Factors associated with matching into highly ranked U.S. neurosurgical residencies.

Objective: To identify applicant characteristics independently associated with matching into highly ranked U.S. neurosurgical residency programs.

Methods: A retrospective cohort study analyzing American Association of Neurological Surgeons (AANS) data was conducted for U.S. medical graduates entering neurosurgical residencies from 2007 to 2017. Variables included demographics, medical school rank, region, advanced degrees, dedicated research years, publication count, and h-index. Primary outcome was matriculation into a "top" program, defined as (1) NIH Top 40 departments, (2) BRIMR Top 20 departments, and (3) Doximity Top 20 programs. Univariate testing was followed by multivariable logistic regression to determine independent predictors of matching into a top program.

Results: Among 1692 residents 82% male; mean age, 31.9 ± 7.9 yr), 26.7% graduated from a U.S. News top-25 medical school; median h-index was 1 (IQR 0-3) with 2 (IQR 0-4) publications; 78.5% took ≥ 1 research year, 8.4% held a PhD, and 1.4% were DO graduates. For NIH top-40 placement, independent predictors were graduating from a top-25 medical school (OR 3.43, 95% CI 2.61-4.50), higher h-index (OR per point 1.12, 1.07-1.17), PhD (OR 2.15, 1.39-3.33), and Master's/MPH degrees (OR 2.05-3.31). Gap years (OR 0.71, 0.55-0.92) and DO degrees (OR 0.06, 0.01-0.45) decreased odds. BRIMR and Doximity models showed comparable effects although older age unfavorably impacted BRIMR matches.

Conclusion: Highly ranked neurosurgery residencies consistently favor graduates of highly ranked medical schools who demonstrate strong research productivity. Each incremental h-index point raises top program match likelihood by 12-18 %. In contrast, unproductive gap years and holding an osteopathic (DO) degree each independently predicted lower odds of matching to a top program. These benchmarks can guide applicants and mentors as residency selection evolves beyond numeric board scores.