Analysis of academic publishing output among 1634 successful applicants in the 2011-2018 neurosurgery residency match

The impact of NIH funding and program reputation score on research output and residency matches in neurosurgery: A bibliometrics analysis

The neurosurgery residency applicant selection process is complex, with peer-reviewed publications (PRP) recently becoming a key focus. While PRP may significantly impact applicant matching, equitable opportunities for research may vary for students. We aimed to evaluate the impact of NIH funding and program reputation score on applicants' ability to match into top neurosurgery residency programs. Successfully matched PGY1 neurosurgery applicants in the 2022-2023 cycle were evaluated. PRP, Blue Ridge Institute for Medical Research (BRIMR) medical school and residency NIH-funding ranking, and residency Doximity reputation score were evaluated. PGY1 residents (n = 235, 73% male) included 84% MDs, 1.0% DO, 10% MD/PhD, and 5% IMGs. Thirty-one (13.2%) superpublishers (> 25 PRPs) were identified (93.5% male) and had a higher number of non-MD degrees (32.3% vs. 13.3%, p = 0.007). Matching into a top 20 NIH-ranked residency program was associated with completion of a top 20 NIH-medical program (OR = 2.70, p = 0.015), superpublisher status (OR = 2.87, p = 0.024), and affiliation with a top 40 NIH-ranked neurosurgery program (OR = 3.44, p < 0.001). Matching into a top 40 reputation program was predicted by being a superpublisher (≥ 25 publications; OR = 2.66, p = 0.04) and attending a medical school with an affiliated top 40 reputation neurosurgery program (OR = 4.85, p < 0.001). PRP has become a large focus in determining a candidate's competitiveness for top neurosurgery residency programs. Our results clarify the factors impacting PRP, including the importance of NIH funding and the neurosurgery department's reputation. These results highlight both best practices for training residents and potential disadvantages some medical school candidates may have from lower-ranked programs or limited research opportunities. Further studies are warranted to evaluate the impact of these factors on the equity of neurosurgery residency candidates.

The Bibliometric Evolution of Neurosurgery Publications From 1977 to 2023

BACKGROUND AND OBJECTIVES

Neurosurgery is a world leader in disseminating neurosurgical science. Although the literature has seen significant increases in academic collaboration, data science, and authorship diversity, the bibliometric evolution of Neurosurgery remains unknown. This study sought to elucidate bibliometric trends in Neurosurgery from 1977 to 2023.

METHODS

Wolters Kluwer and Web of Science were used to identify all publications in Neurosurgery from 1977 to 2023. Database utilization was analyzed from 2007 to 2023 using abstract keywords. The BERTopic tool analyzed prevailing subspecialty themes. Publication types including clinical/case report/review were analyzed. Statistical analysis included exponential and linear regression.

RESULTS

From 1977 to 2023, 29 755 publications containing 127 171 authors were published in Neurosurgery. From 1977 to 2023, the mean authorship count per publication exponentially increased (2.4 to 8.4, 2.0% annually) (R 2 = 0.76), small authorship groups (≤ 5 authors) linearly decreased (90% to 37%) (R = 0.93), multinational authorship groups linearly increased (0% to 21.2%) (R = 0.95), and authorship affiliations per publication exponentially increased (1.3 to 4.6, 3.2% annually) (R 2 = 0.65). From 1990 to 2023, female first authorship linearly increased (7.5% to 15.7%) (R = 0.93), Bachelor degree first authorship increased (0.6% to 12.5%), and MD/PhD senior authorship increased (6.2% to 24.7%), with more review articles and less case reports. Cerebrovascular topics dominated from 1980 to 2020, with spine topics most represented in the 2020s. Database utilization demonstrated an exponential, 4.6-fold increase from 2007 (0.38%) to 2023 (2.14%) (R = 0.63).

CONCLUSION

Neurosurgery publications have demonstrated increasing authorship counts, authorship diversity, collaboration, and database utilization since the journal's 1977 inception, prominently publishing on topics in cerebrovascular and spine research.

Senior Mentorship and Scholarly Success: Assessing Influences on Successful Neurosurgery Residency Applicant's H-Index

BACKGROUND

Research productivity is on the rise as neurosurgical residency positions become increasingly competitive. We explored the relationship between neurosurgical residency applicant's senior author's research productivity and matching into a neurosurgery residency program.

METHODS

A retrospective analysis of bibliometric data for applicants who matched into neurosurgery in 2022-2023 and their senior authors was conducted using Scopus.

RESULTS

Logistic regression revealed a significant association between h-index values and top 40 match outcomes (P = 0.038). The maximum h-index of senior authors significantly predicted matches at top 40 programs (P = 0.003). Affiliation with a top 40 medical school increased both applicant and senior author h-indices (P = 0.05, P < 0.001 respectively). Linear regression of the maximum h-index of senior authors in preresidency publications explained 42% of this variability (P < 0.001). A multiple linear regression model incorporating this with publication number elucidated 69% of the variance in interns' h-index. Authorship data categorized as first, second, and third author positions showed 1847 first author, 1417 second author, and 118 third author publications over 2-years. Applicants at top 40 residency programs had more first and second author publications compared to those from nontop 40 programs (P = 0.0158, P = 0.0275).

CONCLUSIONS

There is a strong correlation between a neurosurgical applicant's academic output and that of their senior authors. The number of publications and the maximum h-index of senior authors significantly predict applicant h-indices. We also demonstrated that there is a significant difference in the academic productivity of applicants and senior authors of applicants who successfully match into a top 40 i(h)5 rated neurosurgical residency.

"Home Field Advantage": The Presence of a "Home" Neurosurgical Residency Training Program is Associated With Improved Match Outcomes

BACKGROUND AND OBJECTIVES

Competition for neurosurgical residency training positions remains fierce. The support provided by applicants' home neurosurgery residency training programs (NRTP) is suspected to play a key role in the National Resident Matching Program (NRMP) process. We sought to evaluate the impact of the presence of an Accreditation Council for Graduate Medical Education-accredited NRTP at medical students' home institutions has on NRMP match outcomes.

METHODS

Our cross-sectional observational study examined all US allopathic senior student Electronic Residency Application Service applications to a single NRTP from 2016 to 2022.

RESULTS

We analyzed a total of 1650 Electronic Residency Application Service applications to a single NRTP, of which 1432 (86.8%) were from schools with an Accreditation Council for Graduate Medical Education-accredited NRTP (NRTP+) and 218 (13.2%) were from schools without a residency (NRTP-). NRTP+ applicants matched a higher rate on both pooled analysis (80.8% vs 71.6%, P = .002) and paired analysis ( P = .02) over the seven-cycle study period. This difference was present before (82.4% vs 73.9%, P = .01) and after (77.2% vs 65.6%, P = .046) the COVID-19 pandemic. Cohorts were overall similar; however, NRTP+ applicants had more publication experiences (19.6 ± 19.0 vs 13.1 ± 10.2, P < .001) and were more likely to complete a research gap year (RGY) (25.8% vs 17.0%, P = .004). Completing a RGY was associated with an increased likelihood of matching for NRTP+ applicants but not for NRTP- applicants: NRTP+: 84.9% vs 78.1% ( P = .0056); NRTP-: 70.3% vs 70.9% ( P = .94).

CONCLUSION

The presence of a NRTP at a medical student's home institution is associated with improved NRMP match outcomes. This held true both before and after the COVID-19 pandemic. Applicants from schools with a NRTP had more publication experiences and were more likely to complete a RGY. Completion of a RGY is associated with an increased likelihood of matching only for students with an affiliated NRTP.

Exploring the gender gap in neurosurgery: A cross-sectional analysis of preresidency publications among neurosurgery residents

Background and Aims

While the number of female physicians has increased since the 1970s, there continues to be a lack of female surgeons compared to their male counterparts, with the gender gap more prominent in surgical subspecialties such as neurosurgery. While surgical subspecialities have accelerated initiatives to close the gap, potential disparities in research opportunities may position women at a disadvantage, particularly in neurosurgery, where academic publications are an indicator of residency match success. In this paper, we sought to investigate whether gender disparities exist in preresidency neurosurgery publications among current neurosurgery residents.

Methods

The present study selected residency programs from the top 25 neurology and neurosurgery hospitals in US News & World Report's 2022 Ranking. A database of neurosurgery residents and their publications was created using PubMed, neurosurgery residency program websites, and supplementary search. Articles published between the time of birth and December 31st of the year of graduation (medical degree) were used to determine publications before residency.

Results

Our research indicates that 25.7% (n = 135/526) of US neurosurgery residents at top 25 hospitals are women and 74.3% (n = 391/526) are men. Men (n = 391) had a median of 7 (interquartile range [IQR], 3-14.5; range, 0-129) publications before residency, and women (n = 135) had a median of 7 (IQR, 4-11.0; range, 0-74) publications before residency. There were no significant differences in the median number of publications between genders (p = 0.65).

Conclusion

In conclusion, our research indicates there is no gender disparity in preresidency publications among neurosurgery residents. To improve women's representation in the field, further study is needed to better understand gender inequality among neurosurgeons, particularly in the earlier stages of medical training.

Impact of Gender and Underrepresented in Medicine Status on Research Productivity Among Ophthalmology Residency Applicants

PURPOSE

Insufficient representation of women and underrepresented in medicine (URiM) students remains a problem among the ophthalmology workforce. In the residency selection process, research productivity is an important factor. We aimed to determine the average research output listed by applicants and assess for differences by gender and race.

DESIGN

Retrospective cohort study.

METHODS

All San Francisco Match applications to the Wilmer Eye Institute for the 2019, 2020, and 2021 ophthalmology residency cycles were retrospectively reviewed. Each applicant's number of published research articles was recorded and subclassified into first-author publications in any field, publications in ophthalmology, and first-author publications in ophthalmology. Multivariable logistic regression was performed to determine factors associated with successful publication.

RESULTS

A total of 1376 applications were reviewed. On average, women had a greater number of publications in ophthalmology (2.08 vs 1.73, P = .05) and presentations (4.52 vs 4.09, P = .01) compared with men. Self-identified URiMs were less likely to list publications in ophthalmology (odds ratio [OR] 0.650, P = .05) and first-author publications in ophthalmology (OR 0.570, P = .02) compared to non-URiMs.

CONCLUSIONS

Our findings highlight disparities in research productivity by self-identified URiM status. On the other hand, women had similar if not higher research outputs than men. Greater research mentorship and opportunities to support URiM students may facilitate the recruitment of diverse trainees to ophthalmology programs.

Prevalence of International Medical Graduates in Integrated Plastic Surgery Programs

International medical graduates (IMGs) are physicians who did not attend medical school in the USA or Canada. IMGs comprise nearly one-quarter of the physician workforce and play a vital role in health care. Here, we aimed to identify the prevalence of IMGs in integrated programs and evaluate factors that influence their success in the residency match.

Methods

The annual match reports from 2010 to 2020 were retrieved and summarized. Electronic surveys for program directors and program coordinators were distributed to US integrated plastic surgery programs. Each program's website was appraised for information regarding the eligibility of IMGs. Websites were also used to identify the number of IMG residents.

Results

The number of applicants who matched into integrated programs ranged from 69 to 180 per year, of which US applicants comprised 61-165. US IMGs filled one to three positions per year, whereas non-US IMGs filled two to seven. Although 48% of programs have matched non-citizen IMGs and 79% have not encountered difficulties during the visa process, 67% of coordinators reported that the onboarding process is more challenging for IMGs. There are no IMGs in 52% of programs, and most institutions offer information on their website regarding visa sponsorship.

Conclusion

IMGs make up less than 10% of filled positions per cycle. Although most programs accept IMGs, a small number matriculate. This may be explained by the competitiveness of integrated programs and the volume of IMG applications. Further research is needed to identify contributing factors of low IMG representation in plastic surgery programs.

Gearing Up for the U.S. Medical Licensing Examination Step 1 Pass/Fail Transition, Evaluating the Role of Research Productivity as an Alternative During the Neurosurgical Residency Selection Process: An Overview

Neurosurgery residency programs are the most competitive among the surgical specialties for applicants to match into. U.S. Medical Licensing Examination (USMLE) step 1 scores are staple and pivotal in narrowing down applicants for granting interviews and ranking in the match process. The upcoming transition from a numeric to binary step 1 scoring shifts the emphasis on using the status quo Step 2 Clinical Knowledge numeric scoring as the only objective measure. It can prove insubstantial for accurate assessment of competencies, further urging residency programs to widen their selection protocols to allow multiple assessments of competency. Research experience has consistently proved to result in higher successful match rates, and a positive correlation is seen with the number of research publications and Hirsch indices. However, with a predicted emphasis on research with the shift in scoring practices, these tools provide inadequate insight into authorship, contributions, type of publications, and community impact, warranting the need to include supplementary modifications, surrogates, or alternatives to such tools for a more comprehensive and equitable assessment of research. This study summarizes the role of research in the neurosurgical match process, describes nuances in research evaluation, and introduces novel Hirsch indices and additional strategies to address these nuances for equitable evaluation of research productions.

Shared Objective Mentorship via Virtual Research and Education Initiatives for Medical Students and Residents in Neurosurgery: A Systematic Review and Methodological Discussion of the Neurosurgery Education and Research Virtual Group Experience

OBJECTIVE

Virtual mentorship and research programs are becoming increasingly popular to facilitate education and career development for students and residents. We review virtual research initiatives for early trainees in neurosurgery and describe our effort to expand access to resources and shared objective mentorship (SOM) via the novel Neurosurgery Education and Research Virtual Group (NERVE).

METHODS

A systematic review of neurosurgical programming delivered via a virtual platform was conducted using PubMed, Embase, and Scopus databases. Identified articles were screened. Those meeting prespecified inclusion criteria were reviewed in full and examined for relevant data. Data analysis was performed using Microsoft Excel, and means and standard deviations were calculated. Descriptive analysis of NERVE characteristics was also performed.

RESULTS

Of the 2438 identified articles, 10 were included. The most common (70%) implementation style was a webinar-based lecture series. The least common (10%) was a longitudinal curricular interest group. Of the total NERVE cohort, 90% were first generation medical students and 82% attended institutions without home programs. Survey results indicated 73.8% had contributed to at least 2 research projects throughout the year.

CONCLUSIONS

There is a scarcity of virtual neurosurgical resources which facilitate SOM opportunities for trainees. In our systematic review, NERVE is the only multi-institutional virtual initiative aimed at increasing access to neurosurgical education and research opportunities for the purpose of SOM among early trainees from disadvantaged backgrounds. This highlights the group's niche and potential impact on increasing diversity in neurosurgery, improving trainees' career development, and facilitating future resident research productivity.

Analyzing international medical graduate research productivity for application to US neurosurgery residency and beyond: A survey of applicants, program directors, and institutional experience

Background

The authors investigated perceived discrepancies between the neurosurgical research productivity of international medical graduates (IMGs) and US medical graduates (USMGs) through the perspective of program directors (PDs) and successfully matched IMGs.

Methods

Responses to 2 separate surveys on neurosurgical applicant research productivity in 115 neurosurgical programs and their PDs were analyzed. Neurosurgical research participation was analyzed using an IMG survey of residents who matched into neurosurgical residency within the previous 8 years. Productivity of IMGs conducting dedicated research at the study institution was also analyzed.

Results

Thirty-two of 115 (28%) PDs responded to the first research productivity survey and 43 (37%) to the second IMG research survey. PDs expected neurosurgery residency applicants to spend a median of 12-24 months on research (Q1-Q3: 0-12 to 12-24; minimum time: 0-24; maximum time: 0-48) and publish a median of 5 articles (Q1-Q3: 2-5 to 5-10; minimum number: 0-10; maximum number: 4-20). Among 43 PDs, 34 (79%) ranked "research institution or associated personnel" as the most important factor when evaluating IMGs' research. Forty-two of 79 (53%) IMGs responding to the IMG-directed survey reported a median of 30 months (Q1-Q3: 18-48; range: 4-72) of neurosurgical research and 12 published articles (Q1-Q3: 6-24; range: 1-80) before beginning neurosurgical residency. Twenty-two PDs (69%) believed IMGs complete more research than USMGs before residency. Of 20 IMGs conducting dedicated neuroscience/neurosurgery research at the study institution, 16 of 18 who applied matched or entered a US neurosurgical training program; 2 applied and entered a US neurosurgical clinical fellowship.

Conclusion

The research work of IMGs compared to USMGs who apply to neurosurgery residency exceeds PDs' expectations regarding scientific output and research time. Many PDs perceive IMG research productivity before residency application as superior to USMGs. Although IMGs comprise a small percentage of trainees, they are responsible for a significant amount of US-published neurosurgical literature. Preresidency IMG research periods may be improved with dedicated mentoring and advising beginning before the research period, during the period, and within a neurosurgery research department, providing a formal structure such as a research fellowship or graduate program for IMGs aspiring to train in the US.

The role of medical school prestige and location in neurosurgery residency placement: An analysis of data from 2016 to 2020

OBJECTIVE

There remains a gap in the literature analyzing how categorical variables may affect the highly competitive neurosurgery residency application process for MD Seniors in the United States. We aimed to improve understanding of the impact of medical school prestige and geographic location on candidacy for neurosurgery residency.

METHODS

Schools were stratified into high and low prestige cohorts based on the U.S. News and World Report Rankings and by geographic location. Publicly available match data displayed by websites of included medical schools from 2016 to 2020 were examined, and neurosurgery residency placement rates were then compared. Analysis was performed using Fisher's exact test and chi-square analysis, with a p-value of 0.05.

RESULTS

There were 6685 total matches in the high-prestige cohort and 12,997 total matches in the low-prestige cohort, with 115 (1.72%) and 113 (0.87%) neurosurgery matches, respectively (OR = 2.00, p < 0.0001). Considering geographic location, there were 5244 total matches in the Midwest, 3456 total matches in the West, 4994 total matches in the South, and 6053 total matches in the Northeast, with 51 (0.97%), 24 (0.69%), 83 (1.66%), and 114 (1.88%) being neurosurgery residency placements, respectively (p < 0.0001).

CONCLUSIONS

Neurosurgery residency placement may be correlated with attending more prestigious medical schools and those located in the Northeast or South United States. Further elucidation of similar variables may prove to be important as neurosurgery residency becomes more competitive and the evaluation process changes.