Individual and Environmental Contributors to Cultivating Neurosurgery Resident Academic Productivity

Introduction: Scholarship has been critical to the development of neurosurgery. As grades and board examinations become pass-fail, finding metrics to distinguish applicants coupled with an emphasis on academic productivity has led to exponential growth of reported research output amongst neurosurgery residency applicants. We aimed to evaluate applicant-intrinsic and environmental factors, the seed and soil respectively, that associate with growth of an academically productive neurosurgery resident.

Methods: Applicant demographics, clerkships grades, listed activities, and publication history were extracted from Electronic Residency Application Service archives from two geographically distinct academic neurosurgery programs for the 2014-2015 match cycle. Subsequent publications during residency were tallied from indexed PubMed articles, and residency program and post-residency career paths were examined. Factors associated with residency publications were examined using univariate and multivariate regressions.

Results: 228 U.S. medical school applicants to neurosurgery were assessed (89% of US neurosurgery applicants), with 173 matching across 93 programs. The average publication number of matched applicants was higher at 6.6 (range: 0-43) compared to unmatched applicants (2.9, range: 0-51). 93.1% of publications were substantiated on PubMed review. Matched candidates published 19.3 manuscripts (range: 0-120) on average during residency. Factors associated with higher residency publications on univariate analysis included taking a non-degree-granting extra year for research in medical school, consistently high clerkship grades, depth of pre-residency research involvement (publications, first-authorship, conference abstracts), number of co-residents, and academic output of neurosurgery department leadership. However, after multivariate correction, the training environment played an outsized role in predicting resident academic output. The number of residents per class also significantly associated with resident academic output (OR: 1.14, p=0.01) while taking an extra research year in medical school trended toward significance (OR: 1.21, p=0.07).

Conclusion : In neurosurgery, cultivating an environment that promotes research endeavors is critical for resident academic growth while pre-residency publication number does not consistently predict publication potential during residency.