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. Honors or at least High Pass should be obtained in all clinical clerkships, including Surgery, Medicine, Pediatrics, OB-GYN and Psychiatry. Honors in your neurosurgical sub-internships is, of course, critical. If your school reports class ranks, top quartile status is very helpful, as is Alpha Omega Alpha (AOA) Medical Honor Society election — although programs recognize that many schools do not offer AOA, or conduct AOA elections after ERAS submission. ERAS accounts for this variability by providing “No AOA Chapter at my school” and “AOA elections conducted during senior year” options for selection. Candidly, if you are concerned that your grades may not be competitive for a successful neurosurgery match, urgent and early mentorship from an academic neurosurgeon with experience in mentoring resident applicants is strongly advised.
USMLE Examination Scores
Traditionally, the USMLE Step 1 examination was considered a critical component of the successful neurosurgery application. As of January 2022, Step 1 is reported on a pass/fail basis only, eliminating this as a significant ERAS element. Many programs have shifted attention to Step 2, but standards and recommendations are considerably less consistent. Applicants are encouraged to sit the exam early and attempt to achieve a very high score whenever possible; however, the impact of an especially high or low score on a successful application is difficult to assess. Academic study will likely provide further insight in future years; however, this remains an area of active study, as well as significant heterogeneity between training programs and their respective recruitment strategies.