Hello, my name is Michael Carsey. I'm a chief resident at the University of Utah. I would like to discuss with you our project entitled the survey of applicant views regarding the neurosurgical fellowship process. There's one disclosure which is not relevant to this paper. Postgraduate fellowships in neurosurgery are important for many reasons, such as improving surgical or research skills, helping develop an academic career, as well as helping to improve employment in specific fields or job markets. However, the current process regarding fellowship matching remains quite nebulous despite significant effort from the CAST system, Senior Society, organized neurosurgery, and other subspecialty fields. And there are a number of reasons for this. Some are known and some are unclear. The purpose of this survey was to help to identify some of these factors. We performed an electronic survey of U.S. neurosurgical residents in their 5th, 6th, and 7th years. After approval from the CSNS resolution was accomplished, we achieved a 45% response rate, which we thought was quite reasonable for this kind of survey. Essentially, our survey questions helped to try to identify the fellowship process that residents underwent throughout their residency, and then also develop areas that they thought could be improved. Most residents entered into endovascular or spine fellowships. Most residents applied for 2-5 programs and then underwent 2-5 interviews. In deciding programs, the most important things were word of mouth as well as faculty mentorship. Most residents applied for fellowships within their PGY 5, 6, and 7 years. The majority of residents did not encounter any application deadlines, suggesting that admission was on a rolling schedule. And a breakdown of when interviews and applications were offered and performed are shown here. Most residents stated that they had adequate time to contemplate an offer and accepted their first offers. But however, there were a number that had still additional interviews during the point in time that they received an offer. In terms of improvement of the MATCH system, the majority of residents, over 93%, suggested that there could be room for improvement from the national neurosurgical organizations. And these included things such as common application due dates, a fellowship database with publicly reported fellowship details, improved coordination of interview timing, as well as improved transparency. Very few residents actually suggested that the accreditation or the rigor of the programs was something to be questioned, as shown here. The vast majority of pediatric fellowship applicants said that they were very satisfied with the MATCH process and they felt that their process was quite fair. Now, in asking residents whether they felt a legally binding centralized MATCH would be preferable, 16% said they strongly supported such a system, as compared to 28% which opposed and 11% which strongly opposed. Now, there was a large chunk that remained neutral, but over 26%, which we feel might be due to a lack of information about what a centralized MATCH system might look like. In conclusion, the vast majority of residents described a need for improving the fellowship application system with some ideas and strategies shown here. There was a split regarding a need for a formal MATCH, with a large portion of residents remaining neutral. However, they may just simply be unaware about what the other potential possibilities of a centralized MATCH system may look like. Other subspecialties used in MATCH system, two specific ones are the National Resident Matching Program, or NRMP, as well as the San Francisco MATCH Program. Pediatric neurosurgery uses an established MATCH system, and the residents that went into pediatric fellowships that replied to this survey reported significantly higher rates of satisfaction with their fellowship process and improved fairness. And there are other subspecialties quite similar to neurosurgery, such as orthopedics, that have established MATCH subspecialty programs for many years now. And the overwhelming support towards these programs is quite strong, despite the drawbacks such as cost, pressure to attend multiple interviews, as well as lost time in training due to the interview system. The overall conclusion from most of the orthopedic literature is that it is not a perfect system, but continues to evolve, improve, and something that neurosurgery could potentially take a look at and learn from. I'd like to thank Kristin Krause, our academic editor, that helped with the manuscript, which is now available for anyone interested in learning more about our survey and its results. I'd also like to thank several contributors in offering some insight into the MATCHing system. It has been something of discussion for many decades in organized neurosurgery and in ways of trying to improve it for residents. I'd also like to thank Sandy Meyer from the CSNS that helped with dissemination of the survey.

Michael Carsey

neurosurgical fellowship process

factors influencing fellowship matching process

survey

improvements in fellowship application system