How strategic engagement with programs drives neurosurgery match success

Area of Science:

• Medical Education
• Neurosurgery Residency Training
• Surgical Match Outcomes

Background:

• The neurosurgery residency application landscape is increasingly strategic.
• Applicants must balance relationship-building with academic achievements.
• The shift to United States Medical Licensing Examination (USMLE) Step 1 pass/fail (P/F) grading and program signaling has altered applicant strategies.

Purpose of the Study:

• To evaluate the influence of program-specific engagement on neurosurgery residency match outcomes.
• To assess how the importance of relationship-building has evolved post-USMLE Step 1 P/F and program signaling.
• To identify key predictors for obtaining a residency interview.

Main Methods:

• Analysis of survey responses from 465 US MD neurosurgery applicants (2022-2025) via the TexasSTAR database.
• Multivariable logistic regression to assess relationship variables (away rotation, signaling, geography) against match success.
• Random forest modeling to determine dominant interview predictors and ANOVA for temporal changes.

Main Results:

• Away rotation (aOR 8.48) and program signaling (aOR 2.17) were strong predictors of match success and interview offers.
• Relationship variables were more impactful for applicants with lower academic metrics (e.g., Step 2 CK < 244).
• Post-2022, applicants submitted fewer applications and interviews, with increased reliance on program-specific engagement; academic metrics declined in predictive power.

Conclusions:

• Program-specific engagement strategies are paramount for securing neurosurgery residency interviews.
• The trend indicates that targeted connections are more valuable than application volume post-USMLE Step 1 P/F.
• A shift towards more strategic applicant engagement is evident in the neurosurgery match process.