I was recently PM’d by a 2nd year medical student asking this question. As a current applicant myself, I am certainly no authority. Nevertheless, I did reply with my personal opinions on the question. None of this is particularly original, but in case it can be helpful to anyone, I have pasted my response below. As always, dissenting views are welcomed.

There are basically two hurdles: A) Getting the interview; B) Being highly ranked.

A) Getting the interview:

I consider much of getting interviews at competitive programs to require satisfying certain check boxes:

1. Step 1 (say, 230s*+) (*corrected)
2. Publication(s) (best if representing serious research experience)
3. Letters (best if it is someone the reader knows)
4. Honors on neurosurgery rotations, including away rotation(s)
5. Interesting person, at least on paper.
6. Absence of red flags (a failed course, criminal history, immigration problem, etc)

If you satisfy ALL 6 of these criteria, I think you would likely at least be offered an interview at most programs.
Certainly, a stronger step 1, more and better publications, truly outstanding letters and uniformly stellar academic performance will increase the percentage of programs that will offer interviews. I have not yet heard of anyone getting interviews everywhere they applied, but I’m sure it happens. In the interesting person category, I place things like how engaging your personal statement is (though it is often not read), extracurricular activities, interests, accomplishments. You may have an “in” at certain places by virtue of which school you went to, where you did sub-Is, and who your chairman is friends with, but the above 6 criteria should serve you well for most places. Note that there is a lot of variability in how many people programs interview. Stanford and Pittsburgh interviewed only ~24 people each this year whereas Mayo and Johns Hopkins, interviewed (including their sub-Is), about 80-90 people each.

B) Being highly ranked:

(Again, my comments here are merely speculation, having not yet matched and having little idea how I will be ranked.) I think that check boxes here apply less, as it is much more subjective. However, I think there are certain identifiable factors:

1. All of the criteria in section A above. A strong applicant will obviously be considered more seriously.

2. Will this applicant make us look good? Sad but true. Some programs wish to feel that they are successful by matching applicants who are easily recognizable as “strong.” Thus, even though similarly qualified applicants from North Dakota and Hopkins may both be invited for an interview, if you are trying to match at Tier1 East coast program X, the Hopkins applicant will probably be ranked higher. Similarly, IF it would appear (to the interviewer’s perceptive eye) that you are going to be a resident who will score 99th percentile on the neurosurgery boards, write grants, or become a future chairman, these would all inflate the program’s ego, and thus you may be ushered more enthusiastically into the fold.

3. How interested is the applicant in this program and why? If you have a serious and legitimate reason to truly love the program, this can come across in the interview. Did you do a sub-I and love it? Do you adore the research of a particular faculty member at the institution, and have perhaps collaborated with him/her in the past? Do you have family in that city? Is your spouse strongly considering a program at the same institution/city? These are things that are difficult to insert at will into your application. However, this is probably a good thing, as it helps ensure people end up at places that are really good fits for them. However, tactful communication with residents/faculty after the interview regarding your strong interest in a program and perhaps having your chair contact the program and communicate your specific interest in that particular program on your behalf, may make you seem a more desirable candidate. Everyone like to feel loved. They would prefer to match a person who they are confident will be happy and enthusiastic, than someone who maybe has more publications and better test scores, but who may carry a chip on their shoulder feeling that they should have ended up at a “better” program

4. Do the residents like this applicant? In some programs, residents are a formal part of the selection committee; at others they simply pass on their impressions to the faculty who may incorporate the input into their own deliberations. At the very least, residents can usually exclude one or two people they really didn’t like (if needed), and promote one or two they think would be great co-residents, while the rest are left relatively un-influenced by the residents. I don’t think there is any program where the residents have absolutely no say. In this regard, I think it is certainly an advantage to have spent time at the program via sub-I, etc, so the residents know who they would be getting as a co-resident and know you are hard working and good to work with.

5. Does this person seem a good fit for the program? Again, this is very subjective. If the program is very research oriented, they will be looking for someone who plans to apply for grants etc during their residency. If they are renowned for their ____ program, they may find someone who has a demonstrated active interest in that field to be a natural fit. If the program is in the mid-west, a Californian may be questioned regarding their motives in applying, and how well they would like living in that area, etc, etc. Likewise, in order to be a good fit, you usually need to be a good team player, hard worker, etc, who will help get things done rather than just win awards and publish papers. If you are able to connect well with your interviewers, and have a strong track record from your rotations and letters, your work ethic and team spirit will likely be assumed.

6. Is this person going to rank us #1? This is a card you can only play at 1 program. For some (ridiculous) reason, many programs feel that it is better to match the top 2 people on their rank list, than suffer the ?embarrassment? of matching someone who is 14th on their rank list. This can cause them to rank certain applicants to some degree in order of how they expect to be ranked by those applicants. Of course this makes no sense and works against the program, as they may fail to match someone who they liked more, but ranked lower, just because they felt the person would not rank them highly. While I would like to think that neurosurgeons are intelligent enough to understand that the rank system works best if they rank people in order of who they really want, there are still lots of attending, including chairmen, who believe that the 2-digit USMLE score is a percentile. You get my point. This said, if you plan to rank a program #1, let them know. It can’t hurt, and it just may help.

Agree with most of the above, but I’d recommend a slightly higher step I score - 130 won’t get you very far.

huge penis

Programs seem to do things slightly differently (i.e. some have the residents present in the “rank list meeting” some don’t) but what you outline is quite accurate.  At some places resident input and subI experience is weighted more heavily than others.  I think if you are sincerely interested in a place and willing to work hard, the subI can go far.  Residents have told me that expressing sincere interest after the interview is helpful (more than the simple thank you).  Most importantly the “you’re #1” card is reserved for number 1.  An attending told me not to do it to several people because “it’s a small world afterall”.  He told me a horror story of grudges being held into someone’s residency as they weren’t seen as trustworthy (ouch!).  I think it’s hard to find the balance and decide how much interest to show.  Some people are doing 3 revisits?!  Also I think timing is key because doing a revisit or sending the heavy interest email after they had the rank list meeting may not be helpful.

Guenarius - 26 January 2009 06:05 AM

Agree with most of the above, but I’d recommend a slightly higher step I score - 130 won’t get you very far.

130 is the two digit score, dumbass

Here are a few of my personal opinions:

1) Get yourself out of the supplicant role as soon as possible.  Even though you may very well be lucky to match at BNI, Hopkins, UVA, etc, that’s not the right attitude to have if you interview there.  Think and process information critically during your interviews with faculty and residents.  Always be thinking about how the institution can help you reach your goals, not how you hope you make a good impression and hope they “like you”.

2) Pay attention to the residents at the programs to which you apply.  It’s obvious, but this is the group of people that have matched at this program before, and people like them will probably match in the future...are you guys cut from the same cloth.  If you look around and think “God this is the biggest bunch of douchebags I’ve ever seen...”, look elsewhere.

3) I don’t really know what goes into the formula for determining who the “top programs” are.  If you set the standard at “accreditation”, then there are what 100 programs that will produce board-eligible neurosurgeons every year.  If your goal is to be a department chairman someday, then sure, shoot for the moon.  If you want to be a private practice spine surgeon and drive a Ferrari, I would guarantee there are better places to train than some of the “big names” out there.

Feculence - 26 January 2009 04:14 PM

Here are a few of my personal opinions:

1) Get yourself out of the supplicant role as soon as possible.  Even though you may very well be lucky to match at BNI, Hopkins, UVA, etc, that’s not the right attitude to have if you interview there.  Think and process information critically during your interviews with faculty and residents.  Always be thinking about how the institution can help you reach your goals, not how you hope you make a good impression and hope they “like you”.

2) Pay attention to the residents at the programs to which you apply.  It’s obvious, but this is the group of people that have matched at this program before, and people like them will probably match in the future...are you guys cut from the same cloth.  If you look around and think “God this is the biggest bunch of douchebags I’ve ever seen...”, look elsewhere.

3) I don’t really know what goes into the formula for determining who the “top programs” are.  If you set the standard at “accreditation”, then there are what 100 programs that will produce board-eligible neurosurgeons every year.  If your goal is to be a department chairman someday, then sure, shoot for the moon.  If you want to be a private practice spine surgeon and drive a Ferrari, I would guarantee there are better places to train than some of the “big names” out there.

I second this.  You need to figure out where you want to go with your career, and look for programs that will get you there.  And I totally agree about judging by the people who are already there.  Particularly the lower level residents.  Not only will you have to work with them the longest, but they will also continue to determine what kind of people are willing to rank the place for many years after you match there.

But I think Stem Cell’s post was more about making sure that no doors are closed to you, and that you ARE competitive for the kind of program that best serves your goals.  Because, like it or not, applications are screened based on the criteria he lists, and best fit is a consideration for those programs only if there are still too many people to interview at that point.  And no matter how well it serves your goals, you can’t match someplace you didn’t get an interview.

Even 230s may be on the lower side of what some competitive programs might be seeing in applicants, but, if the other 5 boxes are solidly checked, it should be enough to at least get you in the door at programs that interview lots of applicants. Especially, if you break that magic “99” 2 digit score (I think ~236?), then you may be considered “perfect” eyes of some If you want to be “comfortable,” pretty much anywhere, I think 250+ should see you in the door at any program. Obviously a number of (frequently vocal) people get in the 260s and even 270s, but I really don’t think this would be required to match anywhere.