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 NRMP1952 – 37,000 students processed /yr. – 4,100 programs matched – 24,000 matches – User guide: – Help: – ERAS1995 – 31 specialties – million documents/yr. – Help: – ( )

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

Timeline for NSRMP: ERAS REGISTRATION INTERVIEW DATES LISTED: SNS/ERAS INTERVIEW DATE COORDINATION7-8/10 NRMP REGISTRATION APPLICATIONS SUBMITTED 8-10/09 DEADLINE: APPLICATIONS 11/1-09 INTERVIEW INVITATIONS 9 to INTERVIEWS to 2/10 QUOTA CHANGE DEADLINE DEADLINE: RANK LISTS MATCH WEEK MATCH DAY MATCH OUTCOME: STUDENTS/ PROGRAMS

Interest/qualifications for NS Rank lists submitted Positions/applicants Applicants/position 1.9:1 2.4:1 Ranked applicants/position Applications: total /272 US seniors matched 88% %-171 Positions offered NS only/first choice Av. USMLE/matched Av. Applications/student Av. Offers received

NS Residency Positions Available/US Senior Student Applicants Matched /71% /93% /79% /83% /88% /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 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. %US %Tot. Neurosurg Neurology Orthosurg Fam. Med

Neurosurgery Program Directors Match Survey Response rate: 60% (58/99) Easy Difficult Data download 91% 9% System use overall 93% 7% Rank list entry 100% ---- Help Desk 100% ---- Compare SFM 94% 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 increased44% Range 10-25% Number Same30% More time better42% No difference39% Started later73%

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

Number of Applications: 2009 Increased68% Unchanged32% Range increase: n= %

Profile of Applicants: 2009 Quality improved66% Quality unchanged34% More females41% Backup specialty selected 22% Students advised re backup23%

Use of ERAS to prepare/export rank list to NRMP Easy45% Fair20% 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 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