Gearing Up for the U.S. Medical Licensing Examination Step 1 Pass/Fail Transition, Evaluating the Role of Research Productivity as an Alternative During the Neurosurgical Residency Selection Process: An Overview.

Neurosurgery residency programs are the most competitive among the surgical specialties for applicants to match into. U.S. Medical Licensing Examination (USMLE) step 1 scores are staple and pivotal in narrowing down applicants for granting interviews and ranking in the match process. The upcoming transition from a numeric to binary step 1 scoring shifts the emphasis on using the status quo Step 2 Clinical Knowledge numeric scoring as the only objective measure. It can prove insubstantial for accurate assessment of competencies, further urging residency programs to widen their selection protocols to allow multiple assessments of competency. Research experience has consistently proved to result in higher successful match rates, and a positive correlation is seen with the number of research publications and Hirsch indices. However, with a predicted emphasis on research with the shift in scoring practices, these tools provide inadequate insight into authorship, contributions, type of publications, and community impact, warranting the need to include supplementary modifications, surrogates, or alternatives to such tools for a more comprehensive and equitable assessment of research. This study summarizes the role of research in the neurosurgical match process, describes nuances in research evaluation, and introduces novel Hirsch indices and additional strategies to address these nuances for equitable evaluation of research productions.

Negative Pressure Assisted Microenvironment Surgical Hood: A Novel Cost-Effective Device to Minimize Aerosol Contamination During Neurosurgical Procedures in Times of COVID-19.

OBJECTIVE: Present guidelines on reducing aerosol generation during neurosurgical procedures are futile. The aim of this article was to describe a novel device to contain aerosol within a small localized environment around the operative field-the negative pressure assisted microenvironment surgical hood (NEPA-MESH). METHODS: This device can be assembled using easily available materials-steel wires, image intensifier cover, surgical drape, and three-dimensional-printed self-locking copolyester double hoops. Large-bore pipes in continuity with a high-volume suction apparatus create a constant negative pressure microenvironment around the operative field. The CEM DT-9880 particle counter was used to estimate particle concentration inside the NEPA-MESH during various stages of a neurosurgical procedure as well as outside. The NEPA-MESH was tested in different craniotomies and endoscopic procedures. RESULTS: Mean particle concentration inside the NEPA-MESH and outside during drilling in various procedures was calculated and compared using unpaired t test. Significant reduction in particle concentrations was recorded for particles sized 0.3 µm (t = 17.55, P < 0.0001), 0.5 µm (t = 11.39, P < 0.0001), 1 µm (t = 6.36, P = 0.0002), 2.5 µm (t = 2.04, P = 0.074), 5.0 µm (t = 7.026, P = 0.0008), and 10 µm (t = 4.39, P = 0.0023). CONCLUSIONS: As definitive evidence demonstrating the presence of coronavirus disease 2019 (COVID-19) in aerosol particles is awaited, we describe a cost-effective strategy to reduce aerosol contamination. Significant reduction in particle concentrations was seen outside the NEPA-MESH compared with inside it during various stages of neurosurgical procedures.