Neurosurgery is a very competitive specialty. Good grades in the first two years of medical school are essential and even more important is performance in clinical clerkships. High pass and honors should be in nearly all clinical rotations, including Surgery, Medicine, Pediatrics, OB-GYN and even Psychiatry. Honors in your neurosurgical sub-internships and rotations is, of course, critical. Being in the top quartile of your medical school class is very helpful, as is being a member of the Alpha Omega Alpha (AOA) Honor Medical Society, as this gives the residency admission committee the best evidence that you are among the top of your class. You can still match without being AOA, but it will be more difficult to match at top programs. Some top medical schools do not have AOA chapters. If this is the case at your home institution, the Electronic Residency Application Service (ERAS) allows you to select the “No AOA Chapter at My School” option on the application. If you think your grades are marginal, you should find a good advisor to council you on where you stand.
Board scores are extremely important as they provide the most objective comparison of all applicants. Therefore, they do play a significant role in the selection of candidates for interviews. Due to the competitive nature of the neurosurgery match, the mean United States Medical Licensing Examination (USMLE) Step 1 score of successful applicants is around 240. Here is a rough breakdown of scores:
< 220: Seek advice on whether you have a reasonable chance at matching, how best to improve your application and how to plan advantageous away rotations. People do match with these scores but only with a very solid application.
220-230: Your score will not stand out to programs, and your clinical performance on away rotations will become very important. Seek trusted advice on how to best leverage your application and on which programs you should rotate with and apply to. People do match every year with these scores.
230-240: These are solid scores, and you should do well if your clinical performance is good. This alone will not be sufficient to match at top-tier programs. Excellent clinical performance and a strong research portfolio is also needed.
240-250: This is a good score. Your application will be considered by most programs.
>250: Your board score is outstanding and will stand out.
Having USMLE Step 2 on your application is not at all necessary but does make your application stronger while demonstrating initiative. Additionally, it is helpful to the program in which you match for licensing purposes. If you believe that your score on Step 1 is marginal, a high score on Step 2 is imperative.