Centralization

Increasing centralization of high-level neurosurgical practice at academic centers has increased the need for academic neurosurgeons. The lack of systematic metrics-based analyses among neurosurgery trainees and the recent pass-fail USMLE system necessitates a multiparametric approach to assess academic success among trainees.

Methods: We conducted a comprehensive analysis of the University of Miami residency program using two datasets, one containing applicants' pre-residency metrics and a second containing trainees' intra-residency metrics. Intra-residency metrics were subjectively and anonymously assessed by faculty. Univariate and multivariate logistic regression analyses were performed to determine differences among academic and non-academic neurosurgeons and identify predictors of academic careers.

Results: Academic neurosurgeons had a significantly higher median Step 1 percentile relative to non-academic neurosurgeons (p=0.015), and medical school ranking had no significant impact on career (p>0.05). Among intra-residency metrics, academic neurosurgeons demonstrated higher mean rating of leadership skills (MD=0.46, p=0.0011), technical skill (MD=0.42, p=0.006), and other intra-residency metrics. Higher administrative and leadership skills were significantly associated with increased likelihood of pursuing an academic career (OR=9.03, 95%CI[2.296 to 49.88], p=0.0044). Clinical judgment and clinical knowledge were strongly associated with pursuit of an academic career (OR=9.33 and OR=9.32, respectively with p=0.0060 and p=0.0010, respectively).

Conclusions: Pre-residency metrics had little predictive value in determining academic careers. Furthermore, medical school ranking does not play a significant role in determining a career in academic neurosurgery. Intra-residency judgment appears to play a significant role in career placement, as academic neurosurgeons were rated consistently higher than their non-academic peers in multiple key parameters by their attending physicians ¹⁾.