If you really think about it, we have no idea what we’re getting into when we apply for neurosurgery.  We all have some vague idea of what neurosurgery is and that perhaps we like it, but how many of us really understand what we need to become well-trained neurosurgeons?

I certainly didn’t.  It’s actually a bit unfair to ask us to rank a program based upon 12 hours of limited exposure to it and its constituents, especially when we have no idea what we want.

When I was interviewing, the things that we all considered to be important aspects of “good” neurosurgical training were how many aneurysms an institution clipped per year or how many cases people did.  These numbers would be highly touted by “top tier” programs and frequently repeated by resident applicants around the country.  But, even if an institution did 4000 cases per year, if the resident involvement was minimal in each case, would you really come out a well-trained surgeon?  Would you rather go to a surgeon that has clipped 500 aneurysms or one that has watched 4000 and only clipped a few?

The RRC does a pretty damn good job about ensuring consistency across the spectrum of programs.  When you graduate, you will have been trained in all sorts of cases: aneurysms, spine, brain tumors, etc.  Sure, some programs do a lot more of certain cases than others, but in the end, you will be trained.  Ask questions about these points and you’ll get the same answer almost everywhere, especially if we’re all try to paint rosy pictures.

So what makes one program different from another?

Answering that point should be the mission of your interview.

In my opinion, there are several things:

1) Lifestyle
2) Resident support
3) Resident operative experience

These things are difficult to flesh out from one day of interviews, especially when all the faculty and residents have on their best faces.  Everyone is very eager to tell you about the positive aspects of the program.  Just like when you’re the interviewer, you want to ask questions that people don’t have canned answers for to catch them off guard.

Lifestyle: programs are located in all sorts of cities.  Do you want to live in a city with a nightlife, lots of skiing, one that is warm, one where you get mugged a lot, etc.?  Ask residents and faculty if they have families or what they do outside of the hospital.  What’s call like?  Is it all in-house or is there home call as well?

Resident support: some programs are better about this than others.  Do they provide a book or computer fund?  A conference fund?  Do they buy loupes for you?  To what sort of courses do they send you and do they pay for you to go?

Resident operative experience: this is extremely hard to gauge without doing a subinternship at the program and actually seeing what the residents do.  Things you can do to flesh out the answer to this question are to compare the responses of the faculty and the residents.  Any sort of inconsistency should raise your eyebrows.

Other than that, tailor your questions to what you think you like: is there a lot of cerebrovascular?  Are most aneurysms clipped or coiled?  Have recent graduates gone into private practice or academics?

As I examined my final rank list before submitting it, I realized that in the end, I used two criteria to rank programs: 1) my gut, and 2) geography.

Best of luck, and see you guys on the trail.