For the MD/PhDs on UH (and other research-minded folks): I have received mixed responses from the nsg faculty at my home institution (which is admittedly not very research-focused) regarding my desire to be very aggressive about further establishing my research career during residency. How much did you discuss your research aspirations during interviews/sub-Is, etc, and what was the response?

Honestly, and I am being quite blunt here, most faculty could care less! Very few neurosurgeons have a very active research life. If you look in the grand scheme there are few neurosurgeons who do this after residency. I would say if you are interested in a career with research as a component, I would take the research years in residency very seriously and be as productive as possible. In my experience, the faculty at my institution (a very academic program) was happy that I was involved in research and for most of them that box was ticked off.

Most of the programs I visited were active in research, so my stated intent to actively pursue further research during residency was generally well received. When discussing exactly what form this may take, I think a little tact is in order. If you ask your interviewer whether or not it would be realistic to have successfully competed for an NRSA prior to starting your research years, and to graduate from residency with a K-award in hand, you may run the risk of a defensive response if neither has previously been achieved at that program. However, if you state that you would love to figure out a way to make either or both happen at your program of interest, I think you will generally be met with favorable feedback about how how this might possibly be achieved, and/or whom else you should speak with about your plan. At worst, your interviewer may offer a measured response questioning the relative wisdom of committing so much time to research during residency, etc. If you are very committed to doing research during residency and consistently obtain a cool response from your interviewers about research, I this is useful information that was worth the time and effort to elicit during the interview. You may encounter some individual faculty who will elect to challenge you about your commitment to clinical neurosurgery, given your stated research interests, as well as questions on how you will balance both elements of your career. I think these are fair questions that you will have done well to have thought through carefully before your interview. Although most faculty you interview with may not be role models for your idealized research/neurosurgery career, most are very happy for residents to be productive and successful scientifically, as it looks good for the program

Great question.... I was in the same boat and wanted to gauge reactions of Chairs and PDs to becoming gung-ho research guy and possibly even doing significant amounts of it outside of the prescribed research time. During the interviews I breached the subject in a mitigating fashion… just like Stem Cell mentioned. If I felt they were putting out a positive vibe I gradually opened up the topic further. I even told most “regular” attendings of my goals and then asked them what they thought the Chair/PD would think about it… just to see if there has been any smoke blown up my ass.

Out of over a dozen programs I visited only one Chair frowned upon the idea of “extracurricular research” and said flat out it wouldn’t be possible. Half were neutral/luke warm ranging from “that sounds great, but no one has ever tried to set that up before so we’ll see what we can do...” to “I admire your drive, but it’s really busy here… no one will try to stop you… but it’s REALLY busy here.”

The positive half was really surprising. Two chairs thought extracurricular research was GREAT and said they had done the same themselves. One even said “that is the RIGHT way of doing it.” A third chair was like “sure I’d support that effort, but you have so much research already you really should just finish ASAP and get on with it. I’d consider waiving the research years for you” (an interesting option for sure!).  Another said there are some departmental funds available for such situations but that I’d “have to hold off until AFTER PGY-2.” One favorite was an R01 funded attending (not a chair or PD) who told me that if I matched there he would take me under his wing and personally see to it that I had everything I needed to succeed including sharing one of his technicians and a bench in his lab. Whoa.

So, attitudes depend on the particular chair/PD/faculty.... Based on my limited sample, if anything, I thought the “mid-tier” programs were most open to the idea of becoming a research wiz during residency. This makes sense because many of them are trying to bolster their program’s reputation by churning out academicians. I felt heavily recruited in this league (3 personal calls from chairs and some e-mails).

My advice is to keep the strategy of applying broadly. Even if you have the CV to hit up all the top tier schools you should definitely include lesser tier schools with strong research infrastructure (particularly in neuroscience and bioengineering). You may be pleasantly surprised like I was. Contrary to what most people will tell you, establishing yourself in research during residency, while quite difficult, can be readily accomplished with enthusiastic faculty support (firsthand witness). If research is important to you, you should not rank highly any program that discourages you in this regard… even if it is a top tier research school with tons of money, cool gadgets, and nobel laureates.

just do garbage research and publish it in neurosurgery journals, that’s what most people do. remember to put lots of professor-level faculty members on your papers, especially if they’ve never heard of your project

Thanks for the insightful responses, they are extremely helpful. My sense is that this approach to residency is relatively uncommon; I have had a hard time finding much useful advice at home. A couple more questions:

1. Do you feel that it is more important to find a supportive program, or to be at an institution with a scientific climate that will support your goals? Obviously a program with both of these properties would be ideal…

2. Would you be willing to list specific programs that impressed you? From what I can tell, some of the elite research institutions have neurosurgery residency programs that are considered “mid-tier.”

1. Are you interested in basic science, clinical, or translational research? I will assume for now you are interested, at least in part, in basic science. Agree both a supportive program and a strong research institution would be ideal, but from what I saw on the trail, the program made more difference to resident productivity than the institution. There were some universities where theoretically you should be able to excel, but the residents there did not seem to be doing much, either due to the program structure or culture. Talking to non-neurosurgeon PIs at different institutions was quite enlightening, as they would often give you the bottom line about how much a resident from that program typically could or could not accomplish in their lab, compared to other post-docs, etc. Nevertheless, if you are stubborn and tenacious, you can probably accomplish high quality research even at a less supportive program.

2. For basic science research, of the places I visited, I was most impressed with the consistently high productivity of the residents at Stanford, Brigham and Iowa. Rochester has amazing potential, but has only recently started allowing >1yr for research, and has only recently started attracting the basic science-type applicants. UCSF is of course also infamous for its basic science productivity. Numerous other programs have had some or several residents be extremely productive, but I think it would be decidedly unusual for someone NOT to be very productive at Stanford, BWH, Iowa or UCSF. Residents at UVA and Columbia also seemed to be very productive in terms of publications, however, it seemed hard-core basic science was less emphasized. Just my impressions. Can’t speak for Duke or Penn, but heard good things…

You’re right, I’m predominantly interested in basic science and would like to continue to performing bench research. However, I also realize that I will have to choose a project that will dovetail with my clinical interests. My goal is to end up on the NRSA --> K Award track, as you mentioned above and elsewhere on UH. Several of the programs you have listed are already on my radar, I’ll definitely check out the others. Thanks again for your input.