Residency Application Process

Neurosurgery is one of the most exciting fields in medicine. Because of this, it is also very competitive. Be mindful of this as you enter the match process and be as prepared and informed as possible. The content on this site is designed to help you evaluate whether neurosurgery is the field for you, and if so, to assist you in becoming a competitive applicant.

Please visit the NRMP match for more information.

The neurosurgery residency matching program is part of the National Resident Matching Program (NRMP) www.nrmp.org and uses the Electronic Residency Application Service (ERAS) system www.aamc.org/eras. Applications open in late September or early October each year, and the match takes place the subsequent March for positions that will start the following July. The ERAS application consists of personal demographics, a photograph, a standardized CV, United States Medical Licensing Examination (USMLE) scores, bibliography, expanded detail on a select number of experiences (research, leadership, volunteerism, work, etc.), a personal statement, letters of evaluation from neurosurgeons, letters of recommendation and a letter from the Dean’s office of your home institution.

USMLE Step 1 examination is reported on a pass/fail basis only, elevating the importance of and Step 2 in the assessment of resident applicants. Correspondingly, it is recommended to study for and sit the exam well in advance of the ERAS submission deadline.

Letters-of-recommendation or evaluation are required from at least 3 and ideally 4 sources. The most common convention is to request letters from your home program, as well as from each of your 2 away rotations. Neurosurgery is moving towards standard letters of evaluation which highlight broader feedback from residents and faculty at each of your rotation sites and should be requested from the Chair and Program Director who frequently co-author these letters.

Individuals with very robust research resumes such as MD/PhD students may consider including a letter from someone who is not a neurosurgeon (e.g., neuroscientist PhD thesis advisor). Applicants can also consider a letter from a neurosurgeon or other faculty with whom they have worked with extensively and may be able to provide more background on the applicant’s particular characteristics. While these can be obtained from non-neurosurgeons most students should obtain letters from faculty neurosurgeons if at all possible. Where possible, letters should be requested and obtained prior to the ERAS opening date, so that a completed application with at least 3 letters can be submitted immediately; however, if your rotation schedule is such that not all of your visiting rotations and associated letters will be available at that time, ERAS accommodates uploading of additional letters typically until November 1

Applicants are expected to take ownership of completing and submitting their materials to ERAS in a timely fashion and should be proactive in assuming responsibility for each component. Many programs access and begin screening applications as soon as they are available, and so your interview opportunities may in part depend on a prompt and complete submission. Determining the optimal number of applications to submit is nuanced and warrants individualization. As of 2023, neurosurgery applicants are able to signal 25 programs, and so the conventional recommendation is to select at least 25 programs to take advantage of this screening threshold—ideally representing a broad range of geographies and prestige levels. Individuals with atypical circumstances, such as couples match participants, borderline applicants, or individuals without a home program, may consider a broader field. Personalized mentorship is strongly recommended to finalize your individual plans at this step of the process to ensure signals are well-utilized. Over time, as we receive more information on the impact of program signaling, additional guidance will be available.

Interviews are by invitation only and typically occur in. November, December, or January. Although interviews were remote for the 2020-2021, 2021-2022, and 2022-2023 seasons due to COVID-19, as of the 2023-2024 cycle, the Society of Neurological Surgeons (SNS) has deferred decision-making in that regard to individual programs, with many returning to in-person interviews, while others have maintained a remote application process. Also of note, it is not unusual for multiple residency programs to schedule interviews on the same date,  which will force applicants to prioritize one program per date. Many programs alert the SNS regarding anticipated dates in advance of interview invites being distributed, which may help individuals anticipate and avoid key conflicts. Cancellation is not strictly forbidden; however, it is considered unprofessional to cancel within several weeks of the interview date, as this disadvantages both the program and the applicant who would have been able to take advantage of the open interview slot, were they provided appropriate notice.

Applicant and program final rank list submission dates are determined by the NRMP and typically occur in mid-to-late February, with match day occurring in mid-March.

The final match rank list must be submitted by the applicant and residency programs by late February. Results of the match ranking are generally available mid-March.

Electronic Residency Application Service (ERAS)
ERAS is a service that transmits applications, letters of recommendation, Medical Student Performance Evaluations (MSPE aka Dean’s letter), medical school transcripts, USMLE transcripts, Comprehensive Osteopathic Medical Licensing Examination (COMLEX) transcripts and other supporting credentials from you and your designated Dean’s office to program directors electronically. ERAS consists of MyERAS (the website where you create your application), the Dean’s Office Workstation (DWS), the Program Director’s Workstation (PDWS) and the ERAS PostOffice.

MyERAS Website
Complete your application and personal statement, select programs for application, and assign documents to be received by each program (e.g., letters-of-recommendation). Although no one program can receive more than 4 letters from a given applicant, you may upload additional letters and select different subsets of 4 to send each program.

Dean’s Office Workstation (DWS)
This is ERAS software used by staff at your Dean’s office. To create an electronic token that you will to access MyERAS. They also use this system to scan and attach supporting documents to your application, such as a photograph, medical school transcripts, MSPE and letters of recommendation.

Program Director’s Workstation (PDWS)
This ERAS software is used by residency program directors and residency coordinators to receive, sort, review, evaluate, and rank applications.

ERAS PostOffice
This is a central bank of computers that transfers application materials between applicants and Dean’s offices and residency programs. You can monitor the activity of your files on the ERAS PostOffice via the Applicant Data Tracking System (ADTS).

ERAS provides a standardized platform for applicants to summarize and organize their educational, academic, and personal histories, including awards and achievements, leadership and volunteer efforts, hobbies and interests, or unique aspects of your life experience. Start early, and take time to complete your application, with particular attention to accuracy, completeness, and professionalism. For example, ensure that the accompanying photograph is professional in dress and demeanor; avoid submitting an incomplete or disorganized application; and comb each component for grammatical or typographical errors, which may communicate a lack of attention-to-detail to the residency programs.

Timetable

Preclinical Years (M1/M2)
Ensure excellent grades, pass USMLE Step 1, and begin to develop research resume and professional mentorship with neurosurgeons at your institution or in your area. If you lack a home program, reach out to the AANS for help identifying local neurosurgical leaders who would welcome a student mentee. Step 2 timing is institution dependent but should be completed and scored well in advance of the September during your M4 year. Early exposure to neurosurgery via shadowing or preclinical experiences is recommended where offered; please contact departmental leadership at your institution for detailed advising in that regard.

Clinical Clerkship Year (M3)
Ensure excellent grades, shooting for honors in all of your clinical clerkships — students who achieve honors in surgery, but no other rotation may be considered a red flag for poor collaborative skills, or a lack of investment in fully developing themselves as a future physician. In anticipation of your M4 year, online research is recommended to survey the landscape of neurosurgery training programs and identify candidate locations for your away rotations. Most students will complete a single one-month rotation at their home institution, followed by two one-month visiting sub-internships at other departments. Personalized advising is recommended to identify rotations and a schedule that are compliant with the requirements of your home curriculum and optimized for your strengths and goals as a neurosurgery resident applicant.

Application Year (M4)
Students are recommended to request letters-of-recommendation from faculty at their home institution during the M3/M4 summer. Students should provide faculty no less than 30 days’ notice, longer if possible, and the request should be submitted during or after the clinical neurosurgery rotation. Host institutions expect that all visiting students will request a letter from the chair and/or program director; however, you should be proactive about requesting meetings with both early in your rotation, during which you should formally express the letter request. M4 summer is also an important time to begin work on your ERAS application, including your personal statement, which many students find to be more challenging and time-consuming than anticipated.

Away rotation scheduling is determined on an individual basis; however, students should strive to complete their neurosurgery rotations by the end of October—earlier if possible. The official ERAS submission date may change yearly; please refer to the website for confirmation in that regard. Submission on the opening date is strongly advised, and applicants must plan accordingly in terms of obtaining letters-of-recommendation and completing the application components in detail.

Most programs will issue interview invitations during October, and as of 2023, SNS issued a formal recommendation that programs send interview invitations on Friday afternoons, to reduce stress on students completing clinical rotations. Interviews should be scheduled promptly, and most will be conducted during the October to January timeframe. Students should plan to attend any pre-interview events such as virtual meet-and-greets or dinners as this generally allows applicants the opportunity to engage with residents and/or faculty in a more informal setting.

Communication with programs after the interview is not formally sanctioned, but thank you notes and follow-up letters expressing interest or asking questions may be warranted under certain circumstances. Programs soliciting information regarding your rank list is considered a match violation, and applicants are not expected to answer questions in that regard, but scrupulous and professional communication is always advised.

In March, students will receive confirmation of their match status on the Monday prior to Match Day. Unmatched students may enter the Supplemental Offer and Acceptance Program (SOAP) during that week; matched individuals will obtain their program assignment on Match Day.