Defusing the Neurosurgery Arms Race: A Blueprint for Quality-Focused Residency Selection

Area of Science:

• Medical Education
• Psychology
• Game Theory
• Neurosurgery Residency Selection

Background:

• Publication expectations in neurosurgery residency selection have intensified.
• Traditional objective metrics have receded, leading to an "arms race" prioritizing publication volume over impact.
• Raw publication counts are imperfect signals of merit, disadvantaging applicants without robust research infrastructure.

Purpose of the Study:

• Examine how raw publication counts function as imperfect signals of merit in neurosurgery residency selection.
• Propose a framework to realign incentives toward rigor, equity, and clinical relevance in scholarly work.
• Address the negative consequences of the current publication-focused system, including compressed timelines, low-impact output, anxiety, and burnout.

Main Methods:

• Literature review drawing on medical education, psychology, and game theory.
• Analysis of the "arms race" phenomenon in neurosurgery residency selection.
• Proposal of a framework with specific recommendations for reforming scholarly assessment.

Main Results:

• Current system disproportionately disadvantages applicants without access to research infrastructure.
• The focus on volume incentivizes low-impact output and contributes to applicant anxiety and burnout.
• A proposed framework aims to shift focus from publication counts to meaningful scholarship.

Conclusions:

• Reforms such as quality-weighted scoring, capping reported research items, and recognizing nontraditional contributions can improve residency selection.
• Piloting objective assessments and conducting longitudinal research are crucial next steps.
• Neurosurgery can lead a transition toward meaningful scholarship in residency selection, setting a precedent for medical education.