Neurosurgery Resident Matching Program ERAS NRMP AAMC Society of

Neurosurgery Resident Matching Program ERAS/NRMP: AAMC Society of Neurological Surgeons Philip R. Weinstein, MD SNS Match Committee

NSRMP TRANSITION SFM TO ERAS/NRMP MATCH RESULTS FOR 2009 Program Director Survey PROBLEMS ENCOUNTERED GOALS FOR THE FUTURE QUESTIONS AND CONCERNS

Rationale for Transition to AAMC Match • • • Financial considerations Separate applications for GS internship Integration of PGY 1 into neurosurgery Neurology and ENT transition was satisfactory Disadvantages – Loss of personalized service – Later match date: simultaneous – Longer interview period

Background/Contacts • NRMP – – – 37, 000 students processed /yr. 4, 100 programs matched 24, 000 matches User guide: www. nrmp. org Help: nrmp@aamc. org 866 -617 5837 • ERAS – – 1952 1995 31 specialties 22. 650 million documents/yr. Help: erashelp@aamc. org (202 -828 0413)

Cost • ERAS – Free to programs – Students: $60/1 -10 programs $8/11 -20 $15/21 -30 $25 ea. /31+ • NRMP – $175/Dean’s Office institutional fee – $30/Program + $30/matched applicant – $50/Student

Timeline for NSRMP: 2009 -2010 • ERAS REGISTRATION 4 -30 -09 • • INTERVIEW DATES LISTED: SNS/ERAS INTERVIEW DATE COORDINATION 7 -1 -09 7 -8/10 • • • NRMP REGISTRATION APPLICATIONS SUBMITTED DEADLINE: APPLICATIONS INTERVIEW INVITATIONS INTERVIEWS QUOTA CHANGE DEADLINE: RANK LISTS MATCH WEEK MATCH DAY MATCH OUTCOME: STUDENTS/ PROGRAMS 9 -1 -09 8 -10/09 11/1 -09 9 to 11 -09 10 -09 to 2/10 1 -31 -10 2 -24 -10 3 -15 -09 3 -18 -10 3 -22 -10

Interest/qualifications for NS • • • Rank lists submitted Positions/applicants Applicants/position Ranked applicants/position Applications: total US seniors matched Positions offered NS only/first choice Av. USMLE/matched Av. Applications/student Av. Offers received 2008 254 0. 7 1. 9: 1 --356 88%-154 179 --236 24 4. 7 2009 317 0. 6 2. 4: 1 3. 9 458/272 82%-171 191 221 239 38 --

NS Residency Positions Available/US Senior Student Applicants Matched • • • 1998 2001 2004 2007 2008 2009 148/71% 151/93% 153/79% 171/83% 179/88% 191/82%

Unmatched US Seniors/Total 2009 (n=44/126) • Only 10 of 44 US seniors ranked an alternative in the match – PGY-1 gen’l surg. only 2 – Gen’l surg. Categorical 2 – Neurology 1 – Radiology 1 • Remainder used Scramble or chose to wait, take fellowship and try again • No open NS positions this year • 19% US Seniors unmatched • Students go to Dean’s Office or NS mentors for advice/assistance • Unmatched 2008 70 US+IMG vs 126 (2009)

Stressful Circumstance for NS committed students • Application, interview, rank listing and acceptance for a back up non-neurosurgical specialty eliminates possibility of participating in the Scramble (if there is one) for an open unfilled position in a NS program because of the NRMP contractual agreement to accept the position if matched to a backup specialty.

Comparative Match Data Pos. Neurosurg. Neurology Orthosurg. Fam. Med. %US %Tot. 191 196 641 2535 90 63 92 42 100 100 91

Neurosurgery Program Directors Match Survey- 2009 Response rate: 60% (58/99) • • • Easy Data download 91% System use overall 93% Rank list entry 100% Help Desk 100% Compare SFM 94% Difficult 9% 7% ------4%

Favorite Features • Online, electronic • Paperless, efficient • Easy to track, score, rank, complete, distribute, review applications • Sorting, grouping, filter, reports • Post office, communications • Interview manager • Easier for students to prepare and submit applications • Additional later submissions filed automatically • Project data for selection meetings

Problems Encountered ERAS not user friendly, difficult to rank, files lost Letters of recommendation not transmitted Download to disc difficult Unable to access from home (should not be a problem) • Not MAC compatible (pdf files download to disc) • •

Interview Process • Number increased • Range • Number Same 44% 10 -25% 30% • More time better • No difference • Started later 42% 39% 73%

Interview Process • • • Listed dates on SNS website Coordinated regionally Willing to coordinate 2010 Interview during externship Second visit allowed Second visit encouraged 90% 50% 82% 29% 85% 35%

Number of Applications: 2009 • Increased 68% • Unchanged 32% • Range increase: n=20 -100 20 -25%

Profile of Applicants: 2009 • • • Quality improved Quality unchanged More females Backup specialty selected Students advised re backup 66% 34% 41% 22% 23%

Use of ERAS to prepare/export rank list to NRMP • • Easy 45% Fair 20% Not used 68% Comment: This is easy and saves lots of time/effort. Call Help desk as needed.

Application additions requested • • • Undergraduate transcripts List of neurosurgery rotations USMLE II scores (sent when available) Additional 2 -3 reference letters (? neurosurgeons) Statement of goals after training Comment: Each of these items can be requested by individual programs on department web sites and/or in interview acceptance letter but are not required by ERAS.

Interview Scheduling • Programs list dates on SNS and ERAS websites: Coordinators attempt regional scheduling by weeks and days Suggested remedies: Earlier interview invitations Shorter interview period: Nov. and Dec. or Nov. and Jan. Allow interviews during externship visit

Transition Action Items for 2009 -10 • List special application requirements or preferences on department web site, brochures, interview acceptance letter • Inform less qualified NS interested students at your school that simultaneous application to a back-up specialty is advisable since unfilled positions are rarely if ever available through the Scramble • Avoid repeat recruitment visits and expense payments and pre-match commitments despite late match date • Refine PGY-1 curriculum/rotations • Coordinate interview dates with neighboring programs in July; offer multiple dates

SNS Match Rules • Don’t ask; don’t tell about rank list: • No commitments prior to match by students or program • Clerkship helps but is optional • Second visit allowed but not encouraged or required or official • No interview or visit expenses paid • Avoid gender or marital discrimination

Summary • Neurosurgery is continuing to attract qualified, competent and dedicated residency applicants • The transition to ERAS/NRMP has occurred smoothly and without major adjustment problems in most cases • Future efforts to reduce the number of applications to programs and interviews per student and to coordinate interview travel time and expense are needed • Counseling and alternative planning for potentially and actually unmatched US senior students is needed