Association of Women Surgeons

So You Want to be a Neurosurgeon: A Career Resource Guide for Successful Navigation

as published in: The American Journal of Surgery (2011) 202, 360-3.

Surbhi Jain, MD, FACS
Assistant Professor, Neurosurgery Service
Neuro-Oncology Program,
H. Lee Moffitt Cancer Center
12901 Magnolia Drive,
Tampa, FL 33612
Phone: 813-745-3871

Keywords: Neurosurgery, Neurological surgery, Residency programs, Fellowship training, Career resource

Abstract: Neurosurgery is not just about head injuries and brain tumors. It is a specialty that currently stands at the forefront of biomedical and technological developments. Modern neurosurgery not only requires creativity and perseverance on behalf of your patients but also requires clinical acumen, surgical judgment and technical expertise. This career resource guides the reader through the pathway to a practice in neurosurgery.

History lives in words and memory, but it also lives in objects. That is why people collect original art and books, even when there are reproductions that appear and feel identical to the original. This is no less true for the history of neurological surgery. One of the earliest surgical procedures of which we have evidence is said to be perforating the skull to let out demons or to release insanities resulting from head wounds. With the advent of written history, the techniques employed and the tools used to make holes in the skull have been described in great detail. In the 20th century, neurosurgery was developed by the meticulous procedures of Harvey Cushing and the technical genius of Walter Dandy.¹

Women began to have significant influence on neurosurgery in United States starting in the days of Harvey Cushing. In academic neurosurgery, women account for about 6% of the neurosurgeons who are full-time faculty members (25 of 400) and represent 4.6% of those in private practice (145 of 3145). Clearly, the total number of (American Board of Neurological Surgery) ABNS-certified female neurosurgeons has grown since the first woman gained certification in 1960.²

Neurological Surgery is a discipline of medicine and the specialty of surgery that provides the operative and non-operative management of disorders of the central, peripheral, and autonomic nervous systems. There are broad general categories of neurosurgical diseases that are commonly managed by neurosurgeons: cerebrovascular (hemorrhage and aneurysms); traumatic head injury (THI); degeneration diseases of the spine; tumors in the CNS; and functional neurosurgery.

This career resource guides the interested medical student and physician through the pathway to a practice in neurosurgery. The information presented here is available elsewhere; however this reading was assembled to make your search easier.

Most people think all neurosurgeons dreamed of doing brain surgery from an early age. However, the truth is that most are first introduced to the field of neurosurgery in medical school, where they subsequently develop their interest. If a student is interested in neurosurgery, she or he should try and identify a mentor early. Mentors periodically meet with their mentees to provide guidance, and even discuss potential research projects. Doing a surgical clerkship in the junior or senior year is strongly encouraged in order to gain appreciation for the discipline and to become acquainted with a specific program and its members. High USMLE scores, high grades in medical school (including in Alpha Omega Alpha), strong letters of recommendation from other neurosurgeons, and research activity are generally helpful. Given its increasingly competitive nature, only very rarely do spots go unmatched in the National Residency Matching program (NRMP) neurosurgery programs.

Residency 

There are approximately 100 programs that currently provide neurosurgery residency training in the United States. Accreditation of residency training programs is an established process through the Accreditation Council of Graduate Medical Education (ACGME) and its specialty Residency Review Committees (RRC). Status regarding accreditation, as well as links to individual programs may be found on the Website for the Accreditation Council for Graduate Medical Education (ACGME).3 Details of each program can be found at FREIDA online database at http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.shtml. Information and applications for the Neurosurgery Residency Matching Program (NRMP) can be found at www.nrmp.org        

Curriculum requirements for Neurosurgical Residency programs are determined by the Residency Review Committee (RRC) and published by the Accreditation Council for Graduate Medical Education (ACGME).³ Neurosurgical training is a minimum of 72 months in length, of which 42 months are on clinical neurosurgical rotations; a 3-month block rotation on neurology; 12 months as chief resident; and up to 24 months devoted to specialized areas of study including basic sciences, neuroradiology, neuropathology and research. As of July 1, 2009, the training program in neurological surgery no longer requires one year of surgery internship. The PGY-1 includes a minimum of 3 months of fundamental clinical skills training (critical care, trauma, and other rotations as determined by the Program Director), and may include up to 6 months of neurosurgery, which will count toward the 42 months required.⁴ Although the minimum training is 72 months (6 years), many programs are 7 years in length to include an additional 12 months devoted to research or advanced training. 

Board certification of neurosurgeons is maintained by the American Board of Neurological Surgery (ABNS). The certification process is comprised of two examinations: a written primary examination that is taken during residency, and an oral examination. The primary examination is an important step in the process toward certification. It is carefully designed to evaluate candidates' knowledge and provide direction for continued learning. It is prepared by the ABNS under the purview of the National Board of Medical Examiners (NBME). Each applicant for oral examination must first successfully pass the Primary Examination for credit toward certification. Oral examination is scheduled within five years of completing residency training. Recertification is required every ten years after passing the oral exam.

Certification (by the ABNS) constitutes an affirmation that the specialist has completed an approved educational training program and an evaluation process, including written and oral examinations, designed to asses the knowledge, skills, and experience necessary to provide quality patient care in neurological surgery. Information regarding Board Certification may be found at the ABNS Website.

The Fellowship Match for Neurosurgery was established in 1993. Its goal is to coordinate fellowship appointments, thus relieving the pressure of uncoordinated appointments and forced early choices. There are many fellowships available in subspecialized fields of Neurosurgery. Some fellowships in Pediatric Neurosurgery, Spinal Neurosurgery, Peripheral Nerve Surgery and Cerebrovascular Surgery are accredited through the Committee on Accreditation of Subspecialized Training (CAST). Program information, requirements, and applications may be found at http://www.societyns.org/fellowships/sns-cast_accredit_fellowships.html. Many other fellowships in other areas of subspecialized training are also available outside of the match, for example, Skull Base Surgery, Epilepsy and Functional Neurosurgery, and Neurointerventional Surgery.

AANS Medical Student Summer Research Fellowship: The American Association of Neurological Surgeons (AANS) through the Neurosurgery Research and Education Foundation offers the AANS Medical Student Summer Research Fellowship (MSSRF) program. The fellowship is open to medical students in the United States or Canada who have completed one or two years of medical school and wish to spend a summer working in a neurosurgical laboratory, mentored by a neurosurgical investigator who is a member of the AANS and will sponsor the student. Further information about this medical student summer research fellowship program may be found at www.aans.org 

Many medical schools offer summer research fellowships to preclinical students. The best way for medical students to find research opportunities is through their schools.

Numerous clinical and research fellowships are available for both residents and neurosurgery faculty. There are awards sponsored by the AANS, the CNS as well as awards sponsored by private organizations or in conjunction with private organizations. Some of the prestigious awards such as Neurosurgery Research and Education Fellowship (NREF), Young Clinician Investigator Award (YCI), VanWagenen Fellowship Award etc are designed to support residents and young neurosurgeons for scientific enrichment. Many additional awards are available from joint section specialities. The information for most of the following awards can be found via www.neurosurgery.org.   

Neurosurgical societies are available at the local, state, regional and national levels. Participation is encouraged for both residents and faculty. The two most prominent national organizations are:

The American Association of Neurological Surgeons (AANS)

The AANS was founded in 1931 as the Harvey Cushing Society, with the purpose of advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Today, the AANS has a worldwide membership of 6500. Resident membership is encouraged. Applicants for Active membership must be Board Certified by the ABNS. Further information regarding membership application can be found at the AANS Website.

The Congress of Neurological Surgeons (CNS)⁶

The purpose of the CNS is to promote the public welfare through the advancement of neurosurgery, by a commitment to excellence in education, and by dedication to research and scientific knowledge. The first annual meeting of the Congress was held in 1951, in Memphis Tennessee, with an initial membership of 121. Today there are over 5000 members worldwide. This organization also accepts resident and medical student members. Further information is available at the CNS Website. www.cns.org

Many national subspecialty organizations also exist, some are jointly-sponsored by the CNS and the AANS. Additionally, there are national organizations with specialized interests that may extend to several medical specialties (Stroke Council, North American Spine, etc). Information regarding membership to joint sections of the CNS and AANS is available at www.neurosurgery.org.

In a nutshell, neurosurgery is a very demanding, yet extremely rewarding specialty. It is well suited to those individuals who have a strong interest in the human nervous system and the various disorders that can affect it. The technological advances that continue to evolve will help keep neurosurgery a fresh and exciting field for decades to come.

References