Вы находитесь на странице: 1из 6

J Neurosurg 120:167–172, 2014

©AANS, 2014

Factors neurosurgery candidates use when choosing a


residency program

Clinical article
Lauren H. Marasa, M.D., and Thomas A. Pittman, M.D.
Department of Neurosurgery, University of Kentucky Hospital, Lexington, Kentucky

Object. Many factors affect an applicant’s decision when selecting a residency program. While some issues are
likely important to all applicants, others may be specific to, or weighed differently by, those applying to certain spe-
cialties. In an effort to better understand how applicants to neurosurgery programs make decisions about relative rank,
the authors created a survey to identify the program characteristics thought most important by applicants.
Methods. An electronic survey was created and posted to the neurosurgery residency coordinator’s forum. Co-
ordinators throughout the country were asked to send the survey link to students who were scheduled to begin as
first-year residents in July of 2012. A paper copy of the survey was also distributed at the Society of Neurological
Surgeons intern boot camp in Atlanta, Georgia, in July of 2012.
Results. One hundred ninety-six students obtained a neurosurgical postgraduate year 1 position in the 2011–
2012 match; 40 survey responses were received (response rate 20.4%). The factors cited as being most important
in selecting a residency were the residents currently in the program, team camaraderie, and the number of operative
cases performed. The interview day, specifically the opportunity to talk to the residents, was also thought to be im-
portant, as was the knowledge that the applicant would likely be ranked by the program.
Conclusions. Applicants for neurosurgical training choose a program for reasons similar to those given by ap-
plicants to other specialties. Neurosurgery applicants seem marginally more interested in an emphasis on academics
and research and slightly less concerned with a program’s location, but overall, the differences appear minimal. The
interview process is very important, and contact by a representative after the interview also seems significant in ap-
plicants’ decision making. By recognizing what applicants think is important in choosing a residency, programs can
more effectively recruit residents and more efficiently use faculty time and department resources.
(http://thejns.org/doi/abs/10.3171/2013.7.JNS13290)

Key Words      •      neurosurgery resident      •      neurosurgery program      •


program selection

T
he choice of a training program is one of the most programs successfully tailor the interview experience,
important decisions a physician will make. Despite and ultimately, increase the success of the trainees.
the significance of the choice, relatively little is
known about how students select a residency. The infor-
mation that is available indicates that the most important Methods
drivers of the decision are the satisfaction of the current An electronic survey was developed using Survey
residents, the perceived quality of the faculty and clini- Monkey. The survey included 23 multiple-choice and 9
cal experience, and the location of the training facility.16,18
open-ended questions. The first question was structured
However, some have suggested that these factors vary
to define the relative importance of 25 listed factors in
with the characteristics of the applicant and the specialty
determining how applicants rank residency programs.
of interest.1,14,18,19
The 25 factors reflected discussions with applicants and a
Neurosurgery is a small, competitive specialty. While
review of the available literature. Participants were asked
there is literature that applies to other specialties,3,10–12,15,22
to choose which factors were “most important,” “impor-
there is no information available about program selection
that is specific to neurosurgical applicants and, conse- tant,” “slightly important,” “least important,” or “not im-
quently, no way to know whether their motivations differ portant” in selecting a program. The choices were then
from those applying in other fields. By better understand- This article contains some figures that are displayed in color
ing how applicants rank neurosurgery programs, it may on­line but in black-and-white in the print edition.
be possible to increase the efficiency of the match, help

J Neurosurg / Volume 120 / January 2014 167


L. H. Marasa and T. A. Pittman

assigned a numerical value: 5 for “most important,” 4 for geographical location were uniformly used to narrow the
“important,” 3 for “slightly important,” 2 for “least im- possibilities, 90% of respondents also employed websites
portant,” and 1 for “not important.” Those with the high- to gather information that they then used to decide wheth-
est average ratings were considered most important. Since er to apply to a program. The most commonly consulted
there was no limit to how many factors one could mark websites included the National Resident Matching Pro-
as “most important,” we asked participants in an open- gram website, program-specific websites, and commercial
ended question to name the single most important factor sites like uncleharvey.com. Half of those surveyed said
influencing their rank list. This allowed differentiation that these websites affected which programs they chose
of the variables in cases in which several choices were to visit and to rank.
characterized as “most important.” Multiple-choice ques- When asked why applicants declined an invitation to
tions focused on the interview experience, including the interview, the most common responses were a schedul-
number of choices of interview location, satisfaction with ing conflict and/or that the applicant already had enough
the process, and the importance of various parts of the in- interviews scheduled (Fig. 2). Most applicants (53.8%)
terview day. Responses to all of the open-ended questions had no preference regarding which day of the week an in-
were grouped according to common themes, and the most terview was held, but of those applicants who did have a
common answers were used to identify the issues about preference, 17.9% preferred Friday; 12.8%, Saturday; and
which the applicants felt strongly. 10.3%, Thursday. Reasons given for these preferences in-
A link to the survey was posted to the neurosurgery cluded increased travel flexibility and less time away from
residency coordinator’s forum. Residency coordinators required rotations. Almost all applicants (80%) agreed
were asked to send the survey link to the students who that interview order had no influence on their rank list.
had matched into the 2012 first-year slots at their respec- The interns surveyed interviewed at an average of 13 in-
tive programs. Additionally, a paper copy of the survey stitutions and ranked an average of 12 programs. The most
was handed out to first-year neurosurgery residents at the common reasons an applicant chose not to rank a program
Society of Neurological Surgeons intern boot camp in At- were the program’s reputation and location.
lanta, Georgia (July 2012). The survey results contained Most applicants stated that their favorite part of the
no personal identifiers. Results from the online survey interview process was the opportunity to meet other ap-
were combined with those obtained from the participants plicants. The expense involved was troublesome and lim-
in Atlanta. All first-year neurosurgery residents were giv- ited the ability of some applicants to travel to selected
en the opportunity to participate in the study through their programs. About a third of applicants said that at least
program coordinators to account for any potential selec- 1 program paid for their lodging; however, only 1 appli-
tion bias. cant noted that this affected his or her rank list. Similarly,
while the majority of programs provided transportation to
either the interview site or to dinner, this had no influence
Results on program ranking. Dinner with the residents the night
One hundred ninety-six positions were offered in before the interview was common and seemed to be val-
the 2012 match: 194 were filled initially, and the other 2 ued by the applicants. Most would prefer that the dinner
were filled through the Supplemental Offer and Accep- not be held at the home of one of the faculty or residents.
tance Program process.17 Forty of the first-year residents The most valuable part of the evening was thought to be
responded to the study survey, giving an overall response the opportunity to interact with the residents in a setting
rate of 20.4% (40 of 196). away from the hospital.
When choosing from a list of 25 options, most of the Almost all applicants (90%) reported that the inter-
respondents (52.8%) selected the current residents as the view day greatly influenced their rank order list. They
most important factor in choosing a residency. Team ca- found 2 things most important: the belief that the inter-
maraderie, program faculty, the number of operative cas- viewer had reviewed their application and personal state-
es, and an emphasis on academics were also consequential ment in advance, and having the chance to talk to the
in program selection (Fig. 1). When an open-ended ques- residents throughout the day. Most applicants (62.5%) pre-
tion was asked, applicants again identified the residents in ferred a formal introduction of the program given by the
the program and team camaraderie as the most important program director or chairman, 45% favored having one
factors in selecting a program (43.6%). Interestingly, when of the residents give a presentation on the program, and
the question was asked in this format, 25% of participants 37.5% wanted to attend grand rounds (Fig. 3). A signifi-
listed location as the most important variable in choosing cant majority of applicants (70%) preferred one-on-one
a program. Operative autonomy of the residents was the interviews, but 25% preferred 2 faculty members per in-
third most common response (20.5%). The idea of opera- terviewee (Fig. 4). Almost all of the applicants (87%) pre-
tive autonomy was recognized to be distinct from that of ferred to interview only with the faculty (Fig. 5). For most
case volume. Over half of the applicants did a subintern- applicants, the questions asked were of little account, but
ship at the program that became their first choice (57.5%). 10% reported that knowledge-based interview questions
This group identified team camaraderie and faculty/resi- or being asked to perform tests of dexterity caused them
dent interactions as the most important reasons for rank- to place a program lower on their rank list.
ing the program. Operative volume was the next signifi- Essentially all applicants (97.5%) sent thank-you
cant driver. notes to someone (for example, coordinator, interviewer,
The first step in the application process involves se- or resident) from the programs at which they interviewed.
lecting where to apply. While program reputation and In most cases (66.7%), they received a response, but only

168 J Neurosurg / Volume 120 / January 2014


Factors neurosurgery candidates use when choosing a residency

Fig. 1.  Factors affecting a neurosurgery applicant’s ranking of residency programs. Applicants rated each factor as being not
important in their decision (1), least important (2), slightly important (3), important (4), or most important (5). OR = operating room;
PGY-1 = postgraduate year 1.

31% said this correspondence affected their rank order. ment since the consequences of the choice of residency
Most applicants (89.7%) reported that representatives program, both during and after the period of training, are
from 1 or more programs contacted them before the rank tremendous.
lists were due, by email (76.6%), phone call (64.7%), or Some information related to how applicants decide
letter (58.8%). Of those who were contacted, the majority where to train is available. In most studies, the dominant
(69.4%) stated that this had an impact on their rank order. factors in choosing a program are the characteristics of
Most (74.3%) of those who were contacted by a represen- the workplace environment and the location.1,5,12,16,18 Ap-
tative from 1 or more programs prior to submitting their plicants also give consideration to a program’s academic
match list matched at 1 of the programs that had contacted accomplishments and reputation,7,9,13 patient volume and
them. diversity,16 and interview experience.4,6,21 Salary, student
interactions, and research opportunities have, in general,
Discussion been less important in making a decision.16,19
The factors considered in selecting a program seem
The process of selecting a residency is long and to vary, to some degree, with the characteristics of the ap-
costly. A substantial amount of time is required to evalu- plicant. Personality type likely plays a role in selecting a
ate programs, and the requisite travel can be expensive. training program, as do gender and minority status.1,2 Ap-
Scheduling a series of interviews is difficult, and the time plicants in different specialties seem to weigh the char-
spent away from medical school is, at best, inconvenient. acteristics of the program differently.18,19 Interestingly,
However, for most students, it seems to be a useful invest- the deciding factors may be changing over time. Many of

J Neurosurg / Volume 120 / January 2014 169


L. H. Marasa and T. A. Pittman

Fig. 2.  Top reasons neurosurgery applicants declined interviews.

the more recent reports suggest that students place an in- portant factors in deciding where to interview. It seems
creased emphasis on the work environment and are less likely that programs in unacceptable settings have been
concerned with the academic reputation of a program than eliminated prior to interviewing, so that relative advan-
they once were. tages of one or another location appear less important in
The concerns of applicants to neurosurgery programs the ranking process.
are, for the most part, similar to those of applicants to The interview process is also likely more important
other specialties. Applicants to neurosurgery programs than is suggested by the ordinal question format. Nearly
are focused on the current residents and their interactions all applicants (90%) identified the interview day as being
with each other and with the faculty, plus the quality of the extremely significant in their evaluation of programs. For
faculty and operative volume. Neurosurgical applicants some, it provides the only opportunity to meet and talk to
seem marginally more interested in a program’s empha- the residents and faculty and, consequently, is a primary
sis on academics and, in particular, some opportunities factor in an applicant’s assessment of these groups. Be-
in research than are applicants to other programs. When yond that, applicants value the impression that their ap-
placed in an ordinal rank format, a program’s location plication has been reviewed prior to the interview. Appar-
seems slightly less important than other factors, but it is ently, with rare exceptions, what is actually discussed in
interesting that, when asked in an open-ended question, the interview is of little consequence. A formal introduc-
25% of applicants identified location as the most impor- tion to the program is also appreciated, and the applicants
tant variable in selecting a program. It is also important would, in general, prefer it be given by the program direc-
to recognize that location and reputation are the most im- tor or chairman.

Fig. 3.  Preferences of applicants of how to spend the interview day.

170 J Neurosurg / Volume 120 / January 2014


Factors neurosurgery candidates use when choosing a residency

tively small number of respondents and the possibility


that they may not be representative of the larger pool of
applicants. Since the response rate was markedly higher
among participants at the Neurosurgery Boot Camp, and
since nearly all first-year neurosurgery residents now at-
tend Boot Camp, it seems possible to address both issues
by distributing future surveys at each Boot Camp session.

Conclusions
Applicants for neurosurgical training select a resi-
dency for reasons similar to those given by applicants to
Fig. 4.  Types of interviews preferred by interviewees. other specialties. They are marginally more interested in
the program’s academic and research opportunities and
slightly less concerned with location than are applicants
It is interesting how often communication after the to other specialties. For nearly all applicants, the impres-
interview affects an applicant’s rank list. Apparently, this sions formed during the interview process are of primary
type of communication is very common: nearly 90% of importance in ranking a program. It is surprising how of-
applicants reported that they were contacted by a repre- ten applicants revise their rank lists in response to some
sentative from 1 or more of the programs at which they expression of interest by a program representative.
had interviewed. It isn’t clear what information was passed
on nor is it known whether it was accurate. Nonetheless, Acknowledgments
a significant majority of applicants (69%) said that they
changed their rank list because of the contact, which is We wish to thank Amy Dilorenzo and Randall Schell for their
slightly higher than reported for other specialties.20 Ulti- advice and support; the members of the Society of Neurological
Sur­geons for allowing this survey to be incorporated into the intern
mately, nearly three-quarters of applicants who were con- boot camp; and Ms. Stacey Sindelar and all neurosurgery program
tacted matched at 1 of the programs that had contacted co­ordinators who helped distribute and implement this study.
them.
While some aspects of a program, such as its loca- Disclosure
tion, cannot be changed, there are opportunities to make
a residency more attractive to applicants. Since most ap- The authors report no conflict of interest concerning the mate-
plicants make their initial decisions about where to apply rials or methods used in this study or the findings specified in this
based, in part, on their review of websites,8 it seems rea- paper.
sonable to manage a program’s web presence. In addition, Author contributions to the study and manuscript preparation
include the following. Conception and design: Pittman. Acquisition
the interview day can be scheduled to allow as much time of data: Marasa. Analysis and interpretation of data: both authors.
as possible for the applicants to speak to the current resi- Drafting the article: both authors. Critically revising the article: Pitt­
dents, and the faculty should be encouraged to review the man. Reviewed submitted version of manuscript: Pittman.
applications prior to the interviews. It also seems useful
to contact the most competitive applicants to express the
program’s interest within the guidelines of the National
References
Resident Matching Program.
The principle limitations of this study are the rela-   1.  Aagaard EM, Julian K, Dedier J, Soloman I, Tillisch J, Pérez-

Fig. 5.  Applicant choice of interviewer. The graph shows the profession of interviewer preferred by interviewees.

J Neurosurg / Volume 120 / January 2014 171


L. H. Marasa and T. A. Pittman

Stable EJ: Factors affecting medical students’ selection of an 13.  Marciani RD, Smith TA, Heaton LJ: Applicants’ opinions
internal medicine residency program. J Natl Med Assoc 97: about the selection process for oral and maxillofacial surgery
1264–1270, 2005 programs. J Oral Maxillofac Surg 61:608–614, 2003
  2.  Cole KL, Leibrandt TJ, Pezzi CM, Kukora JS: Do men and 14.  Markert RJ, Rodenhauser P, El-Baghdadi MM, Juskaite K, Hil-
women use the same criteria in selecting a general surgery res- lel AT, Maron BA: Personality as a prognostic factor for spe-
idency program? Results of a 20-year study in a non-university cialty choice: a prospective study of 4 medical school classes.
program. J Surg Educ 64:204–207, 2007 Medscape J Med 10:49, 2008
  3.  Davydow D, Bienvenu OJ, Lipsey J, Swartz K: Factors influ- 15.  Mayeaux EJ Jr, Arnold J: Why first-year family practice resi-
encing the choice of a psychiatric residency program: a survey dents choose their residency programs. Fam Med 25:253–256,
of applicants to the Johns Hopkins residency program in psy- 1993
chiatry. Acad Psychiatry 32:143–146, 2008 16.  Nagler A, Andolsek K, Schlueter J, Weinerth J: To match or
  4.  DeIorio NM, Yarris LM, Gaines SA: Emergency medicine not: factors influencing resident choice of graduate medical
residency applicant views on the interview day process. Acad edu­cation program. J Grad Med Educ 4:159–164, 2012
Emerg Med 16:S67–S70, 2009 17.  National Resident Matching Program: Results and Data: 2012
  5.  DeSantis M, Marco CA: Emergency medicine residency se- Main Residency Matchsm. (http://www.nrmp.org/data/results
lection: factors influencing candidate decisions. Acad Emerg anddata2012.pdf) [Accessed July 28, 2013]
Med 12:559–561, 2005 18.  Nuthalapaty FS, Jackson JR, Owen J: The influence of quality-
  6.  Dumont TM, Horgan MA: The surgical skills laboratory resi- of-life, academic, and workplace factors on residency program
dency interview: an enjoyable alternative. J Surg Educ 69: selection. Acad Med 79:417–425, 2004
407–410, 2012 19.  Wang T, Wong B, Huang A, Khatri P, Ng C, Forgie M, et al:
  7.  Flynn TC, Gerrity MS, Berkowitz LR: What do applicants look Factors affecting residency rank listing: a Maxdiff survey of
for when selecting internal medicine residency programs? A graduating Canadian medical students. BMC Med Educ 11:
comparison of rating scale and open-ended responses. J Gen 61, 2011
Intern Med 8:249–254, 1993 20.  Yarris LM, DeIorio NM, Gaines SS: Emergency medicine
  8.  Kutikov A, Morgan TM, Resnick MJ: The impact of residency residency applicants’ perceptions about being contacted after
match information disseminated by a third-party website. J interview day. West J Emerg Med 11:474–478, 2010
Surg Educ 66:212–215, 2009 21.  Yarris LM, DeIorio NM, Lowe RA: Factors applicants value
  9.  Laskey S, Cydulka RK: Applicant considerations associated when selecting an emergency medicine residency. West J
with selection of emergency medicine residency program. Emerg Med 10:159–162, 2009
Acad Emerg Med 16:355–359, 2009 22.  Yousuf SJ, Kwagyan J, Jones LS: Applicants’ choice of an
10.  Lewis P, Hayward J, Chertoff J: Student interviews for radiol- ophthalmology residency program. Ophthalmology 120:
ogy residency: what influences how students rank programs? J 423–427, 2013
Am Coll Radiol 7:439–445, 2010
11.  Lindauer S, Payne MD, Shroff B, Tüfekçi E: Factors influenc-
ing applicant ranking of orthodontic programs. Angle Orthod Manuscript submitted February 12, 2013.
76:84–91, 2006 Accepted July 25, 2013.
12.  Love JN, Howell JM, Hegarty CB, McLaughlin SA, Coates Please include this information when citing this paper: published
WC, Hopson LR, et al: Factors that influence medical student online October 18, 2013; DOI: 10.3171/2013.7.JNS13290.
selection of an emergency medicine residency program: impli- Address correspondence to: Thomas A. Pittman, M.D., Depart-
cations for training programs. Acad Emerg Med 19:455–460, ment of Neurosurgery, University of Kentucky, 800 Rose St.,
2012 MS105, Lexington, KY 40536. email: tpitt2@uky.edu.

172 J Neurosurg / Volume 120 / January 2014

Вам также может понравиться