Applying to residency: survey of neurosurgical residency applicants on virtual recruitment during COVID-19.

OBJECTIVE: The COVID-19 pandemic caused a significant disruption to residency recruitment, including a sudden, comprehensive transition to virtual interviews. The authors sought to characterize applicant experiences and perceptions concerning the change in the application, interview, and match process for neurological surgery residency during the 2020-2021 recruitment cycle. METHODS: A national survey of neurosurgical residency applicants from the 2020-2021 application cycle was performed. This survey was developed in cooperation with the Society of Neurological Surgeons (SNS) and the American Association of Neurological Surgeons Young Neurosurgeons Committee (YNC) and sent to all applicants (n = 280) who included academic video submissions to the SNS repository as part of their application package. These 280 applicants accounted for 69.6% of the total 402 neurosurgical applicants this year. RESULTS: Nearly half of the applicants responded to the survey (44.3%, 124 of 280). Applicants favored additional reform of the interview scheduling process, including a centralized scheduling method, a set of standardized release dates for interview invitations, and interview caps for applicants. Less than 8% of students desired a virtual-only platform in the future, though the majority of applicants supported incorporating virtual interviews as part of the process to contain applicant costs and combining them with traditional in-person interview opportunities. Program culture and fit, as well as clinical and research opportunities in subspecialty areas, were the most important factors applicants used to rank programs. However, subjective program "fit" was deemed challenging to assess during virtual-only interviews. CONCLUSIONS: Neurosurgery resident applicants identified standardized interview invitation release dates, centralized interview scheduling methods, caps on the number of interviews available to each candidate, and regulated opportunities for both virtual and in-person recruitment as measures that could significantly improve the applicant experience during and effectiveness of future neurosurgery residency application cycles. Applicants prioritized program culture and "fit" during recruitment, and a majority were open to incorporating virtual elements into future cycles to reduce costs while retaining in-person opportunities to gauge programs and their locations.

Optimizing the residency application process: insights from neurological surgery during the pandemic virtual application cycle.

OBJECTIVE: In this article, the authors describe the impact of the COVID-19 virtual match cycle and discuss approaches to optimize future cycles through applicant and neurosurgical education leadership insights. METHODS: Anonymous surveys of neurosurgery program leaders (program directors and program chairs), program administrators (PAs), and 2020-2021 neurosurgery residency match applicants were distributed by the SNS, in conjunction with the Association of Resident Administrators in Neurological Surgery and AANS Young Neurosurgeons Committee. RESULTS: Responses were received from 77 (67.0%) of 115 PAs, 119 (51.7%) of 230 program leaders, and 124 (44.3%) of 280 applicants representing geographically diverse regions. During the virtual application cycle relative to the previous year, programs received more Electronic Residency Application Service applications (mean 314.8 vs 285.3, p < 0.0001) and conducted more applicant interviews (mean 45.2 vs 39.9, p = 0.0003). More than 50% of applicants applied to > 80 programs; 60.3% received ≤ 20 interview invitations, and 9% received > 40 invitations. Overall, 65% of applicants completed ≤ 20 interviews, whereas 34.7% completed > 20 interviews. Program leaders described one 4-week home subinternship (93.3%) and two 4-week external subinternships (68.9%) as optimal neurosurgical exposure; 62.8% of program leaders found the standardized letter of recommendation template to be somewhat (47.5%) or significantly (15.3%) helpful. Applicants, PAs, and program leaders all strongly preferred a hybrid model of in-person and virtual interview options for future application cycles over all in-person or all virtual options. Ninety-three percent of applicants reported matching within their top 10-ranked programs, and 52.9% of programs matched residents within the same decile ranking as in previous years. CONCLUSIONS: Optimizing a national strategy for the neurosurgery application process that prioritizes equity and reduces costs, while ensuring adequate exposure for applicants to gain educational opportunities and evaluate programs, is critical to maintain a successful training system.

Burnout among medical students interested in neurosurgery during the COVID-19 era.

OBJECTIVE: The novel Coronavirus Disease 2019 (COVID-19) pandemic has posed unprecedented new stressors to medical student education. This national survey investigated the prevalence of burnout in U.S. medical students interested in pursuing neurosurgical residency during the COVID-19 pandemic. METHODS: A 24-question survey was sent to all American Association of Neurological Surgeons (AANS) medical student chapter members. The abbreviated Maslach Burnout Inventory (aMBI) was used to measure the following burnout metrics: emotional exhaustion, depersonalization, and personal accomplishment. Bivariate analyses were conducted and multivariate analyses were performed using a logistic regression models. RESULTS: 254 medical students were included (response rate of 14.5%). The majority were male (55.1%), White (66.1%), and between their 2nd and 3rd years in medical school (62.6%). Burnout was identified in 38 (15.0%) respondents, a rate lower than reported in the pre-COVID era. In multivariate analysis, burnout was significantly associated with choosing not to pursue, or feeling uncertain about pursuing, a medical career again if given the choice (OR = 3.40, p = 0.0075), having second thoughts about choosing to pursue neurosurgery (OR = 3.47, p = 0.0025), attending a medical program in the Northeast compared to the Southeast (OR = 0.32, p = 0.027) or Southwest U.S. (OR = 0.30, p = 0.046), and indicating that one's future clinical performance will have worsened due to COVID-19 (OR = 2.71, p = 0.025). CONCLUSIONS: Our study demonstrates relatively low rates of burnout among U.S. medical students interested in pursuing neurosurgery during the COVID-19 pandemic. Our findings also demonstrate multiple factors may aid in early identification of burnout, highlighting potential opportunities for intervention.

Burnout and career satisfaction among attending neurosurgeons during the COVID-19 pandemic.

OBJECTIVE: The novel coronavirus SARS-CoV-2 (COVID-19) pandemic has posed significant changes to physician workflow and healthcare delivery. This national survey investigated the impact of the pandemic on burnout and career satisfaction among U.S. attending neurosurgeons. METHODS: A 24-question survey was sent electronically to all American Association of Neurological Surgeons (AANS) attending members. The abbreviated Maslach Burnout Inventory (aMBI) was used to measure the following burnout and career satisfaction indices: emotional exhaustion, depersonalization, and personal accomplishment. Bivariate analyses were conducted and multivariate analyses were performed using logistic regression models. RESULTS: 407 attending neurosurgeons were included in the present study, with an overall response rate of 17.7 %. The majority of respondents were male (88.7 %), White (84.3 %), and in practice for 15 years or more (64.6 %). The majority reported a decrease in work hours due to the pandemic (82.6 %), uncertainty about future earnings (80.3 %), and uncertainty regarding future healthcare reform (84.5 %). Burnout was identified in 83 (20.4 %) respondents, whereas career satisfaction was identified in 316 (77.6 %) respondents. Rate of burnout was decreased when compared to rates reported in the pre-COVID era. In multivariate analysis, burnout was associated with working in a hostile or difficult environment since the rise of COVID-19 (OR = 2.534, p = 0.008), not having children (OR = 3.294, p = 0.011), being in practice for 5-15 years (vs. < 5 years) (OR = 4.568, p = 0.014), spending increased time conducting non-neurosurgical medical care due to COVID-19 (OR = 2.362, p = 0.019), feeling uncertain about future earnings due to COVID-19 (OR = 4.031, p = 0.035), and choosing not to pursue or feeling uncertain about pursuing neurosurgery again if given the choice (OR = 7.492, p < 0.001). Career satisfaction was associated with cerebrovascular subspecialty training (OR = 2.614, p = 0.046) and a willingness to pursue neurosurgery again if given the choice (OR = 2.962, p < 0.001). CONCLUSION: Factors related to the novel COVID-19 pandemic have contributed to changes in workflow among U.S. attending neurosurgeons. Despite these changes, we report decreased burnout and high career satisfaction among U.S. neurosurgeons. Understanding modifiable stressors among neurosurgeons during the pandemic may help to identify effective future interventions to mitigate burnout and improve career satisfaction.

A national survey on the impact of the COVID-19 pandemic upon burnout and career satisfaction among neurosurgery residents.

The coronavirus disease 2019 (COVID-19) pandemic has posed significant changes to resident education and workflow. However, the impact of the pandemic on U.S. neurosurgery residents has not been well characterized. We investigated the impact of the COVID-19 pandemic on U.S. neurosurgery resident workflow, burnout, and career satisfaction. In 2020, a survey evaluating factors related to career satisfaction and burnout was emailed to 1,374 American Association of Neurological Surgeons (AANS) residents. Bivariate and multivariate (logistic) analyses were performed to characterize predictors of burnout and career satisfaction. 167 survey responses were received, with a response rate (12.2%) comparable to that of similar studies. Exclusion of incomplete responses yielded 111complete responses. Most respondents were male (65.8%) and White (75.7%). Residents reported fewer work hours (67.6%) and concern that COVID-19 would impair theirachievement of surgical milestones (65.8%). Burnout was identified in 29 (26.1%) respondents and career satisfaction in 82 (73.9%) respondents. In multivariate analysis, burnout was significantly associated with alterations in elective rotation/vacation schedules (p = .013) and the decision to not pursue neurosurgery again if given the choice (p < .001). Higher post-graduate year was associated with less burnout (p = .011). Residents displayed greater career satisfaction when focusing their clinical work upon neurosurgical care (p = .065). Factors related to COVID-19 have contributed to workflow changes among U.S. neurosurgery residents. We report a moderate burnout rate and a paradoxically high career satisfaction rate among neurosurgery residents. Understanding modifiable stressors during the COVID-19pandemic may help to formulate interventions to mitigate burnout and improve career satisfaction among residents.