influenced the application process and led to mixed outcomes and financial barriers for some applicants despite the return to in-person interviews. These findings illustrate the continuous evolution of neurosurgical residency programs in response to various challenges and reforms.