The interview is one of the most important phases of the neurosurgical residency application process. Since most applicants complete only 2-4 subinternships, the interview is your chance to put a face and a personality to your application for the majority of programs to which you apply.

The good news is that anyone invited to interview by a program has been deemed competent – on paper – to become a neurosurgical resident at that program. The interview, then, is an opportunity to show the faculty and the residents that you are personable, thoughtful, funny, quick-thinking, and – above all – a normal person who they would enjoy spending seven long years in the trenches with. Take advantage of this chance to make the case that you’d be a great colleague.

One of the most rewarding parts of the interview trail is getting to travel around the country and meeting all of your future colleagues. After the first few interviews, you will begin to recognize many of the same applicants attending the same interviews. Many lifelong friendships in neurosurgery begin on the interview trail – cherish this unique experience to make friends with future coresidents and colleagues (and coauthors, grant and paper reviewers…).

However, keep in mind that because neurosurgery is such a small community where word travels quickly, you should always be on your best behavior, avoiding saying negative things about other people or programs. Always be positive, diplomatic and affable!

Beginning in October, programs will begin to send interview invitations to applicants of interest. As of the 2016 interview season, interview invites arrive via several modalities:

• Direct email from the program (usually from the program coordinator, program director, or chairman)
• ERAS message from the program
• Automated email from a scheduling service such as Interview Broker
• Phone call from the program (usually from the program coordinator)

In the authors’ experience, the majority of invitations arrive via direct email from the program or via ERAS message. As a warning, many applicants have experienced difficulties accessing the ERAS message center and the scheduling applet from smartphones (especially Apple iOS-based devices).

Some programs are notorious for sending out a greater number than there are interview slots, and interviews are scheduled on a first-come, first-served basis, so an immediate response to any communication from any program is essential. This fact is further underscored by the fact that programs will usually have only two or three interview dates.

As the invites pile up, it will become more and more difficult to schedule your interviews without double-booking. In the era of smartphones, it is the authors’ experience that popular interview dates can fill up as soon as three minutes after the invitation email is sent!

Fortunately, some advance planning can be performed via using the interview spreadsheet compiled by the Society for Neurological Surgeons (SNS), which lists likely interview dates and program coordinator contact information (among other things) for most programs accepting residents that year.

We recommend creating a cloud-based (e.g. Google Drive, Dropbox, etc.) spreadsheet or calendar well in advance of your first interview invitation that lists all available dates for every program to which you applied. When invitations start arriving, you can easily verify which dates you are available for and reply quickly.

Especially since many applicants will still be rotating when interview invitations begin to arrive, it is important to monitor your inbox frequently for invitations. Some applicants recommend setting up an email monitoring system that sends a text message when emails from ‘[email protected]’ arrive in your inbox. One such method can be found following this guide. Of course, this method will only catch invitations sent via ERAS.

Other applicants give a trusted, less busy family member or friend their email login credentials (not recommended for security reasons) and access to their scheduling calendar so that this proxy can reply within minutes. Still others use smartwatches (which can be more discreetly checked while in the hospital) to alert them of incoming emails. Regardless of how you choose to receive notifications, you should plan to use an email system that is easy to access and that “pushes” new emails to your devices as soon as they arrive.

When you respond to invitations, ensure that you have carefully evaluated your calendar for previously scheduled interviews. If you must decline an invitation, politely thank the coordinator for the invitation. If you must later cancel an accepted invitation, do so as soon as possible (by no means less than a week before the interview date) so the program coordinator can extend the invitation to another applicant. Do not “no-show” an interview under any circumstances.

Most successful applicants attend 15-20 interviews (and rank all, or almost all, of the programs at which they interview). See the NRMP Match statistics for the latest information regarding average rank list lengths, which change from year to year.

While it can be exciting to travel around the country and see new cities, the expense involved can be massive. With few exceptions, the programs located in the same city or greater metropolitan area do not coordinate their interview dates, leading to more expensive long-haul flights. Furthermore, very few medical schools provide extra funding (even loans) for the interview process. Between flights, hotels, ground transportation, and meals, many neurosurgery applicants have reported spending upwards of $10,000 on this process. Luckily, there are ways to save money.

• Consolidate all of your flights onto one airline, if possible. This will enable you to quickly accumulate frequent flier miles, which can be used to purchase flights in the later part of the interview season. If you can fly enough on the same airline to qualify for elite status, miles will accumulate even more quickly. Many applicants recommend flying on Southwest Airlines when possible, as Southwest does not charge fees for changing flights (which can happen as interviews are canceled or rescheduled, or if there is inclement weather, especially in the Northeast or Midwest in December/January, etc.).
• Many applicants have found that signing up for rewards credit cards before the interview season has saved them significant amounts of money. NerdWallet has a useful guide for comparing rewards cards. Popular cards are the Chase Sapphire Preferred, American Express Premier Rewards Gold, and airline-associated cards, all of which come with rewards points bonuses (which can be used as frequent flier miles to book trips) if you spend a certain amount of money in the first few months.
• Stay with friends, at an Airbnb, or low-cost hotel accommodations when possible. Many programs will provide a list of suggested hotels, where you may be able to mention that you are interviewing at their hospital in order to receive a special rate. Still other programs will request that you stay in one (usually expensive) hotel near the hospital. While this is preferable as transportation may be coordinated in advance to and from that hotel, it is usually not required. Verify this in advance with the program coordinator (all of whom are aware that budgets are tight during interview season).
• Use public transportation whenever safe and convenient. Uber or Lyft are usually cheaper than local taxi companies, if available.
• While we cannot and do not purport to provide tax advice, many of the expenses incurred during interview season may be tax-deductible, as they are associated with a job search. Consult a tax professional for advice.

Interview formats vary, but most are two days, with a primarily social event the first afternoon/evening and the actual interviews lasting most of the second day. Consult your invitation email and any additional communication from the program coordinator carefully when planning airfare, accommodation, and ground transportation.

You can use some of the downtime during traveling to begin taking notes about the program you are about to visit. Many applicants use a “padfolio” or similar notebook to write down at least the names of the chairman, program director, and any associate program directors, and their subspecialties, along with several potential research mentors.

Prepare yourself for one of the best parts of the interview process (especially if you like good food): the dinner! While each program does it differently, the dinner, and sometimes a trip to a bar or two afterwards, is when you will likely spend the most time interacting with the current residents. This is a great opportunity to get to know the residents and their lifestyle. Make sure to ask questions that are important for your quality of life. For instance, ask how the residents spend their free time. Do the current residents have families? Is the program family friendly? Additionally, you should try to get a sense of what a day is like in the life of a resident.

This is also a great opportunity for you to see how the residents interact with each other. Do the residents appear to be sincerely happy? Do they seem to enjoy being around each other, or does it seem like the residents are there because they have to be? How many residents show up? Is resident turnout poor because they are working or because they just did not feel like coming? Does this seem like a group of people with which you would enjoy spending the majority of your time? Does your personality fit with the program? You should be evaluating all of these questions and more during and after the dinner.

As a note of caution, the vast majority of the interview dinners and post-dinner activities will involve alcoholic beverages. If you prefer not to drink alcohol for any reason, this is perfectly acceptable, and you will not be pressured to do so. If you do decide to drink, however, take great care to maintain control, and do not, under any circumstances, show up to your interview the next morning intoxicated, hung over, or smelling of alcohol. Our specialty is small and word travels quickly.

There are countless stories of applicants who drank too much at their interview dinners and gained a negative reputation as a result. Lastly, always be on your best behavior – even in the Uber ride on the way to the bar. It would be wise to avoid saying anything negative about anyone on the trail or at another program. This reflects far more poorly on you more than on the person/program of which you are speaking negatively!

While the field of neurosurgery contains a great variety of personalities from the social butterfly to the staunch introvert, the interview dinner is the time to be social with the residents and the other applicants. This event is one of the few times the residents will have the chance to see if you are the type of person they would want to work closely with for several years. The weight put on resident opinions will vary from program to program, but if you garner a ‘no’ vote from residents at the pre-interview dinner, you will almost certainly not be ranked.

Usually, your interview day will consist of a short information session about the program, a tour of the hospital and/or city, meals (usually breakfast and lunch), and the actual interviews. Residents will often be available during downtime to answer any questions that might come up. Take advantage of this opportunity to ask any outstanding questions about the program, but if you have none, socialize about other things!

The neurosurgery department’s library or conference room is a common setting for a program director’s introductory remarks, breakfast and lunch, or a place to wait between interviews.

It is vital to remember that everything you do is being evaluated, either consciously or subconsciously, by the residents and faculty who see you. Do not be late to an interview - it is unacceptable to oversleep during residency, and it is also not acceptable to sleep through part of your interview day. You will be tired from traveling or the previous night’s activities but never complain about this.

The residency application process is tiring, but truly a treat in comparison to the grueling life of residency. If you cannot handle the stress of interviewing, it is questionable how you will fare during residency! Resist the urge to sit in the corner of the conference room, not talk to other applicants or residents, or nod off. Dress in a semi-conservative manner. It is probably best to have at least two suits, as you will likely have back-to-back interviews at some point on the trail.

As a general rule, it is best if your clothes are not what you are remembered for. Do not stand out in a negative way. Various stories have permeated through the interview trail for years. Neurosurgery is small field with a long memory; do not be a story.

While programs structure their interview differently, in general, you will meet with between five to 15 faculty members or groups of faculty members for 10-25 minutes each. There may be an interview station with residents (usually the PGY-4 or PGY-5 residents who will be your chief residents when you are a junior resident taking call, as this is one of the most important relationships during residency).

If you have not been interviewed for a position in several years, it is of vital importance to practice. Even if you have excellent answers to all of the common questions (see below), so much of an interviewer’s impression of you is based on the “intangibles”:

• Shake hands with everyone in the interview room before and after your interview, introducing yourself with your full name during the first handshake. Your handshake should be firm and well-balanced – do not offer only your fingers, and do not apply a “death grip” either. Make eye contact and smile during the handshake and at other times (see below).
• Body language is crucial. Sit straight with your hands comfortably at your side or holding a “padfolio” from your institution or the folder of information you were provided at the interview. Lean in towards your interviewer. Avoid crossing your arms, turning away from your interviewer, or nervously fidgeting (tapping your foot, moving your fingers, playing with your hair, etc.).
• Make eye contact. If you are uncomfortable with prolonged eye contact, practice. This is one of the easiest ways to appear engaged in a conversation.
• Smile! Not excessively or in a phony manner, but you should be excited to be there and the interviewer should be able to see this by looking at your facial expressions.
• Provide subtle cues that you are listening to your interviewer as he or she speaks to you. Nod after an important clause, use filler phrases such as “mm-hmm”, “right”, and “absolutely” when appropriate. People like to be affirmed in their communication, and no one likes talking to an emotionless, unresponsive statue.
• Use your interviewer’s name when you can. “Great to meet you, Dr. Smith” and “Thank you, Dr. Jones” go a long way toward appearing like a warm and friendly person.

Above all, appear bright, engaged, interested, and always available for a friendly conversation.

Tell me about yourself.

• Try to keep this answer to 2-3 minutes or less – use this as an opportunity to include anything about yourself or your life story that you want the interviewer to learn about you. This should be well-rehearsed and succinct and can even transition into why you chose neurosurgery as a career if it is relevant.

Why neurosurgery?

• Expect to get this question in every interview. Your personal statement likely addresses this, but again, keep this less than 5 minutes and succinct. Focus on yourself and your unique qualities that make neurosurgery right for you. The neurosurgeon interviewing you knows how cool neurosurgery is, you do not have to tell them! Neurosurgery is not the only way to help people!

Why are you interested in our program? What questions do you have about our program?

• This question or something similar will most likely be asked of you. Avoid answering with general reasons like the location or sports team. Obviously, these are added bonuses but save them for the end, if appropriate. Focus on specific aspects of the program, such as the patient population, types of procedures, access to a certain technology, mentorship, anything unique to the program etc. Again, this is an opportunity to impress them with your understanding of the program, the culture there, and expose who you are by describing what it is that attracts you to the program itself.

What is/are your biggest weakness(es)/strength(s)?

• This is one of the most difficult questions for people to answer. Have as many as five prepared for each category (though you will often only be asked for one or two), and make sure to describe how you have been working on improving each one you mention. We recommend resisting the urge to spin your weaknesses into strengths (“I’m a perfectionist…but that means I do really well on everything!”). It can come off as tacky and give the impression that you don’t see yourself as having any real weaknesses.

How would you describe yourself? How would your family/friends describe you? Describe yourself in three words.

• Similar to the above, you can take any angle you wish. This is another opportunity to include information that is not in your application that is unique to you and by which you want to be remembered. It is most important to be prepared – have your answers ready along with short explanations in case you are asked why.

What do you do outside of medicine?

• This is one of the most important questions you will be asked. Since most everyone invited to interview is qualified to do the job, the purpose of the interview is really to identify applicants who are funny, personable, thoughtful, and above all normal. Are you someone who would be fun to spend seven years with – both inside and outside the hospital? It is important to be honest here, because you never know who you are speaking to and if you feel saying you enjoy a certain obscure hobby you’ve only dabbled in it once a long time ago will make you stand out, think again. If you say you are a wood worker, for example, the interviewer might also be one as well.

Who are your role models? Who do you look up to? Who is the smartest person you know?

• You should have a couple prepared, including someone within academics (not necessarily neurosurgery) and someone outside of it. Be warned that the vast majority of applicants use their parents. Unless they are truly the most inspirational people you can think of, we recommend picking other role models in order to set yourself apart from other applicants.

What is your most important accomplishment?/What are you most proud of?

• This will likely be something from your application – and that is OK. You can take this chance to elaborate and describe why it was so meaningful to you. If you have something less tangible and more personal, feel free to share that as well. For example, you can be most proud of your decision to leave school for a year and spend time with a dying family member – perhaps this was not written anywhere in your application but you can describe why it was so meaningful to you and take the chance to reveal your personal values. You can take this answer in any direction you wish.

Tell me about a time that you failed.

• Another opportunity to come prepared to the interview. This is a relatively common question so have your answer ready with a brief description of your failure and what you learned from it. Just like the previous question, you can answer this with an academic experience or a personal one.

What is the greatest sacrifice you have made to get to where you are?

• A tough question, so try to focus on something that reveals who you are and what matters to you most. If nothing comes to mind easily, think of an experience that you went through during your professional life that was difficult. Describing a situation that has to do with family is always a safe option but this one might take some personal reflection. Whatever you choose, make sure that your answer reveals how committed you are to achieving your professional goals.

What leadership roles have you held?

• Simple and self-explanatory but choose what you share wisely. Describe a position you held in such a way that highlights your strengths and will make you stand out. For instance, most students have had some experience as a student leader in student government, but you can describe what it was that you found enjoyable and challenging to make your experience unique.

What do you think you can contribute to this program?

• This is an excellent opportunity for you to shine. Answer this with specific strengths and interests that you are excited about bringing to residency. Ideally, this answer will include both personal and professional attributes that you will contribute. For example, you can discuss your leadership and organizational skills and incorporate a past experience with future plans for the program. You can also mention research interests that fall within the expertise of certain attendings at the program. The more specific you can be, the better.

Tell me something about yourself that is not in your application.

• A high yield question, so make sure to have some answers in your back pocket. Interviewers want to learn about you and your unique attributes so be ready to share. Whether you had an interesting life experience or have recently developed a new hobby that is not listed in ERAS, take this opportunity to show off how interesting and versatile you are. For example, “I went sky diving 6 years ago and I just booked to go again after the Match.” Or on the more professional side, “I used to paint when I was younger and decided to take a class next month” or “I’m learning X language”… you can choose how fun and light you would like to make this response and we recommend having a range to choose from based on how the interview is going.

Why should we choose you? Why should we choose you over ___(person from your medical school also interviewing on the same day as you)___?

• A variant of this question may be asked of you and we recommend avoiding any mention of negative attributes in other people. The best way to proceed is to describe your own strengths and what you bring to the table. The interviewer might push you to say something negative about the other applicant but NEVER do this. Politely say, “well I know most about myself so I will focus on the great things I have to offer such as X, Y, and Z.” If you feel pressured to mention the other person, then say something nice about them. “He/she is an excellent applicant; I would love to work with him/her, as I have done so in the past and we actually communicated effectively and efficiently etc.” Anything negative you say about an applicant, even if pressed to do so, will reflect extremely poorly on you, and the above answer will make you look better than any negative thing you could possibly say.

Teach me how to do _______ (a hobby from your application).

• This type of question can often catch you off guard. Of course, being prepared would be ideal but your question may be different than this one. It is acceptable to take a few moments to gather your thoughts and prepare a mini-lesson. Take a deep breath and do your best. In the case of teaching a lesson, make sure to assess your student’s knowledge base before beginning. For example, if you are teaching him/her how to make risotto, ask if they cook often before beginning. Be organized in your response and ensure that they understand by asking “does that make sense?” or “do you have any questions?” Your role as an educator begins on day one of residency, as you will need to teach your patients’ family members about their loved ones’ conditions before you ever teach a medical student or a more junior colleague anything, so nailing this answer reveals your potential in this aspect of your career.

Can you tell me about ____(negative attribute/deficiency)____ on your record?

• This question will be asked if there is anything obviously negative in your application (low USMLE score, leave of absence, etc). We cannot stress this enough: be prepared! Be honest and describe the situation, trying to focus on what happened and how you learned from it or improved by going through it. We advise getting mentorship on how to answer regarding your personal deficiency from school counselors or neurosurgeons who mentor you and can assist in formulating an honest and strong response that will help you rather than hurt you. However, do not make excuses. Every resident will make many mistakes during residency, and interviewers are looking for someone who will take responsibility for them rather than make excuses about them.

Have you played team sports?

• A popular question, as medicine is evolving into a team effort, not just including residents and faculty, but nurses, midlevel providers, respiratory therapists, medical students, etc. Working with other people is very much like playing a team sport and many neurosurgeons draw parallels between the two. This is also another opportunity to jive with the interviewer who may have played or plays the same sport as you!

What was your favorite course in medical school/college?

• A simple question, just be honest and describe why you liked it so much!

What was the most difficult situation you encountered in medical school?

• Again, be honest, and draw a meaningful reason why the situation was difficult for you. Situations from clinical rotations involving ethical dilemmas are a good place to start when brainstorming for this answer.

How have you prepared for the rigors of residency? Are you OK with the long hours?

• Make sure your answer reveals how excited you are about residency by describing your sub-internships and experiences that clearly demonstrated the schedule you will have. Neurosurgery residency and life as a neurosurgeon are rigorous, but by the time you arrive at your interviews, you hopefully have gotten a taste for this during your rotations and realized that you can handle it. Try to describe how committed you are to the profession and how excited you are to learn. There is probably no real way to prepare other than to do sub-internships. Even this is incomparable to being an actual resident. You can describe this in your answer which will hopefully reveal how much you understand about the rigors ahead of you.

What makes you think you have the hands to do this job?

• This is tough, because many of us have not had any experience which can truly prove that you have the hands to do it. One way to answer the question is to state, honestly and openly, that there is no real way to know until you get there, but you are looking forward to learning. Another option is to mention a personal hobby or a situation which led you to know you have strong coordination. Sports, anatomical dissections and anything that requires a still hand, 3D perception and focused hand-eye coordination is a good place to start. Also, if you ever received a compliment on your suturing skills, be sure to mention that, especially if a surgeon was the one complimenting you!

What books have you read recently?

• Be prepared to talk about a few books you have read recently that made an impression on you. As this is yet another opportunity to talk about your interests outside of medicine and to paint a picture of yourself as a fun and well-rounded person, we recommend avoiding books about neurosurgery.

Tell me about your research

• Have a succinct and simple description of your research experiences, including the one or two main techniques, concepts, or skills you took away from the experience and how the research fits into your overall narrative. Make sure it is coherent and that you provide enough background information without being too elaborate. Take this opportunity to describe what about the research excited you and makes you want to pursue research in the future, etc. It goes without saying, but be able to speak for at least a minute or two and answer any question without thinking or hesitation about every research experience you included in the ERAS.

Do you want to do research in residency? If so, in what? With whom?

• This can often be tailored to each program or even interviewer. You can take this as an opportunity to impress the interviewer with your knowledge and preparation of your interviewer’s research or other projects the program has that you are interested in. It would be ideal to be specific about what you would contribute or be interested in getting involved in and why.

Give me your three specific aims for the research you are planning to do.

• If you have significant research experience and interests, you may be asked to outline three specific aims at some of the more research-heavy, academics-focused institutions.

How do you plan to balance clinical responsibilities with research and paper writing during residency?

• Be prepared to have a good answer for this question, especially if you identified research and academics as a primary interest. There is no one great answer, and very few neurosurgeons who do research have found a perfect balance. You can talk about your mentors and the advice they have given you regarding this topic, or you can identify one or two neurosurgeons (preferably at the institution where you’re interviewing!) who have done this particularly well and discuss how they potentially balance their obligations.

What are you looking for in a program?

• It is important to be honest but to also cater to specific programs. If you say “I want a bigger program” while in an interview at a program that takes only one resident each year, then it will seem like you are not very interested in that program.

If you were not going into neurosurgery, which career would you choose?

• Another opportunity to express something personal about yourself that is not in your ERAS application. You can take this opportunity to express a hobby or personal interest that you are passionate about or honestly describe another career that has interested you and elaborate on why you are drawn to that, ideally creating a parallel with qualities that are also found in neurosurgery.

Which subspecialty of neurosurgery interests you?

• Be honest about your interests, but avoid saying anything negative about any subspecialty.

What do you see yourself doing in ten years? What are your professional goals? Are you interested in academic or in clinical medicine?

• This is where your interviewer will attempt to feel out whether you are interested in academics, private practice, or another practice scenario. Be warned that many interviewers at academically-focused programs will be quick to state their cynicism about your answer, as the vast majority of applicants claim that they want to stay in academics, whereas the numbers after graduation do not reflect this. Be ready to justify your answer.

What was the most interesting case that you have been involved in?

• This is a very common question, so be ready with all the details, including patient positioning, approach, anatomy, as all will potentially be asked of you. If you did a sub-internship at the program, make sure to describe a case you saw while on the rotation. You can either describe a specific patient and case to talk about or choose an operation you generally find interesting and discuss the details about it that you’re drawn to.

Where did you do your sub-internships? Which one did you like best/worst and why? Tell me one good and one bad thing about each one.

• Avoid mentioning anything too negative about any specific person or institution (though you may be pressed to find something you didn’t like). This cannot be stressed enough. Answer this question honestly, but diplomatically, and focus on qualities that you enjoyed and appreciated – like morning didactic sessions or exposure to diverse patient populations.

What problems will our specialty face in the next 5-10 years?

• This question is testing your knowledge of the current medical climate and challenges facing neurosurgeons today. Read newsletters and policy statements from the AANS and CNS and other related sources to be up to date on issues regarding payment, policy, and changes that are potentially coming to neurosurgery and to medicine in general. If you attend any of the national neurosurgical meetings, be sure to attend a session or two on this topic as it is often discussed.

What do you plan to contribute to neurosurgery?

• This is another tough question because many applicants do not yet know what they will eventually contribute? Again, just be prepared! Have a personal interest that aligns with an area of need in the field today. For example, if you have had experiences in brain tumor research, use those as an opportunity to elaborate and describe your commitment to continuing those endeavors. You can also mention interests in teaching, academics, technological advancement etc. Whatever you choose, make sure that it makes sense, is well-thought out and is an actual contribution.

These questions will vary, but their general underlying theme is captured by the questions below. Keep in mind that they are testing your clinical decision-making process while working within a team. Patient safety always comes first and before any team dynamics – this cannot be stressed enough and it is important that you mention that as part of your reasoning, however you answer your question.

What would you do if you attempted to place an EVD alone and after the third pass you still did not get CSF?

• The take away from this question is that you should not be afraid to call on your senior for help. If patient safety is on the line, call for help. You will never be discredited for wanting to take care of someone in the best way possible.

How would you react if your chief did not agree with you?

• Team dynamics are very important in residency. The orders of your chief should be obeyed most of the time. If a patient’s life or safety is at stake, however, then call the attending. Usually a clinical picture will be described, such as a patient suffering from cauda equina syndrome in the ED. Your chief will ask you to just observe the patient overnight until rounds the next day. Calling the attending here is the right thing to do.

You disagree with your senior’s assessment of a patient. When do you call the chief/attending?

• See the previous answer – if patient safety is on the line, then you should call the attending. If you are unsure, then it is ok to describe that you are unsure and ask the chief to describe his/her decision making first (hoping that the residency program in question fosters teaching and would find this an acceptable first move).

A patient’s family asks you to do something unethical, such as withhold a difficult diagnosis from your patient. How do you address this?

• This is a classic medical school ethics interview type of question. The patient comes first – this cannot be stressed enough. If the patient does not wish to know his/her diagnosis and he/she stated this to you in person or in writing, is in an unaltered state of mind, and understands the implications of this decision, then it would be OK to withhold the information. Otherwise, the patient should always be aware of their diagnosis and medical management. Your answer should reflect this in a way that involves the family members making this request; your first move should be to persuade them that their involvement with the patient’s care will be beneficial, and that the patient will need their support to cope with this diagnosis and the treatment plan.

Every year, there are several interviewers who like to ask offbeat questions to see if applicants can think on their feet and come up with coherent, thoughtful, and (sometimes) humorous answers. We couldn’t possibly list all of these questions that we have been asked, but here are a few examples.

• Which philosophers have most influenced your life?
• What piece of art has most influenced you?
• What music group or band would you be a part of if you could?
• Is a hot dog a sandwich?
• Would you rather fight one horse-sized duck or 100 duck-sized horses?
• If you were a person in history who would you be?

You may even be asked to solve a riddle or tell a joke – so have an appropriate one ready! As if the interview itself weren’t nerve-wracking enough, a small minority of programs are known for asking you to perform a task involving your hands, usually while the interviewers are asking you questions at the same time. The tasks usually involve building something out of Legos or clay, drawing something, or even tying knots. The point is to get you out of your comfort zone and evaluate your ability to multitask without becoming frazzled.

Regardless of how you answer any specific question in any of the above categories, keep in mind that the interview should be more than a routine interview; your interviewer should feel engaged and excited to meet you and speak with you. The faculty should remember something especially meaningful and enduring about you. A boring interview is neither distinctive nor decisive during the ranking process, but standing out as an excellent conversationalist will be remembered.

At the end (and sometimes at the beginning) of each interview, you will have the opportunity to ask questions about the program. We recognize that faculty and residents will be asking you all day if you have any questions, and you may feel that you do not have any legitimate questions left by the time you get to the actual interviews. However, one of the best ways to convey your interest in a program is to ask your interviewers detailed, specific questions about the program.

By far, the most common question applicants ask is “how do you see the program changing during the next seven years?” While it is important for applicants to know this information, it will often be conveyed during the pre-interview information session and during informal conversations with residents. Since this question is so common, some faculty may see it as lazy and uncreative if you ask this question, so we recommend avoiding it, unless there is a specific potential change to the program you are curious about.

Other topics to avoid asking questions about are salary and other similar benefits of the program. It’s tacky to ask such questions; these benefits vary little among different programs. If there’s a benefit worth mentioning, it will be placed in an information packet or will be available online.

Ask about research opportunities for residents in specific subspecialties you are interested in, and try to find out whether the residents are actually participating, or if the opportunities only exist in theory, but the residents are too busy to take advantage of them.

You can ask about leaving the institution to perform research elsewhere, but be careful not to convey the sense that you don’t appreciate the research available within the institution itself. Ask what recent graduates are doing within neurosurgery and how the program has changed since their time. Ask about cost of living and where residents live, especially in expensive cities.

As mentioned above, after the interview, you should take some time to compile notes on the program you just visited. This may include a list of pros and cons or a spreadsheet of variables you think are important. However, it is most important to remember your “gut feeling” for a program. Specifically, did you fit in with the culture of the program you just visited? Or, could you see yourself at that program, in that city, with those people for the next seven years? The culture of the program is one of the most important factors to consider.

Some applicants find it helpful to speak with a significant other, friend, or family member immediately after each interview to let this person hear their unfiltered opinion of how they felt at the interview; as the process winds down, they can then ask this person for their opinion of which programs the applicants sounded most excited about. However you do it, it is crucial to have some sort of record to refer to, as the interview season is three months long and programs may start to meld together after a while.

It is important to express your gratitude to programs for taking the time to interview you. It is up to you how you do this; thank you note behavior ranges from nothing to individualized, personalized emails to every faculty member and resident one interacted with during the interview day. At a minimum, it is our recommendation to thank the program coordinator (after all, the coordinator worked the hardest to make the interview day possible), chairman, program director, and any faculty member(s) or resident(s) with whom you made an especially strong connection with during the interview session.

Be sure to include details from your conversation in your thank you note. Many programs provide a list of contact information for faculty and residents you can use to send notes. If you do not receive one, many institutions have online directories where email addresses can be found. Barring this, you may email the program coordinator to get a specific faculty member’s or resident’s email address.

Try to send any thank you notes within a week of the interview. If you are interested in a second look (see below,) tell the program director and the program coordinator when you email them. Do not promise to “stay in touch” unless you fully intend on doing so!

Every applicant should familiarize themselves with the rules in the NRMP Code of Conduct regarding post-interview communication. It is clearly stated that programs may express their interest in a candidate and applicants can freely express their interest in a program; however, neither party can ask the other to disclose their ranking preferences or ranking intentions.

Programs may not require applicants to come back for a second visit (see below) or imply that a second visit is used to determine the applicant’s placement. Further, programs are not to engage in post-interview communication that is disingenuous for the purpose of influencing applicants’ ranking preferences.

However, some applicants do report receiving phone calls from program directors or chairmen who suggest they will be “ranked to match” and may attempt to discern where their program stands on the applicant’s rank list. Some perceive these calls from programs as attempts to influence the applicants’ decisions while others view it as a way for programs to genuinely express their interest.

These interactions can be genuine, but there will always be stories on the trail about applicants and programs that were not being honest, and remember that neurosurgery is a small field in which chairmen and program directors all know each other and do discuss matters of common interest, including the application process. Be careful and diplomatic, and take everything with a grain of salt. Under no circumstances should you tell a program that you will rank them first without intending to do so, and never tell more than one program that you intend to rank them first.

There are also stories or rumors about programs that “require” applicants to rank them #1 for the applicant to be considered at that program. Handling these situations can be very difficult and should be addressed on an individual or program basis with the help of your mentors in the field.

The most important rule is to rank the programs based on your preferences, unaffected by outside forces.

Second looks are a tricky part of the interview trail as they are meant to give an applicant a better idea about a program by allowing them to see the day-to-day intricacies of the neurosurgical service. However, second looks, similar to subinternships, may also function as extended interviews where the residents and faculty see how the applicant would fit within the program.

Few programs will have you sit for a formal interview during a second look visit, but expect that the faculty and residents you interact with throughout the day (or night, if you choose to take a night of call) will ask you questions in an attempt to get to know you better. Program policies will vary, but expect to act in an observer capacity only; you will likely not scrub in or be able to participate in any patient care activities.

A few programs will make it very clear during the interview day that second looks are recommended for the applicants to be ranked highly at that program. Most programs will either not mention second looks or explicitly state that they are not required in order to be ranked and should be done only if the applicant truly desires a “second look” at the program. Still others will state that they do not offer second looks, as they believe the interview is enough time to get a feel for their program.

After the costs and time commitment of the interview trail itself, it becomes difficult to commit to multiple second looks. However, they can be completed during gaps in the interview trail or in February when interviews have slowed down and rank lists have not been finalized. The visit can be scheduled with the program director and the program coordinator.

DOI: https://doi.org/10.18791/nsatlas.v10.ch09