Taking a research year before applying to neurosurgery residency is becoming increasingly popular among applicants.
A research year allows you time to focus on academic productivity; if you take advantage of it, a research year can provide you with significant exposure to organized and academic neurosurgery by attending conferences, pursuing collaborative research experiences, and more extensively reading the literature. Furthermore, a research year offers you time to familiarize yourself with the various neurosurgery residency training programs and to begin building connections with your top choices.
Structuring your research year is an individualized process that should be formulated to best serve your application for residency and your growth as a “subspecialty-X” neurosurgeon if you already have a sense of your area of interest. Below are some suggestions on how to maximize your time during your research year, the planning stages of which may start as early as the first year of medical school:
Basic Science and Translational Research
A substantial group of applicants may hope to become physician-scientists, particularly those hoping to pursue subspecialty fields that typically require some bench work (i.e., tumor or functional). These applicants tend to have an affinity for basic science research, and many will have started to help in a lab at the beginning of medical school or during the summer after 1st year. Personally, I started working in a lab of interest at my medical school during the summer before 1st year, and quickly realized that in order to get the most out of my work, I would need to take a year off to work on projects more independently and better develop my knowledge and skills. The year off in the lab also allowed me to grow into a more senior mentor for undergraduates and 1st and 2nd year medical students rotating through my lab.
Starting fresh in a new basic science lab at the beginning of your research year can be very difficult. Getting the most out of any project initially requires months of reading to learn about your lab’s work, and any project that you would be leading independently will most likely not be in submission-ready form by the time you need to leave to start your away rotations. Some larger labs with significant technical and teaching support may facilitate finishing projects for publication over several months, especially if there is already a project in the works that is close to being completed—however, these are rare circumstances.
Those who are newly interested in joining up with a basic science lab at the end of their 3rd year, nevertheless, should not be discouraged. If a first-author manuscript is not possible in the lab by the end of the year, other ways you can maximize your time and demonstrate your scientific ability would be to apply for medical student research grants based on your work (of which there are several), to write review papers or book chapters relevant to your lab work with your PI, and to ensure that you assist your other lab members—particularly the PhD students—to ensure co-authorship on any of their work pending publication. Additionally, working on supplementary clinical research (as will be discussed further in the next section) outside of the laboratory can and should be pursued in parallel wherever possible.
Translational research projects, including research on new devices or technologies, bioinformatics-based studies, or research on machine-learning applications in clinical practice, typically come together in a shorter timeframe than basic research. For students interested in supplementing their application with non-clinical publications, joining a translational research group may be the way to go. Becoming an expert on a particular annular repair device or on the genetics and epigenetics of a relatively rare pediatric epileptogenic lesion (as examples) will not only generate interesting, publishable work, but also will provide you with great conversation points during interviews with relevant faculty. Additionally, several residency programs have niche research efforts that may emphasize device development, bioinformatics, and/or programming skills, and demonstrating any of these will surely engender favor with those programs.
Clinical research is a universal component of the neurosurgical application and can include anything from case reports to meta-analyses to clinical studies. At the end of the day, most clinical research is truly self-driven and is achievable multiple times over during a research year for the ambitious medical student. Given the amount of time it can take to write the paper, go back and forth with your mentors or PIs on drafts, get initial revisions from a journal, make revisions or resubmit to another journal, and finally get from proofs to publication after acceptance, it would be smart to have a few things in the works before your research year starts so that you can be sure that at least a few publications make it through before the ERAS submission deadline; while “submitted” research can definitely go on your residency applications, most programs will tally and hold in higher regard the number of your papers that have successfully passed peer review and are actually published at the time of your application.
Many applicants may wonder whether the content of what they write matters; for example, is it okay for an applicant to have 10-20 papers on various topics and just accept every small project that comes their way? Some heterogeneity is definitely not only acceptable, but also expected given the nature of being a medical student and being subject to the ideas of your superiors. However, stronger applications tend to be those that demonstrate some level of expertise in “subspecialty-X” if you happen to have an inclination, or at least demonstrate strong relationships with one or two well-known mentors by showcasing a significant portfolio with them.
It is also critical to think about the ways you can best showcase your research beyond a single manuscript—are there multiple angles to the study that can be described in more than one paper? Can you submit an abstract prior to the publication of your study to a major conference? Can you collaborate on your topic with another institution to get your name out there and increase the power and impact of your study? The research year provides the much-needed time to get the most out of your clinical research work and really increase your visibility in the neurosurgical community.
Clinical research is also a phenomenal platform to demonstrate leadership, mentorship, and collaborative skills. Being first author on a paper, which tends to be much more attainable in a clinical research setting for medical students, demonstrates to residency programs your ability to lead and push out academic work. The experiences of leading a research effort and being the primary manuscript writer are critical for your development as an academic neurosurgeon, and the sooner you learn the ins and outs of applying for an IRB, working with data management services, managing multiple team members from various departments, working with a statistician or even running your own statistics, formatting manuscripts for specific journals, and the overall submission process, the more efficient your research endeavors during residency (and beyond) will be. Additionally, the demands of being first author inherently confer in-depth knowledgeability on your project’s topic that will serve you extremely well during sub-internship presentations and residency interviews.
The MSCI/MSCR Degree (and Other Advanced Degrees)
One of the newer and increasingly popular dual-degree options for medical students is the Master of Science in Clinical Investigation/Research degree offered through many universities’ Clinical and Translational Science Institutes (CTSI). At most institutions, these 2-year programs are done with a single “year off,” during which the vast majority of the course work is done, followed by some expected interspersed commitment during the 4th year of medical school. The MSCI/MSCR degree programs are federally supported and accredited by an NIH NCATS education grant and therefore must meet specific requirements both for education and research deliverables that aim to support the development of stellar clinical and translational researchers.
These MSCI/MSCR programs are a phenomenal experience for the budding researcher and provide significant structure to a research year to help medical students reach their productivity goals. Students will take courses in study design, grant writing, biostatistics geared towards clinical research, and seminars on oral presentation—just to name a few. Additionally, the grant funding allows for access to professional study design support and statistical support for your projects.
One of the greatest, and perhaps underestimated, benefits of this program is that it was originally designed for practicing clinicians. When I was a student in my own MSCI program, 70-80% of my class were fellows and attendings—including a few from neurosurgery and neuro-oncology. Building those relationships on a peer-to-peer level and getting their feedback on my presentations and research studies overall were invaluable experiences. Additionally, practicing my oral presentations nearly every other month in a constructive setting before conferences and, more importantly, before sub-internship presentations, truly helped me perfect my work.
The MSCI/MSCR program has become a readily recognized and highly respected degree among academic neurosurgeons and many residency programs have started to highlight this degree program as an offering even for their own residents during their research time. Having this degree under your belt will put you ahead of the game. The publication expectations at most MSCI/MSCR programs include submission of at least two manuscripts and multiple abstracts during your course. I found it extremely useful to have my MSCI committee constantly checking on my study progress and facilitating conversations with my mentors regarding expediency in publication.
In terms of other advanced degree programs, such as an MPH or MBA, I was offered some keen advice from a colleague: If you have several research projects ongoing and are using your research year time just to make sure you get them squared away and published, it is definitely possible to get the most out of these degrees. However, if your research portfolio is lacking and you need time to get to know new mentors and acquaint yourself with academic neurosurgery, it may be smarter to just stay focused on research.
Most residency programs hold publication number and quality in higher regard than a secondary degree in a sometimes seemingly unconnected field. Additionally, if you are interested in pursuing an MBA because of a passion for healthcare policy and management that you hope to highlight on your application, be sure that the MBA program you are applying to actually has a defined and well-known healthcare track; most MBA programs unfortunately do not offer this yet.
There is no doubt that you should seek every opportunity during your research year to attend conferences (as I know that many of us overachieving, “type-A,” personalities could not even imagine missing a day on clerkships during our 2nd and 3rd years for conferences). National conferences are the perfect place to develop your relationships with faculty, meet other applicants (your future co-interviewees and colleagues!), and, obviously, present your research. Going to conferences even just to sit in on talks will also help you gain a sense for who the major players are in your field of interest (“subspecialty-X”) and give you an appreciation for the existing literature and ongoing issues in that field.
The two main national conferences are sponsored annually by AANS in April (deadlines typically in October) and by CNS in October (deadlines in March or April). Each subspecialty field also holds a few relatively large national conferences at which it may be easier to obtain a podium presentation or find opportunities to socialize with faculty. Another consideration when applying to conferences is whether that conference publishes abstracts in a supplement; for example, the Society for Neuro-Oncology (SNO) routinely publishes conference abstracts, including those presented as only as posters, in a supplement of Neuro-Oncology. Published abstracts will increase your research visibility, particularly when published in normally high-impact journals.
Local CME conferences and medical student conferences (such as the Medical Student Training Camps) are also excellent ways to get involved in the field and increase your exposure, especially if the CME conferences are taking place at one of your programs of interest. Some local CME conferences will even have an abstract submission and poster presentation section which tend to be easy wins for building your CV. The importance of networking among your peers (in addition to faculty) truly cannot be overstated, especially with your fellow applicants who may be your co-sub-intern, will be there to support you during the interview season, and could potentially end up being your co-resident.
Your Top Choice Residency Program(s)
Above all, the research year is an excellent time to start acquainting yourself with the various neurosurgery residency programs and even start targeting your top choices. Understandably, there is an increasing trend of residency programs favoring applicants that they know well, especially after a strong sub-internship performance. However, the relationship-building can definitely start earlier, and often, these longitudinal relationships with programs are more effective. Reaching out to faculty with strong track-records of mentorship at your top choice programs, even to see if you can help with writing up a case report or review paper, is a smart idea.
While on the interview trail, having a publication with a faculty member at the program you are interviewing at is like having a golden ticket to a positive interview experience, especially with the chair and program director. Beyond demonstrating your specific interest in the program, having a publication with that institution also showcases your ability to seek mentorship and engage with the academic neurosurgery community.
Lastly, if you have a strong preference for a program, do not be afraid to email their faculty and/or residents to see if you can even spend your whole research year at their institution! Many programs will have structured medical student research fellowship experiences or will have attendings that routinely involve students in their research group for extended periods. The more they know you and know they can depend on you to be a productive academician, the more your likelihood of matching increases.
Additionally, being familiar with some faculty and residents through prior research at an outside institution will make your sub-internship experience there more seamless and effective.
For any of these endeavors to be successful, a critical constant is strong mentorship. Seek it out, especially from your more senior fellow medical students and junior residents who likely have already built some helpful research connections and also may have pertinent advice based on recent hindsight. Overall, there is really no correct formula other than being productive!
Feel free to reach out to me and follow me on Twitter for the latest neurosurgery updates below!
Danielle Golub, MD, MSCI
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