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 Althought some students have a strong sense of subspecialty interest before medical school, it is typically near the end of the third year that most students begin to define their future career goals. A few individuals come to neurosurgery at a later point in their career, choosing to do an internship or work in a laboratory prior to applying to neurosurgical residency. Like many surgical subspecialties, neurosurgery has an early match. This match takes place each January for positions that will start July of the following year. For example, a student graduating in the year 2003 will match in January of the year 2003 for a first year neurosurgery position starting in July of the year 2004. Because of the early match, applicants must organize their application process in a timely fashion. The Central Application Service (CAS) is used by most neurosurgical residency programs, and students should complete their CAS application by mid-August to September of the year before the January match. All aspects of the application must be completed by that time, including reference letters, which must be submitted with the application. Completion of the application process is the responsibility of the applicant and not the CAS or the individuals asked to write letters of recommendation.
Interviews are by invitation only. In general, if an applicant has not been asked to interview at a particular institution, the applicant will not match there. Interviews take place during October, November, and December of the year before the match. Several residency programs may have their interviews on the same day, and therefore applicants must decide which interview takes precedence. The final match rank list must be submitted by the applicant and the various institutions in early January. Results of the match ranking are generally available by late January.  CAS is a central application service that allows you to fill out a single application form that can be used to apply to most neurosurgical residency positions. When you register for the neurosurgical match, you will receive a package with an application form. It will contain directions for filling out the application, and special envelopes and stickers for supporting documents. You will be asked to provide an official copy of your college transcript, medical school transcript, United States Medical Licensing Exam (US-MLE) scores with performance profiles, three original letters of reference, and your Dean’s letter. It is expected that the Dean’s letter will arrive on November 1. The package will also contain a directory listing all participating programs and contact information for those programs. The CAS application provides you with a straightforward way of summarizing your educational and research background. It provides you with sufficient space to describe any awards or accomplishments you may have as well as an area to describe your personal interests. Take time with your CAS application. Sloppy or poorly organized applications reflect poorly on the applicant. Make certain that the application is clearly typed and that the personal statement has been proofread repeatedly for grammatical and typographical errors. This application will go to every program to which you apply.  The application process in neurosurgery asks you to provide a thoughtful assessment of your strengths and weaknesses. The personal statement is the one area on the application that allows you to show your individuality and to describe why you chose neurosurgery as a career. It is the one spot on the application that is entirely decided by the applicant. The most important thing a personal statement can do is explain to the reviewer why the applicant should be chosen as a future neurosurgeon. Personal statements that stray far from that purpose do not best serve the interests of the applicant. The personal statement can be difficult to write. It may take several drafts to produce the final product. Take the time to do it well. It is important to your future. Ask others, especially advisors, to review it and make suggestions. It should reflect who you are and why you want to be a neurosurgeon. Remember that program directors will read hundreds of personal statements. Talking about personal aspects of your life helps put personality on your application. Clearly written, grammatically correct, and carefully organized personal statements are essential.  It is important that the individuals who write your letters of recommendation know you reasonably well and are able to speak about you with some insight. Letters from “famous” individuals that do not speak of you in a personalized fashion are not as useful as those that are written by individuals who can speak with credibility about your assets. Finding such individuals means taking the time to talk to faculty members about your plans. Although letters from a variety of individuals are valuable, letters from neurosurgeons are particularly important as they can speak to your ability to practice neurosurgery. At least three letters are necessary when applying for a neurosurgical residency. At least two of these letters should be from neurosurgeons who can speak about your strengths. This means that you should have some contact with the neurosurgery department at your institution or an outside institution to be able to identify such individuals. Additional letters can be helpful. Although the CAS application will make use of only three letters of recommendation, additional letters may be obtained. Such additional letters will need to be sent to the institutions to which you are applying and should probably not exceed a total of six, unless there is a compelling need for additional clarification of your application.  The interview process gives you a chance to see the institutions with which you wish to train and allows these institutions to assess you and your qualifications. You will not be invited for an interview at every program to which you apply. Offering an interview is the first step by which programs begin to narrow the pool of applicants. Because neurosurgical residency is a long process and institutions vary in their character and programs provided, it is important that you seriously assess each institution and your ability to fit in. The interview is your best chance to talk about yourself and to become an individual in the application process. Programs emphasize different questions in the interview process. You can tell a great deal about a program by the emphasis it places on various questions. Even if you decide a program is not right for you, having seen the program will give you important information that you can use to assess other programs. To succeed at an interview, you must remember that it is a two-way process. You should be honest in answering questions and should not be intimidated to ask questions that you want answered. Be direct and straightforward in your answers, but also be succinct. You want to have the chance to talk about several areas. You are likely to be asked about why you chose to go into neurosurgery and what you would like to do in neurosurgery. Although no one expects an applicant to have made a complete decision as to their ultimate goals, some consideration should have been given by the applicant to possible options. For example, what kind of practice setting do you think you would like -– private or academic? It is best not to second-guess the questioner as to the desired answer. You should arrive well in advance of your interview, leaving yourself plenty of time to get to the interview and to find your way. Because many interviews can be all day, you should consider arriving the day before. This will require making arrangements for accommodations the night before and perhaps the evening after an interview. It is unwise to assume that transportation schedules are precise or that a room will always be available in a given town. A well-prepared applicant has considered the various obstacles that can arise and has made appropriate plans to ensure a successful arrival. Try to get sufficient sleep the night before an interview. A refreshed mind can be your greatest asset. Remember that appearance counts. Your appearance will be the first thing appreciated about you and will leave a lasting impression. Make certain you have considered your attire before the interview. Many interview days have considerable amounts of walking associated with them. Wear comfortable business shoes that allow you to walk distances in comfort. Remember that there are no insignificant individuals at any institution. Many applicants have made serious errors by being curt or demanding of individuals such as secretaries or assistants. Neurosurgery requires a team approach, and you should approach the interview with the goal of showing everyone that you are a team player. This means dealing with everyone with respect. If you have the opportunity, review your notes on a given institution or visit their Web site before an interview. It often helps to have some insight about an institution before interviewing there. You may want to bring along copies of abstracts or papers that you have written to provide additional information. Keep in mind that in most instances the individuals with whom you are interviewing will know your application.  Both you and the programs to which you apply will develop a rank list that will be used by the Neurosurgical Matching Program to determine who will match with which program. Details of this matching process can be found on the Neurosurgical Matching Program web site. Some general considerations are important to remember. First, if you don’t want to be in a particular program, don’t rank that program. You could wind up at that program, and participation in the match program constitutes a contract that you will accept the position given to you. Second, don’t assume that because you have been told "you will be ranked very highly here at X University," you will match at that institution even if you rank it number one on your list. Being ranked number five by X University does mean that they ranked you highly, but others may still be more highly ranked. Programs are not permitted to discuss specific rank order with applicants and are specifically instructed not to pressure or have conversations with applicants outside of the normal channels of the interview process. You should not ask a program director how you will be ranked. You can, however, communicate to a program director that you have found a specific program particularly appealing and that you would like to train there. The best way to do this is generally through a letter or by returning for another visit. All programs are seeking individuals who want to train there and hope that the fit of the individual and the institution will be perfect. Discussing your rank order with advisors and colleagues is important. Many students have ranked only the top rated programs and then found themselves without a residency position because of poor choices on the rank list. Be realistic about your qualifications and the likelihood that you will be ranked highly at a given institution. A balanced rank list gives you the best chance to match to a residency position and therefore have a chance to be a neurosurgeon.  Most neurosurgery residency programs have reciprocal arrangements with the surgery departments in their medical centers, so that applicants who match to a given neurosurgical residency program will automatically receive a surgical internship position at that institution. In fact, many programs require the applicant to do their general surgery internship at that institution. If the applicant chooses to do a surgical internship at another institution, most of these positions will require application through the regular match for a surgical internship position. The National Residency Matching Program (NRP) organizes the PGY-1 internship match. A separate application for a surgical internship should strongly be considered by all candidates to guarantee an internship position should the applicant not match in any neurosurgical position.  Matching to a neurosurgery residency is very competitive. The possibility exists that you may not match. Although you may have your heart set on being a neurosurgeon, at least entertain what you would do should you not match. How might you change your application? What would you do in the year before you could apply again? Would you apply again? Would you do a year of research or continue with a year of internship? There are no "right" answers to these questions. Discuss these issues with your advisors and with program directors. Many applicants elect to apply for general surgical positions in addition to neurosurgery. Others may wish to spend a year doing neurology or research. What is most important is to have an alternative plan ready.
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