Neurosurgery
Ellen G. Shaver, M.D.Associate Professor of Neurosurgery
Medical College of Georgia School of Medicine
Augusta, Georgia
Neurosurgery is the surgical specialty concerned with the diagnosis and treatment and of disorders that affect the brain, spinal cord, peripheral nerves and spinal column. The number of Neurosurgery Residency programs and available training positions has remained relatively stable in the past decade. The following statistics regarding Neurosurgical residencies were recently published in the newsletter from The American Board of Neurological Surgery (ABNS): there are 94 accredited Residency programs in the United States, with a total of 829 residents. In January 2001, 289 individuals registered with the Neurosurgical Matching program; 219 submitted ranking lists and 211 were ranked. One hundred forty-two matched, compared to 134 in 2000. In June 2001, 147 residents graduated. These statistics are updated annually at the ABNS website.1
There are several national Neurosurgical organizations. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) sponsor separate annual meetings as well as jointly sponsored annual sub-specialty meetings (e.g. Pediatric Neurosurgery, Spinal Neurosurgery, Cerebrovascular Neurosurgery).2,3 Additionally, the AANS and CNS co-sponsor a website for both patients and professionals. This site is continually updated with information regarding clinical topics of interest, upcoming meetings and abstract deadlines, as well as fellowship, grant and research award applications.
Training Requirements
Medical Students
In the preclinical years, it is helpful to identify a mentor or faculty advisor to recommend possible electives, research opportunities and residency programs of interest to you. The CNS education committee has developed a medical student core curriculum for neurosurgery available to download to a palm pilot, that can be found at www.neurosurgery.org/home.asp.
Because Neurosurgery is an early match (January), it is important to rotate at programs of interest early in the Fourth year. It is also important to get a letter of recommendation (and therefore it is important to rotate on the service) from the chairman of the Neurosurgery department of your medical school.
Residency
Most residencies are 5 or 6 years long, after 1 year of general surgery internship. 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).4 Programs are categorized by state. This website also includes most other medical specialties. Information and applications for the Neurosurgery Residency Matching Program (NSMP) can be found at www.sfmatch.org.
Residency Requirements
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).(4) The current guidelines include: one year of preliminary surgical internship; a minimum 60 months training program in addition to the preliminary year, of which 36 months are on clinical neurosurgical rotations; a 3 month block rotation on neurology; 12 months as chief resident; and up to 21 months devoted to specialized areas of study including basic sciences, neuroradiology, neuropathology and research.
Board Certification
Board certification of neurosurgeons is maintained by the ABNS. The certification process is comprised of 2 examinations: a written examination that is taken during residency, and an oral examination which is taken after several years of practice. Recertification is required every ten years after passing the oral exam. Information regarding Board Certification can be found at the ABNS website.1
Fellowships
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 www.societyns.org/fellowships. Many other fellowships in other areas of subspecialized training are also available, for example, Skull Base Surgery, Epilepsy and Functional Neurosurgery, and Neurointerventional Surgery. Consult individual program websites for information.
Extramural Funding (Research and Travel Fellowships, Grants)
Medical Students
Many medical schools offer summer research fellowships to preclinical students. Check with your medical school Research Office or advisor.
Residents and Faculty
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. The information for most of the following awards can be found via www.neurosurgery.org.
AANS
Neurosurgery Research and Education Fellowship (NREF): This Research Fellowship is designed for neurosurgeons who are preparing for academic careers as clinician investigators. The award is available to MDs in approved residency positions and is offered as a two-year commitment, totaling $70,000 or a one-year grant of $40,000. Applications related to any field of neurosurgery are encouraged.5
VanWagenen Fellowship: This award is open to senior level neurosurgery residents, and is designed to allow foreign travel for scientific enrichment. The Fellowship provides a $45,000.00 stipend for living and travel expenses to a foreign country for 6-12 months.5
Young Clinician Investigator (YCI): This award is open to young, full-time faculty in North American teaching institutions who are pursuing careers as clinician investigators. The purpose of the award is to fund pilot studies that provide preliminary data used to strengthen applications for more permanent funding from other sources. The one-year award totals $40,000. Applications related to any field of neurosurgery are encouraged.5
CNS
CNS Clinical Fellowship Award: This award provides financial assistance to residents and recent graduates (within 12 months of graduation from residency) to obtain clinical skills during a 3-6 month elective rotation at an institution other than the primary training program. Usually two awards, up to $10,000.00 each are given each year.
The CNS/DePuy Acromed Clinical Fellowship in Spinal Neurosurgery: This $50,000.00 award provides one year of spinal surgery fellowship.
The CNS Clinical Fellowship in Syringomyelia and Chiari Malformation: This one year fellowship provides $10,000.00 for clinical or experimental research.
The CNS Margot Anderson Foundation Fellowship in Brain Restoration Research: One year fellowship of $10,000.00 is provided for clinical or experimental research in the area of restorative therapies for brain injury, stroke, or neurodegenerative disorders.
CNS Charles Plants Public Policy Fellowship: This is a one-year fellowship designed to train neurosurgeons in health policy, by working in a Congressional office or Administration in Washington, D.C. Awards are commensurate with the applicant's level of training, up to $75,000.00.
CNS Wilder Penfield Clinical Investigation Fellowship: This scholarship is meant to assist neurosurgeons in the field of clinical investigation, and is open to both residents and fully trained neurosurgeons in both academic and private practice. Support of up to $40,000.00 is available for one year.
CNS International Fellowships: These awards are designed to support neurosurgeons from developing countries while obtaining additional training, and may cover a period from 3 to 6 months.
Many additional awards are available from joint section subspecialties. Please consult specific websites for further information.
Membership in Neurosurgical Societies
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)2
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)3
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. Further information is available at the CNS website.
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.
References
1. The American Board of Neurological
Surgery
6550 Fannin Street, Suite 2139
Houston, Texas 77030
Phone: (713) 790-6015
website:
www.abns.org
2. The American Association of
Neurological Surgeons
5550 Meadowbrook Drive
Rolling Meadows, IL 60008-3852
Phone: 847-378-0500
Fax: 847-378-0600
website:
www.aans.org
3. Congress of Neurological Surgeons
10 North Martingale Road, Suite 190
Schaumburg, IL 60173
Phone: (847) 240-2500
Fax: (847) 240-0804
Toll Free: (877) 517-1CNS
Email:
info@1CNS.org
4. Accreditation Council for
Graduate Medical Education
515 N. State Street, Suite 2000
Chicago, Illinois 60610
Phone: (312) 464-4920
website:
www.acgme.org
5. For information regarding AANS
sponsored grants and fellowships, contact:
Laurie Singer, Grants Coordinator
Phone: (847) 378-0500
website:
www.info@aans.org