Redefining Research Productivity in Neurosurgery Residency Applications Through the Predictive Value of Authorship Order and Research Year Engagement

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Faraj, Rommi Kashlan, Hithardhi Duggireddy, Ryan S. Chung, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7901202/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective With the recent change to pass/fail USMLE Step 1 assessment and increasing reliance on other metrics of applicant ability, neurosurgery residency programs face challenges in evaluating the academic potential of applicants. This study examines the relative contributions of first-author publications, research year completion, and total publication volume to match success. Methods Data were drawn from the Texas STAR (Seeking Transparency in Applications to Residency) survey between 2022 and 2025, including 2,674 U.S. MD applicants and a detailed 2025 sub-cohort (n = 58) with authorship data. Logistic regression models, Chi-squared tests, and t-tests were used to examine associations between publication patterns and match outcomes. Covariates included Step 2 CK score (categorized), geographic connection, and away rotation participation. Results When mutually adjusted, first-author publication count was strongly predictive of match success (OR = 2.76 per additional first-authored paper, 95% CI: 1.82–4.67, p < 0.001), while total publication count was negatively associated with matching when controlling for authorship (OR = 0.64, 95% CI: 0.46–0.84, p < 0.001). Completion of a research year was associated with a significantly higher number of first-author publications (mean = 3.96 vs. 2.53, p = 0.0023), but not with greater total publication volume (mean = 8.04 vs. 6.41, p = 0.07). A greater number of research experiences was inversely associated with match success (OR = 0.53 per experience, 95% CI: 0.38–0.68, p < 0.001). Conclusion First-authored papers better predict match success than total publication count in neurosurgery residency applications. Dedicated research years appear to support meaningful productivity rather than sheer volume. These findings delineate how research experience is weighted in neurosurgery residency selection and may be helpful for medical students applying into neurosurgery. Neurosurgery Residency Match Research Productivity Medical Education Residency Application Research Year Publications Figures Figure 1 Figure 2 Introduction Neurosurgery is among the most competitive specialties in the United States, with match rates for U.S. MD seniors consistently lower than the national average for all specialties. 3 In recent years, the landscape of residency selection has shifted dramatically, driven by the transition of the USMLE Step 1 to pass/fail scoring and concerns about the subjectivity and increasing vagueness of clinical evaluations, which may not reliably differentiate candidates. 1 , 13 As a result, research productivity has emerged as a key differentiator among applicants, with program directors placing elevated emphasis on research output to evaluate candidates. 2 , 3 Total publication count has traditionally served as the primary metric of research productivity. Recent literature has suggested that applicants with more publications are generally more likely to match.⁴ , ⁵ However, this emphasis on volume has contributed to a “research arms race”, where applicants prioritize quantity at the expense of meaningful scientific engagement or mentorship. 6 , 22 This approach has been scrutinized, as total publication count may overestimate research involvement by rewarding superficial or peripheral contributions, and may even bring about misconduct or misrepresentation in neurosurgery residency applications. 14 Despite its widespread use, there is limited evidence that total publication count reliably predicts match success. Recent studies and program director surveys suggest authorship position, particularly first-author status, may better represent an applicant’s leadership, initiative, and ownership of research projects.⁷ Existing literature has not clearly distinguished between superficial involvement and substantive contribution, leaving applicants and advisors uncertain about which aspects of research are valued most valued. Additionally, an increasing number of applicants are pursuing structured research years to strengthen their academic portfolios. While intended to promote scientific development, few studies have assessed whether these years result in meaningful authorship or simply inflate publication numbers. This study addresses these critical gaps by leveraging multi-year data from the Texas STAR (Seeking Transparency in Applications to Residency) database to evaluate whether first-author publication count and engagement in an academic research year are better predictors of neurosurgery match success than total publication volume alone. We examined how the predictive value of these metrics has changed longitudinally after USMLE Step 1 pass/fail scoring and signaling. We aim to provide data-driven guidance for applicants, advisors, and program directors for evaluating research productivity in a shifting landscape where traditional metrics are being reconsidered. Rather than a pre–post comparison of Step 1 policy, this study provides a current-era evaluation of how first-author publications, total publication volume, and completion of a research year relate to interview and match outcomes with descriptive longitudinal context. Methods Cohort This study used deidentified, self-reported data from the Texas Seeking Transparency in Application to Residency (STAR) survey for the 2025 neurosurgery match. Respondents are instructed to provide information exactly as it appears on their Electronic Residency Application Service (ERAS) applications. The 2025 cycle included over 150 participating institutions with an estimated 34% response rate, consistent with prior years. We identified 58 neurosurgery applicants who met the inclusion criteria. MD/PhD students, osteopathic medical students, and international medical graduates were excluded to preserve a homogeneous applicant cohort of U.S. allopathic seniors. An additional 255 neurosurgery applicants from 2022–2025 were included without first-authorship data. For each applicant, we extracted matched program and submitted program applications, yielding approximately 600 applications for the 2025 analysis and 2,674 applications for the 2022–2025 analysis. Variables Applicants reported academic metrics, including the number of peer-reviewed publications, first-author publications, abstracts/ posters/presentations, research experiences, and whether they completed a dedicated research year. USMLE Step 2 CK scores were reported in 5-point intervals and converted to midpoint values for analysis (e.g., 240–244 coded as 242). Match outcome was a binary variable (matched vs. unmatched), while interview offer status was included as a secondary outcome at the individual application level. Relationship variables (e.g., geographic connection and preference signaling) were reported, and a composite relation score (0–4) was the summation of these variables. Statistical Analysis Analyses were conducted using R (version 4.5.0, 2025) and Python (version 3.10). Continuous variables were assessed for normality (Shapiro-Wilk test) and compared using independent t-tests or Wilcoxon rank-sum tests. Categorical variables were compared using Chi-squared tests. Multivariable logistic regression models evaluated associations between first-author publications, total publications, Step 2 CK score, and research experiences with odds of interviewing and matching. Additional models examined whether completing a research year was associated with increased first-author output and improved match likelihood, with interaction terms assessing mediation effects. Firth’s penalized likelihood logistic regression was used for sparse data or multicollinearity. Significance was set at p < 0.05. Results Research Output and Match Success In the 2025 Texas STAR neurosurgery cohort (n = 58), matched applicants had significantly more first-author publications than unmatched peers (mean 3.91 vs. 2.54, p = 0.019) (Table 1 ). Total publications (7.88 vs. 5.99, p < 0.001), submitted publications (5.82 vs. 4.44, p = 0.007), and number of abstracts/posters/presentations (10.33 vs. 8.59, p < 0.001) were also significantly higher in matched applicants. However, the number of research experiences did not significantly differ between groups (6.90 vs. 6.54, p = 0.16). Table 1 Mean comparison of individual research metrics for Texas STAR 2025 (n = 58) participants, stratified by match success and interview offer. Matched MEAN Value Matched Unmatched P-value First-Author Publications 3.91 2.54 0.019 Total Publications 7.88 5.99 < 0.001 Submitted Publications 5.82 4.44 0.007 Abstracts, Posters & Presentations 10.33 8.59 < 0.001 Research Experiences 6.9 6.54 0.16 First-Author/Total Author Ratio 0.422 0.38 0.35 Interview Offer MEAN Value Interview No Interview P-value First-Author Publications 3.21 2.43 < 0.001 Total Publications 7.96 5.61 < 0.001 Submitted Publications 5.5 4.23 < 0.001 Abstracts, Posters & Presentations 10.19 8.31 < 0.001 Research Experiences 6.55 6.57 0.89 First-Author/Total Author Ratio 0.37 0.38 0.48 Interview recipients similarly had higher means for all publication-related metrics compared to those who did not receive interviews, including first-author publications (3.21 vs. 2.43, p < 0.001), total publications (7.96 vs. 5.61, p < 0.001), submitted publications (5.50 vs. 4.23, p < 0.001), and number of abstracts/posters/presentations (10.19 vs. 8.31, p < 0.001) (Table 1 ). The number of research experiences was nearly identical between these groups (6.55 vs. 6.57, p = 0.89). Multivariable Predictors of Match and Interview Outcomes In a multivariable model adjusting for Step 2 CK and relation scores (geographic ties, away rotation, signals), first-author publications were strongly associated with match success (OR = 2.76 per additional first-authored paper, 95%CI: 1.82–4.67, p < 0.001), while total publication count was inversely associated with matching (OR = 0.64 per additional paper, 95%CI: 0.46–0.84, p = 0.0029) (Table 2 ). Other positive predictors of match success included Step 2 CK score (OR = 1.20 per 5-point interval, 95%CI: 1.14–1.40, p < 0.001), relation score (OR = 2.79 per additional relationship variable, 95%CI: 1.85–4.41, p < 0.001), and completion of a research year (OR = 22.08, 95%CI: 5.88-105.74, p 0.05). The total number of research experiences was negatively associated with matching (OR = 0.54 per additional experience, 95%CI: 0.40–0.68, p < 0.001). Table 2 Multivariable logistic regression model examining the association between application research characteristics and the likelihood of matching and receiving an interview invitation to a neurosurgery residency in the 2025 (n = 58) Texas STAR database. Matched Variable Odds Ratio 95% CI Standard Error P-value First-Author Publications 2.76 1.82–4.67 0.54 < 0.001 Total Publications 0.64 0.46–0.84 0.24 0.0029 Submitted Publications 1.08 0.93–1.26 0.088 0.35 Abstracts, Posters & Presentations 1.08 0.85–1.44 0.18 0.54 Research Experiences (per additional experience) 0.54 0.40–0.68 0.15 < 0.001 Research Year 22.08 5.88-105.74 0.87 < 0.001 Step2CK Score (per 5 point increase) 1.24 1.14–1.40 0.056 < 0.001 Relation Score 2.79 1.85–4.41 0.23 < 0.001 Interview Offer Variable Odds Ratio 95% CI Standard Error P-value First-Author Publications 1.59 1.08–2.52 0.48 0.021 Total Publications 1.15 0.93–1.40 0.19 0.16 Submitted Publications 1.08 0.97–1.22 0.066 0.18 Abstracts, Posters & Presentations 1.2 1.03–1.41 0.12 0.021 Research Experiences 0.65 0.50–0.79 0.11 < 0.001 Research Year 63.29 17.52-262.55 0.81 < 0.001 Step2CK Score 1.06 0.99–1.15 0.038 0.088 Relation Score 4.98 3.53–7.33 0.19 < 0.001 A similar model examining our secondary outcome identified similar trends for predictors of receiving and interview offer (Table 2 ). First-author publications (OR = 1.59 per additional first-authored paper, 95%CI: 1.08–2.52, p = 0.021), completion of a research year (OR = 63.29, 95%CI: 17.52-262.55, p < 0.001), abstracts/posters/presentations (OR = 1.20, 95%CI:1.03–1.41,p = 0.021), and relation score (OR = 4.98 per additional relationship variable, 95%CI: 3.53–7.33, p 0.05). As in the match model, more research experiences were associated with decreased odds of receiving an interview (OR = 0.65 per additional experience, 95%CI: 0.50–0.79, p < 0.001). Step 2 CK score was not significantly associated with interview offer in this model (OR = 1.06 per 5-point interval increase, 95%CI: 0.99–1.15, p = 0.088). Research Year and Productivity Applicants who completed a dedicated research year produced more first-author publications (mean 3.96 vs. 2.53, p = 0.002) but did not have a significantly different number of total publications (mean 8.04 vs. 6.41, p = 0.07). In nested logistic regression models, completion of a research year remained a significant predictor of interview offers across all specifications (Table 3 ). When modeling only the effect of a research year (Model 1), completion of a research year versus not was associated with a 12-fold increase in odds of receiving an interview (OR = 12.67, 95%CI: 6.29–25.46, p < 0.001). This association persisted after adjusting for number of first-authored papers (Model 2: OR = 9.73, 95%CI: 4.63–20.14, p < 0.001) and total publications (Model 3: OR = 15.01, 95%CI: 7.22–31.64, p < 0.001). In the full model (Model 4), research year completion remained significantly associated with interview offer (OR = 10.52, 95%CI: 7.22–31.64, p < 0.001), but neither first-author (p = 0,07) nor total publications (p = 0.67) retained significance. Table 3 Adjusted odds ratios and 95% confidence intervals from binomial logistic regression models predicting the likelihood of receiving a neurosurgery interview offer. Model 1 included only the completion of a research year. Models 2 and 3 added first-author publications and total publications, respectively. Model 4 included all three predictors. The research year was a consistently significant predictor across all models. First-author publications were independently associated with increased odds in Model 2, but not in the full model (Model 4). Total publication count showed marginal significance in Model 3 but was not significantly associated in the full model. Model Predictor Odds Ratio 95% CI P-Value Model 1: Research Year Research Year 12.67 6.29–25.46 8.34×10⁻¹³ Model 2: Research Year + First-Author Research Year 9.73 4.63–20.14 1.07×10⁻⁹ First-Author Publications 1.26 1.08–1.48 0.005 Model 3: Research Year + Total Publications Research Year 15.01 7.22–31.64 4.68×10⁻¹³ Total Publications 1.11 1.02–1.23 0.03 Model 4 (Full Model): Research Year + First-Author + Total Publications Research Year 10.52 4.62–24.13 1.89×10⁻⁸ First-Author Publications 1.22 0.98–1.51 0.07 Total Publications 1.03 0.91–1.17 0.67 Stratified Publication Count and Threshold Effects When stratified by total peer-reviewed publication count, a threshold emerged (Table 4 ). Applicants with ≥ 7 publications had significantly increased odds of interview invite (OR = 4.63, 95%CI: 2.74–8.43, p < 0.001) and matching (OR = 5.14, 95%CI: 2.02–18.63, p < 0.001). Lower publication bins showed variable and generally non-significant effects, with wide confidence intervals. When isolating total publications with continuous modeling using Firth logistic regression, each additional publication was associated with increased odds of interview invite in both the whole cohort (OR = 1.16 per paper, 95%CI: 1.13–1.19, p < 0.001) and in the 2025-only cohort (OR = 1.14 per paper, 95%CI: 1.09–1.2, p < 0.001), with higher odds observed for first-author publications in 2025 (OR = 1.29 per first-authored paper, 95%CI: 1.16–1.44, p < 0.001). Table 4 Adjusted odds of receiving a neurosurgery interview offer (top) and successfully matching (bottom), stratified by total peer-reviewed publication count using Firth penalized logistic regression. Applicants with 7 or more publications had significantly increased odds of both receiving an interview and matching compared to those with zero publications. Lower publication bins showed non-significant or modest effects, suggesting a threshold effect in research output required to influence interview and match outcomes meaningfully. Interview Offer Total Publication Count Bin Odds Ratio 95% CI P-Value 1–2 publications 1.18 0.63–2.32 0.62 3–4 publications 1.66 0.96–3.08 0.07 5–6 publications 1.48 0.82–2.83 0.20 7 + publications 4.63 2.74–8.43 < 0.001 Matched Total Publication Count Bin Odds Ratio 95% CI P Value 1–2 publications 3.62 1.31–13.69 0.01 3–4 publications 1.63 0.61–6.10 0.36 5–6 publications 2.16 0.76–8.26 0.16 7 + publications 5.14 2.02–18.63 < 0.001 For match outcomes, each additional first-author publication in 2025 was significantly associated with higher odds of matching (OR = 1.38 per first-authored paper, 95%CI: 1.21–1.6, p < 0.001), as was the total publication count across the entire cohort (OR = 1.13 per paper, 95%CI: 1.08–1.17, p < 0.001). However, each additional publication was not predictive of match success in the 2025-only cohort (OR = 1.06, 95%CI: 0.98–1.15, p = 0.14) (Fig. 1 ). Temporal Trends from 2018 to 2025 Longitudinal analysis revealed a gradual increase in applicant competitiveness over time (Table 5 , Table 6 , Fig. 2 ). Step 2 CK scores rose significantly from a mean of 254.3 in 2018 to 261.1 in 2025 (slope = 0.72 per year, p = 0.0013). The mean number of total peer-reviewed publications also increased significantly, from 4.42 to 7.95 (slope = 0.34 per year, p = 0.0002), as did the number of abstracts, posters, and presentations (9.08 to 10.71; slope = 0.31 per year, p < 0.0001). The proportion of applicants completing an additional research year showed a borderline increase, rising from 22% to 34% over the same period (slope = 0.018 per year, p = 0.056). The number of research experiences remained relatively stable with no significant change over time (p = 0.18). Table 5 Mean metrics for Step 2CK score, Total Publications, Abstracts/ Posters/ Presentations, Research Experiences, and Research Year from 2018–2025. Temporal trends show the “arms race” effect over 8 years. Year Step2CK Score Total Publications Abstracts, Posters & Presentations Research Experiences Research Year 2018 254.27 4.42 9.08 6.17 22% 2019 254.23 6.31 8.42 6.39 22% 2020 255.49 5.65 8.31 6.37 22% 2021 253.82 8 9.61 6.64 27% 2022 255.43 7.19 9.47 6.6 21% 2023 254.71 8.17 10.27 7.13 25% 2024 256.35 6.25 9.86 6.6 33% 2025 261.05 7.95 10.71 6.94 34% Table 6 Linear regression analysis of applicant metrics over time. Each metric was regressed on the survey year to evaluate temporal trends among neurosurgery residency applicant. Variable Slope (Estimate) Std. Error P-value R-squared Step 2 CK 0.7202 0.2219 0.0013 0.0231 Total Publications 0.3359 0.09 0.0002 0.0296 Abstracts/Posters 0.3124 0.0764 < 0.0001 0.0353 Research Experiences 0.1017 0.0751 0.18 0.004 Research Year 0.0181 0.0094 0.056 0.0079 Discussion This study provides a detailed analysis of how research output with a focus on authorship order, total productivity, and the completion of a research year relates to interview and match success for neurosurgery applicants in the 2025 Texas STAR cohort. To our knowledge, this is the first neurosurgical match study to differentiate the effects of first-author versus total publications and to quantify the independent contribution of a research year after adjustment for other academic and strategic variables. These findings offer important empirical guidance for applicants navigating a rapidly evolving match environment. Our results demonstrate that first-author publications are strong, independent predictors of both interview offers and match success, even after controlling for Step 2 CK scores and relationship-based advantages, such as signals, geographic ties, or away rotations. In contrast, total publication count showed a minor negative association with matching, which is a counterintuitive but consistent finding in multivariable models. Additionally, submitted manuscripts and the number of abstracts/presentations were not significantly predictive. These patterns suggest that authorship role and contribution depth may matter more than publication volume alone. This aligns with recent work by Banko et al. and Wadhwa et al., which highlighted the importance of meaningful, lead-author contributions over inflated CVs when predicting resident academic productivity or match outcomes in neurosurgery. 6,9,16,18 The negative association between total publications and match probability, when controlling for first-authorship, may reflect two phenomena. First, a high volume of non-first-author publications may diminish perceived impact, suggesting limited ownership. Second, a mismatch between publication volume and authorship ratio may raise concerns about authenticity or superficial involvement, raising concerns of resume inflation. 23 Programs may interpret excessive middle-author publications without leadership as "CV filler," particularly in an applicant pool where productivity is near-saturated, and prefer applicants with fewer, but more impactful, projects that demonstrate genuine engagement 6 , 10 Similarly, the lack of predictive value from abstracts, posters, and presentations supports the notion that early-stage or lower-impact research outputs are unlikely to influence selection decisions. While presentations can reflect academic curiosity, they may not signal the rigor, persistence, and writing ability that first-author publications convey. These findings suggest a hierarchy of research impact in the neurosurgery match, with peer-reviewed, first-author work at the apex. Interestingly, there was a negative association between the number of research experiences and match/interview outcomes, countering the belief that more experiences improve an applicant's competitiveness. One possible explanation is applicants with a high number of short, disconnected research projects may appear unfocused or overly transactional. Unlike structured research years, which often produce higher-level work, scattered experiences may not yield meaningful products, strong letters, or deep faculty relationships. Moreover, these experiences may come at the expense of clinical performance or extracurriculars that programs also value. Alternatively, this variable may indicate applicants who cycle through many labs in search of a productive outcome. Prior literature similarly suggests that “checklist-style” research engagement lacks predictive validity when not tied to tangible products or sustained mentorship. 10 Dedicated research year completion was among the strongest predictors of interview and match success, with odds ratios exceeding 10 across all models. The strength and consistency of this association suggests research years serve not just as time for publication generation, but also as indicators of applicant maturity, commitment to neurosurgery, and access to high-quality mentorship. 17 Research years also create opportunities to cultivate faculty advocacy, build longitudinal projects, and strengthen letters of recommendation. 17 These are factors not directly captured in the Texas STAR dataset but known to influence match success. 18 Moreover, once research year status was included in our models, neither first-author nor total publication count retained significance, suggesting a research year may mediate these relationships. This supports the environment and mentorship structure of a research year being at least as important as quantity of publications. 19 Stratified modeling revealed threshold: applicants with seven or more total publications had significantly increased odds of interviews and matching, while those with fewer than six publications showed variable or nonsignificant effects. This mirrors findings from Wadhwa et al., who noted neurosurgery applicants increasingly meet publication expectations through year-long productivity surges, often exceeding 5–10 publications per year. 6 Our results refine this observation by showing such a threshold must be met in combination with first-authorship and/or structured research, rather than solely through quantity. Importantly, first-author publications showed a more consistent and linear relationship with outcomes than total publication count. Each additional first-author paper increased match odds by 38% in 2025, whereas total publication count predicted success only when pooled across years. This highlights the growing premium placed on first-authorship particularly in the wake of Step 1 transitioning to pass/fail, redirecting evaluation criteria toward research and Step 2 CK scores. 28 Longitudinal analysis of Texas STAR data from 2018 to 2025 revealed increasing competitiveness in the neurosurgery match. Over this time interval, Step 2 CK scores rose from 254.3 to 261.1, mean total publications increased from 4.42 to 7.95, and research year participation jumped from 22% to 34% in applicants. These trends confirm the growing intensity of the neurosurgery applicant pool and underscore the necessity of strategic research planning. Yet as applicant metrics escalate, returns diminish, fueling anxiety and a perceived "research arms race”. 30 Our findings nuance this narrative: strategic, lead-author research conducted over a structured year is more effective than accumulating bulk publications or pursuing shallow breadth. 15 These insights carry meaningful implications for applicants and advisors. While publication count remains a visible metric, applicants should prioritize depth over breadth, lead authorship over passive participation, and sustained mentorship over opportunistic involvement. Students considering a research year should aim to use that time not only to increase productivity, but to develop sustained, high-impact work that can differentiate them from their peers. Limitations Our study has several limitations. First, data were self-reported via the Texas STAR survey and subject to recall and reporting biases. Second, the authorship sub-cohort included only 58 (1/3 of all) U.S. MD applicants from 2025, limiting generalizability. Third, the dataset excluded DO and international medical graduates, restricting findings to U.S. MD seniors. We could not assess publication quality (e.g., journal impact factors or citation count), research type (e.g., basic science versus clinical), or verity individual author contributions. Other key factors, such as sub-internship performance evaluations and letter strength, were unavailable. Lastly, as Texas STAR participation is voluntary, there is potential for selection bias favoring more competitive or research-active applicants. Wadhwa et al. similarly noted that databases like the NRMP’s ChOM may overestimate research engagement when compared to verified peer-reviewed outputs. 6 Conclusion In the evolving landscape of neurosurgery residency applications, metrics reflecting depth of academic engagement, such as first-author publications and authorship proportion, are more predictive of match success than total publication volume. Structured research years enhance applicant competitiveness by fostering meaningful academic development rather than superficial output. Our findings suggest a shift toward valuing meaningful authorship, academic ownership, and structured engagement over raw publication count. First-authorship and research year completion emerge as reliable indicators of applicant merit than research experience breadth alone. As the field adapts to Step 1 reforms and a growing applicant pool, these metrics offer transparent and equitable benchmarks for selection. 29 Future research should leverage these findings to develop standardized match criteria that promote both academic rigor and equity, as well as examine their correlation with success during residency and beyond. Declarations Conflict of Interest The authors have no conflict of interest Financial Disclosure The authors have no financial disclosures. No funding. Consent to Participate: This manuscript does not involve human subjects. Consent to participate is not required. Human Ethics and Consent to Participate declarations: not applicable Clinical Trial: Clinical trial number: not applicable. References Jaikumar V, Raju B, Jumah F, et al. 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R., Mullin, J. P., Courville, E., Quiceno, E., Roy, J., Moisi, M., Delashaw, J., Hall, D. E., Chambless, L. B., Piccirillo, S. G. M., & Kogan, M. (2025). Arms Race Control Score Standardizes Residency Applicant Publication Assessment. Neurosurgery, 97(1), 250–258. https://doi.org/10.1227/neu.0000000000003372 Cole, K. L., Carter, A., Rawson, C., Tenhoeve, S., Orton, C., Zeinali, M., & Karsy, M. (2025). The impact of NIH funding and program reputation score on research output and residency matches in neurosurgery: A bibliometrics analysis. Journal of the National Medical Association, 117(2), 115–122. https://doi.org /10.1016/j.jnma.2025.03.002 Gupta, R., Chen, J., Roth, S. G., Kamal, N., Reisen, B., Ortiz, A., Feldman, M., Mummareddy, N., Jo, J., & Chambless, L. B. (2024a). 819 Pre-residency Research Output Amongst U.S. Neurological Surgery Residents. Neurosurgery, 70(Supplement_1), 171. https://doi.org/10.1227/neu.0000000000002809_819 Gupta, R., Chen, J., Roth, S., Kamal, N., Reisen, B., Ortiz, A., Feldman, M., Mummareddy, N., Jo, J., & Chambless, L. (2024b). Preresidency research output among US neurological surgery residents. Journal of Neurosurgery, 141(1), 63–71. https://doi.org/10.3171/2023.12.JNS231029 Hahamyan, H. A., Vasireddi, N., Burns, B., Bousquet, S. A., Gould, H. P., Hahamyan, H. A., Vasireddi, N., Jr, B. B., Bousquet, S., & Gould, H. P. (2024). Increasing Trends in Matriculant Publications in the Residency Match: A Scoping Review. Cureus, 16(10). https://doi.org/10.7759/cureus.72569 Hasley, H. L., O’Malley, G. R., Bala, S., Weisman, H. E., & Roth, P. A. (2023). Realistic Assessment of Research Publications by Neurosurgery Residency Applicants. World Neurosurgery, 172, e372–e377. https://doi.org/10.1016/j.wneu.2023.01.030 Hulou, M. M., Samaan, C. A., McLouth, C. J., Madriñán-Navia, H. J., Benner, D., Park, M. T., Essibayi, M. A., Howshar, J. T., Dornbos, D., Graffeo, C. S., & Lawton, M. T. (2023). Competitive neurosurgery residency programs: Predictors of matching outcome and research productivity. Clinical Neurology and Neurosurgery, 232, 107884. https://doi.org/10.1016/j.clineuro.2023.107884 Jaikumar, V., Raju, B., Jumah, F., Nanda, A., Sreenivasan, S. A., Roychowdhury, S., & Gupta, G. (2023). 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. World Neurosurgery, 175, 130-136.e2. https://doi.org/10.1016/j.wneu.2023.04.051 Price, G., Lakomkin, N., Kamat, S., Baron, R. B., Scherschinski, L., & Hadjipanayis, C. (2021). Medical Student Publications in Neurosurgery: At Which U.S. Academic Institutions Do Medical Students Publish Most? World Neurosurgery, 147, 181-189.e1. https://doi.org/10.1016/j.wneu.2020.12.045 Sheppard, J. P., Lagman, C., Nguyen, T., Yokoi, H., Jeong, S. H., Luong, P., Chen, C. H. J., Ong, V., French, A., Franks, A. M., Kwan, I., Mekonnen, M., Ng, E., Evans, A., Preet, K., Udawatta, M., & Yang, I. (2021). Analysis of academic publishing output among 1634 successful applicants in the 2011–2018 neurosurgery residency match. Journal of the Neurological Sciences, 420. https://doi.org/10.1016 /j.jns.2020.117186 Wang, A. F., Wetzel, E. A., West, T. R., Muzyka, L., Runde, A. C., Nasser, A. M., Batsaikhan, U., Shankar, G. M., Choi, B. D., & Nahed, B. V. (2025). Quantity versus quality: Analysis of research publications in the 2023 neurosurgery match. Journal of Neurosurgery, 142(6), 1818–1825. https://doi.org/10.3171/2024.10.JNS242070 Yaeger, K. A., Schupper, A. J., Gilligan, J. T., & Germano, I. M. (2021). Making a match: Trends in the application, interview, and ranking process for the neurological surgery residency programs. Journal of Neurosurgery, 135(6), 1882–1888. https://doi.org/10.3171/2020.11.JNS203637 Yu, N., Hoch, J. S., Martin, A. R., & Shahlaie, K. (2023). Trends in successfully matched neurosurgery residency applicants. Journal of Neurosurgery, 139(5), 1456–1462. https://doi.org/10.3171/2023.3.JNS222397 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7901202","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":550838391,"identity":"ae9a4161-dade-4591-9337-24fc6230eccc","order_by":0,"name":"Razan R. 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When isolated against other variables, firth logistic regression was used with total publication count and first-author publication count as continuous predictors for 2025 and all survey years.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7901202/v1/db96271d2d90fedc3b33925c.png"},{"id":96926408,"identity":"4b73d1a0-43ea-4da6-985e-b8c4ab707530","added_by":"auto","created_at":"2025-11-27 14:25:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14126,"visible":true,"origin":"","legend":"\u003cp\u003eStandardized trends in applicant metrics across survey years from 2018 to 2025. All variables were Z-score normalized to allow comparison on a standard scale. Metrics include the mean Step 2 CK score, the number of peer-reviewed publications, the number of abstracts, posters, and presentations, the number of research experiences, and the proportion of applicants who complete an additional research year.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7901202/v1/41cfd33e11b142e9867f4517.png"},{"id":99796270,"identity":"f9680fb7-223a-4890-b65d-ce8b1dd7607e","added_by":"auto","created_at":"2026-01-08 13:40:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1295707,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7901202/v1/66929101-8a0c-4c40-ac01-2f7440b17c7e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Redefining Research Productivity in Neurosurgery Residency Applications Through the Predictive Value of Authorship Order and Research Year Engagement","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeurosurgery is among the most competitive specialties in the United States, with match rates for U.S. MD seniors consistently lower than the national average for all specialties.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In recent years, the landscape of residency selection has shifted dramatically, driven by the transition of the USMLE Step 1 to pass/fail scoring and concerns about the subjectivity and increasing vagueness of clinical evaluations, which may not reliably differentiate candidates.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e As a result, research productivity has emerged as a key differentiator among applicants, with program directors placing elevated emphasis on research output to evaluate candidates.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTotal publication count has traditionally served as the primary metric of research productivity. Recent literature has suggested that applicants with more publications are generally more likely to match.⁴\u003csup\u003e,\u003c/sup\u003e⁵ However, this emphasis on volume has contributed to a \u0026ldquo;research arms race\u0026rdquo;, where applicants prioritize quantity at the expense of meaningful scientific engagement or mentorship.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e This approach has been scrutinized, as total publication count may overestimate research involvement by rewarding superficial or peripheral contributions, and may even bring about misconduct or misrepresentation in neurosurgery residency applications.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDespite its widespread use, there is limited evidence that total publication count reliably predicts match success. Recent studies and program director surveys suggest authorship position, particularly first-author status, may better represent an applicant\u0026rsquo;s leadership, initiative, and ownership of research projects.⁷ Existing literature has not clearly distinguished between superficial involvement and substantive contribution, leaving applicants and advisors uncertain about which aspects of research are valued most valued. Additionally, an increasing number of applicants are pursuing structured research years to strengthen their academic portfolios. While intended to promote scientific development, few studies have assessed whether these years result in meaningful authorship or simply inflate publication numbers.\u003c/p\u003e\u003cp\u003eThis study addresses these critical gaps by leveraging multi-year data from the Texas STAR (Seeking Transparency in Applications to Residency) database to evaluate whether first-author publication count and engagement in an academic research year are better predictors of neurosurgery match success than total publication volume alone. We examined how the predictive value of these metrics has changed longitudinally after USMLE Step 1 pass/fail scoring and signaling. We aim to provide data-driven guidance for applicants, advisors, and program directors for evaluating research productivity in a shifting landscape where traditional metrics are being reconsidered. Rather than a pre\u0026ndash;post comparison of Step 1 policy, this study provides a current-era evaluation of how first-author publications, total publication volume, and completion of a research year relate to interview and match outcomes with descriptive longitudinal context.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eCohort\u003c/h2\u003e\u003cp\u003eThis study used deidentified, self-reported data from the Texas Seeking Transparency in Application to Residency (STAR) survey for the 2025 neurosurgery match. Respondents are instructed to provide information exactly as it appears on their Electronic Residency Application Service (ERAS) applications. The 2025 cycle included over 150 participating institutions with an estimated 34% response rate, consistent with prior years. We identified 58 neurosurgery applicants who met the inclusion criteria. MD/PhD students, osteopathic medical students, and international medical graduates were excluded to preserve a homogeneous applicant cohort of U.S. allopathic seniors. An additional 255 neurosurgery applicants from 2022\u0026ndash;2025 were included without first-authorship data. For each applicant, we extracted matched program and submitted program applications, yielding approximately 600 applications for the 2025 analysis and 2,674 applications for the 2022\u0026ndash;2025 analysis.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eApplicants reported academic metrics, including the number of peer-reviewed publications, first-author publications, abstracts/ posters/presentations, research experiences, and whether they completed a dedicated research year. USMLE Step 2 CK scores were reported in 5-point intervals and converted to midpoint values for analysis (e.g., 240\u0026ndash;244 coded as 242). Match outcome was a binary variable (matched vs. unmatched), while interview offer status was included as a secondary outcome at the individual application level. Relationship variables (e.g., geographic connection and preference signaling) were reported, and a composite relation score (0\u0026ndash;4) was the summation of these variables.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAnalyses were conducted using R (version 4.5.0, 2025) and Python (version 3.10). Continuous variables were assessed for normality (Shapiro-Wilk test) and compared using independent t-tests or Wilcoxon rank-sum tests. Categorical variables were compared using Chi-squared tests. Multivariable logistic regression models evaluated associations between first-author publications, total publications, Step 2 CK score, and research experiences with odds of interviewing and matching. Additional models examined whether completing a research year was associated with increased first-author output and improved match likelihood, with interaction terms assessing mediation effects. Firth\u0026rsquo;s penalized likelihood logistic regression was used for sparse data or multicollinearity. Significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eResearch Output and Match Success\u003c/h2\u003e\u003cp\u003eIn the 2025 Texas STAR neurosurgery cohort (n\u0026thinsp;=\u0026thinsp;58), matched applicants had significantly more first-author publications than unmatched peers (mean 3.91 vs. 2.54, p\u0026thinsp;=\u0026thinsp;0.019) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Total publications (7.88 vs. 5.99, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), submitted publications (5.82 vs. 4.44, p\u0026thinsp;=\u0026thinsp;0.007), and number of abstracts/posters/presentations (10.33 vs. 8.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were also significantly higher in matched applicants. However, the number of research experiences did not significantly differ between groups (6.90 vs. 6.54, p\u0026thinsp;=\u0026thinsp;0.16).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean comparison of individual research metrics for Texas STAR 2025 (n\u0026thinsp;=\u0026thinsp;58) participants, stratified by match success and interview offer.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eMatched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMEAN Value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMatched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnmatched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFirst-Author Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSubmitted Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAbstracts, Posters \u0026amp; Presentations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eResearch Experiences\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFirst-Author/Total Author Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e\u003cb\u003eInterview Offer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMEAN Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eInterview\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eNo Interview\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFirst-Author Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSubmitted Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAbstracts, Posters \u0026amp; Presentations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eResearch Experiences\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFirst-Author/Total Author Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInterview recipients similarly had higher means for all publication-related metrics compared to those who did not receive interviews, including first-author publications (3.21 vs. 2.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), total publications (7.96 vs. 5.61, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), submitted publications (5.50 vs. 4.23, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and number of abstracts/posters/presentations (10.19 vs. 8.31, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The number of research experiences was nearly identical between these groups (6.55 vs. 6.57, p\u0026thinsp;=\u0026thinsp;0.89).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMultivariable Predictors of Match and Interview Outcomes\u003c/h2\u003e\u003cp\u003eIn a multivariable model adjusting for Step 2 CK and relation scores (geographic ties, away rotation, signals), first-author publications were strongly associated with match success (OR\u0026thinsp;=\u0026thinsp;2.76 per additional first-authored paper, 95%CI: 1.82\u0026ndash;4.67, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while total publication count was inversely associated with matching (OR\u0026thinsp;=\u0026thinsp;0.64 per additional paper, 95%CI: 0.46\u0026ndash;0.84, p\u0026thinsp;=\u0026thinsp;0.0029) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Other positive predictors of match success included Step 2 CK score (OR\u0026thinsp;=\u0026thinsp;1.20 per 5-point interval, 95%CI: 1.14\u0026ndash;1.40, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), relation score (OR\u0026thinsp;=\u0026thinsp;2.79 per additional relationship variable, 95%CI: 1.85\u0026ndash;4.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and completion of a research year (OR\u0026thinsp;=\u0026thinsp;22.08, 95%CI: 5.88-105.74, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Submitted publications and total number of abstracts/posters/presentations were not significant predictors of match outcome (both p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The total number of research experiences was negatively associated with matching (OR\u0026thinsp;=\u0026thinsp;0.54 per additional experience, 95%CI: 0.40\u0026ndash;0.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable logistic regression model examining the association between application research characteristics and the likelihood of matching and receiving an interview invitation to a neurosurgery residency in the 2025 (n\u0026thinsp;=\u0026thinsp;58) Texas STAR database.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003eMatched\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFirst-Author Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.82\u0026ndash;4.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.46\u0026ndash;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSubmitted Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u0026ndash;1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAbstracts, Posters \u0026amp; Presentations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85\u0026ndash;1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eResearch Experiences (per additional experience)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40\u0026ndash;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eResearch Year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.88-105.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eStep2CK Score (per 5 point increase)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.14\u0026ndash;1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eRelation Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.85\u0026ndash;4.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e\u003cb\u003eInterview Offer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eOdds Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eStandard Error\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFirst-Author Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.08\u0026ndash;2.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u0026ndash;1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSubmitted Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97\u0026ndash;1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAbstracts, Posters \u0026amp; Presentations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.03\u0026ndash;1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eResearch Experiences\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.50\u0026ndash;0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eResearch Year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.52-262.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eStep2CK Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.99\u0026ndash;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eRelation Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.53\u0026ndash;7.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA similar model examining our secondary outcome identified similar trends for predictors of receiving and interview offer (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). First-author publications (OR\u0026thinsp;=\u0026thinsp;1.59 per additional first-authored paper, 95%CI: 1.08\u0026ndash;2.52, p\u0026thinsp;=\u0026thinsp;0.021), completion of a research year (OR\u0026thinsp;=\u0026thinsp;63.29, 95%CI: 17.52-262.55, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), abstracts/posters/presentations (OR\u0026thinsp;=\u0026thinsp;1.20, 95%CI:1.03\u0026ndash;1.41,p\u0026thinsp;=\u0026thinsp;0.021), and relation score (OR\u0026thinsp;=\u0026thinsp;4.98 per additional relationship variable, 95%CI: 3.53\u0026ndash;7.33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were each significant predictors. Total publication count and submitted publications were not independently predictive of interview offers (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). As in the match model, more research experiences were associated with decreased odds of receiving an interview (OR\u0026thinsp;=\u0026thinsp;0.65 per additional experience, 95%CI: 0.50\u0026ndash;0.79, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Step 2 CK score was not significantly associated with interview offer in this model (OR\u0026thinsp;=\u0026thinsp;1.06 per 5-point interval increase, 95%CI: 0.99\u0026ndash;1.15, p\u0026thinsp;=\u0026thinsp;0.088).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Year and Productivity\u003c/h3\u003e\n\u003cp\u003eApplicants who completed a dedicated research year produced more first-author publications (mean 3.96 vs. 2.53, p\u0026thinsp;=\u0026thinsp;0.002) but did not have a significantly different number of total publications (mean 8.04 vs. 6.41, p\u0026thinsp;=\u0026thinsp;0.07). In nested logistic regression models, completion of a research year remained a significant predictor of interview offers across all specifications (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When modeling only the effect of a research year (Model 1), completion of a research year versus not was associated with a 12-fold increase in odds of receiving an interview (OR\u0026thinsp;=\u0026thinsp;12.67, 95%CI: 6.29\u0026ndash;25.46, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This association persisted after adjusting for number of first-authored papers (Model 2: OR\u0026thinsp;=\u0026thinsp;9.73, 95%CI: 4.63\u0026ndash;20.14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and total publications (Model 3: OR\u0026thinsp;=\u0026thinsp;15.01, 95%CI: 7.22\u0026ndash;31.64, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the full model (Model 4), research year completion remained significantly associated with interview offer (OR\u0026thinsp;=\u0026thinsp;10.52, 95%CI: 7.22\u0026ndash;31.64, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but neither first-author (p\u0026thinsp;=\u0026thinsp;0,07) nor total publications (p\u0026thinsp;=\u0026thinsp;0.67) retained significance.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdjusted odds ratios and 95% confidence intervals from binomial logistic regression models predicting the likelihood of receiving a neurosurgery interview offer. Model 1 included only the completion of a research year. Models 2 and 3 added first-author publications and total publications, respectively. Model 4 included all three predictors. The research year was a consistently significant predictor across all models. First-author publications were independently associated with increased odds in Model 2, but not in the full model (Model 4). Total publication count showed marginal significance in Model 3 but was not significantly associated in the full model.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel 1: Research Year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.29\u0026ndash;25.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.34\u0026times;10⁻\u0026sup1;\u0026sup3;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eModel 2: Research Year\u0026thinsp;+\u0026thinsp;First-Author\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.63\u0026ndash;20.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.07\u0026times;10⁻⁹\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFirst-Author Publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.08\u0026ndash;1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eModel 3: Research Year\u0026thinsp;+\u0026thinsp;Total Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.22\u0026ndash;31.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.68\u0026times;10⁻\u0026sup1;\u0026sup3;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.02\u0026ndash;1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eModel 4 (Full Model): Research Year\u0026thinsp;+\u0026thinsp;First-Author\u0026thinsp;+\u0026thinsp;Total Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.62\u0026ndash;24.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.89\u0026times;10⁻⁸\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFirst-Author Publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.98\u0026ndash;1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.91\u0026ndash;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eStratified Publication Count and Threshold Effects\u003c/h3\u003e\n\u003cp\u003eWhen stratified by total peer-reviewed publication count, a threshold emerged (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Applicants with \u0026ge;\u0026thinsp;7 publications had significantly increased odds of interview invite (OR\u0026thinsp;=\u0026thinsp;4.63, 95%CI: 2.74\u0026ndash;8.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and matching (OR\u0026thinsp;=\u0026thinsp;5.14, 95%CI: 2.02\u0026ndash;18.63, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Lower publication bins showed variable and generally non-significant effects, with wide confidence intervals. When isolating total publications with continuous modeling using Firth logistic regression, each additional publication was associated with increased odds of interview invite in both the whole cohort (OR\u0026thinsp;=\u0026thinsp;1.16 per paper, 95%CI: 1.13\u0026ndash;1.19, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and in the 2025-only cohort (OR\u0026thinsp;=\u0026thinsp;1.14 per paper, 95%CI: 1.09\u0026ndash;1.2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with higher odds observed for first-author publications in 2025 (OR\u0026thinsp;=\u0026thinsp;1.29 per first-authored paper, 95%CI: 1.16\u0026ndash;1.44, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdjusted odds of receiving a neurosurgery interview offer (top) and successfully matching (bottom), stratified by total peer-reviewed publication count using Firth penalized logistic regression. Applicants with 7 or more publications had significantly increased odds of both receiving an interview and matching compared to those with zero publications. Lower publication bins showed non-significant or modest effects, suggesting a threshold effect in research output required to influence interview and match outcomes meaningfully.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eInterview Offer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Publication Count Bin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2 publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.63\u0026ndash;2.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026ndash;4 publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.96\u0026ndash;3.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;6 publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.82\u0026ndash;2.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u0026thinsp;+\u0026thinsp;publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.74\u0026ndash;8.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eMatched\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal Publication Count Bin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eOdds Ratio\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eP Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2 publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.31\u0026ndash;13.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026ndash;4 publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.61\u0026ndash;6.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;6 publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.76\u0026ndash;8.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u0026thinsp;+\u0026thinsp;publications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.02\u0026ndash;18.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor match outcomes, each additional first-author publication in 2025 was significantly associated with higher odds of matching (OR\u0026thinsp;=\u0026thinsp;1.38 per first-authored paper, 95%CI: 1.21\u0026ndash;1.6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as was the total publication count across the entire cohort (OR\u0026thinsp;=\u0026thinsp;1.13 per paper, 95%CI: 1.08\u0026ndash;1.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, each additional publication was not predictive of match success in the 2025-only cohort (OR\u0026thinsp;=\u0026thinsp;1.06, 95%CI: 0.98\u0026ndash;1.15, p\u0026thinsp;=\u0026thinsp;0.14) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eTemporal Trends from 2018 to 2025\u003c/h2\u003e\u003cp\u003eLongitudinal analysis revealed a gradual increase in applicant competitiveness over time (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Step 2 CK scores rose significantly from a mean of 254.3 in 2018 to 261.1 in 2025 (slope\u0026thinsp;=\u0026thinsp;0.72 per year, p\u0026thinsp;=\u0026thinsp;0.0013). The mean number of total peer-reviewed publications also increased significantly, from 4.42 to 7.95 (slope\u0026thinsp;=\u0026thinsp;0.34 per year, p\u0026thinsp;=\u0026thinsp;0.0002), as did the number of abstracts, posters, and presentations (9.08 to 10.71; slope\u0026thinsp;=\u0026thinsp;0.31 per year, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The proportion of applicants completing an additional research year showed a borderline increase, rising from 22% to 34% over the same period (slope\u0026thinsp;=\u0026thinsp;0.018 per year, p\u0026thinsp;=\u0026thinsp;0.056). The number of research experiences remained relatively stable with no significant change over time (p\u0026thinsp;=\u0026thinsp;0.18).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean metrics for Step 2CK score, Total Publications, Abstracts/ Posters/ Presentations, Research Experiences, and Research Year from 2018\u0026ndash;2025. Temporal trends show the \u0026ldquo;arms race\u0026rdquo; effect over 8 years.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStep2CK Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal Publications\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbstracts, Posters \u0026amp; Presentations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eResearch Experiences\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eResearch Year\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e254.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e254.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e255.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e253.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e255.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e254.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e256.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e261.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLinear regression analysis of applicant metrics over time. Each metric was regressed on the survey year to evaluate temporal trends among neurosurgery residency applicant.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSlope (Estimate)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStd. Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR-squared\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStep 2 CK\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.7202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.2219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Publications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.3359\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0296\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAbstracts/Posters\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.3124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0353\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResearch Experiences\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0751\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResearch Year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0079\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a detailed analysis of how research output with a focus on authorship order, total productivity, and the completion of a research year relates to interview and match success for neurosurgery applicants in the 2025 Texas STAR cohort. To our knowledge, this is the first neurosurgical match study to differentiate the effects of first-author versus total publications and to quantify the independent contribution of a research year after adjustment for other academic and strategic variables. These findings offer important empirical guidance for applicants navigating a rapidly evolving match environment.\u003c/p\u003e\u003cp\u003eOur results demonstrate that first-author publications are strong, independent predictors of both interview offers and match success, even after controlling for Step 2 CK scores and relationship-based advantages, such as signals, geographic ties, or away rotations. In contrast, total publication count showed a minor negative association with matching, which is a counterintuitive but consistent finding in multivariable models. Additionally, submitted manuscripts and the number of abstracts/presentations were not significantly predictive. These patterns suggest that authorship role and contribution depth may matter more than publication volume alone. This aligns with recent work by Banko et al. and Wadhwa et al., which highlighted the importance of meaningful, lead-author contributions over inflated CVs when predicting resident academic productivity or match outcomes in neurosurgery. \u003csup\u003e6,9,16,18\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe negative association between total publications and match probability, when controlling for first-authorship, may reflect two phenomena. First, a high volume of non-first-author publications may diminish perceived impact, suggesting limited ownership. Second, a mismatch between publication volume and authorship ratio may raise concerns about authenticity or superficial involvement, raising concerns of resume inflation.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Programs may interpret excessive middle-author publications without leadership as \"CV filler,\" particularly in an applicant pool where productivity is near-saturated, and prefer applicants with fewer, but more impactful, projects that demonstrate genuine engagement \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSimilarly, the lack of predictive value from abstracts, posters, and presentations supports the notion that early-stage or lower-impact research outputs are unlikely to influence selection decisions. While presentations can reflect academic curiosity, they may not signal the rigor, persistence, and writing ability that first-author publications convey. These findings suggest a hierarchy of research impact in the neurosurgery match, with peer-reviewed, first-author work at the apex.\u003c/p\u003e\u003cp\u003eInterestingly, there was a negative association between the number of research experiences and match/interview outcomes, countering the belief that more experiences improve an applicant's competitiveness. One possible explanation is applicants with a high number of short, disconnected research projects may appear unfocused or overly transactional. Unlike structured research years, which often produce higher-level work, scattered experiences may not yield meaningful products, strong letters, or deep faculty relationships. Moreover, these experiences may come at the expense of clinical performance or extracurriculars that programs also value. Alternatively, this variable may indicate applicants who cycle through many labs in search of a productive outcome. Prior literature similarly suggests that \u0026ldquo;checklist-style\u0026rdquo; research engagement lacks predictive validity when not tied to tangible products or sustained mentorship.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDedicated research year completion was among the strongest predictors of interview and match success, with odds ratios exceeding 10 across all models. The strength and consistency of this association suggests research years serve not just as time for publication generation, but also as indicators of applicant maturity, commitment to neurosurgery, and access to high-quality mentorship.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Research years also create opportunities to cultivate faculty advocacy, build longitudinal projects, and strengthen letters of recommendation.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e These are factors not directly captured in the Texas STAR dataset but known to influence match success.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Moreover, once research year status was included in our models, neither first-author nor total publication count retained significance, suggesting a research year may mediate these relationships. This supports the environment and mentorship structure of a research year being at least as important as quantity of publications.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eStratified modeling revealed threshold: applicants with seven or more total publications had significantly increased odds of interviews and matching, while those with fewer than six publications showed variable or nonsignificant effects. This mirrors findings from Wadhwa et al., who noted neurosurgery applicants increasingly meet publication expectations through year-long productivity surges, often exceeding 5\u0026ndash;10 publications per year.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Our results refine this observation by showing such a threshold must be met in combination with first-authorship and/or structured research, rather than solely through quantity.\u003c/p\u003e\u003cp\u003eImportantly, first-author publications showed a more consistent and linear relationship with outcomes than total publication count. Each additional first-author paper increased match odds by 38% in 2025, whereas total publication count predicted success only when pooled across years. This highlights the growing premium placed on first-authorship particularly in the wake of Step 1 transitioning to pass/fail, redirecting evaluation criteria toward research and Step 2 CK scores.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eLongitudinal analysis of Texas STAR data from 2018 to 2025 revealed increasing competitiveness in the neurosurgery match. Over this time interval, Step 2 CK scores rose from 254.3 to 261.1, mean total publications increased from 4.42 to 7.95, and research year participation jumped from 22% to 34% in applicants. These trends confirm the growing intensity of the neurosurgery applicant pool and underscore the necessity of strategic research planning. Yet as applicant metrics escalate, returns diminish, fueling anxiety and a perceived \"research arms race\u0026rdquo;.\u003csup\u003e30\u003c/sup\u003e Our findings nuance this narrative: strategic, lead-author research conducted over a structured year is more effective than accumulating bulk publications or pursuing shallow breadth.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThese insights carry meaningful implications for applicants and advisors. While publication count remains a visible metric, applicants should prioritize depth over breadth, lead authorship over passive participation, and sustained mentorship over opportunistic involvement. Students considering a research year should aim to use that time not only to increase productivity, but to develop sustained, high-impact work that can differentiate them from their peers.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eOur study has several limitations. First, data were self-reported via the Texas STAR survey and subject to recall and reporting biases. Second, the authorship sub-cohort included only 58 (1/3 of all) U.S. MD applicants from 2025, limiting generalizability. Third, the dataset excluded DO and international medical graduates, restricting findings to U.S. MD seniors. We could not assess publication quality (e.g., journal impact factors or citation count), research type (e.g., basic science versus clinical), or verity individual author contributions. Other key factors, such as sub-internship performance evaluations and letter strength, were unavailable. Lastly, as Texas STAR participation is voluntary, there is potential for selection bias favoring more competitive or research-active applicants. Wadhwa et al. similarly noted that databases like the NRMP\u0026rsquo;s ChOM may overestimate research engagement when compared to verified peer-reviewed outputs.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the evolving landscape of neurosurgery residency applications, metrics reflecting depth of academic engagement, such as first-author publications and authorship proportion, are more predictive of match success than total publication volume. Structured research years enhance applicant competitiveness by fostering meaningful academic development rather than superficial output. Our findings suggest a shift toward valuing meaningful authorship, academic ownership, and structured engagement over raw publication count. First-authorship and research year completion emerge as reliable indicators of applicant merit than research experience breadth alone. As the field adapts to Step 1 reforms and a growing applicant pool, these metrics offer transparent and equitable benchmarks for selection.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Future research should leverage these findings to develop standardized match criteria that promote both academic rigor and equity, as well as examine their correlation with success during residency and beyond.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no financial disclosures. No funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u0026nbsp;\u003c/strong\u003eThis manuscript does not involve human subjects. Consent to participate is not required. Human Ethics and Consent to Participate declarations: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial:\u0026nbsp;\u003c/strong\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJaikumar V, Raju B, Jumah F, et al. 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. \u003cem\u003eWorld Neurosurg\u003c/em\u003e. 2023;175:130-136.e2. doi:10.1016/j.wneu.2023.04.051\u003c/li\u003e\n\u003cli\u003eNational Resident Matching Program. \u003cem\u003e2023 Program Director Survey\u003c/em\u003e. Washington, DC: NRMP; 2023. Available at: https://www.nrmp.org.\u003c/li\u003e\n\u003cli\u003eNational Resident Matching Program. 2025 Main Residency Match Results and Data Report. Washington, DC: NRMP; 2025. Available at: https://www.nrmp.org/about/news/2025/05/nrmp-releases-2025-main-residency-match-results-and-data-report-providing-in-depth-insight-into-the-largest-residency-match-in-history/.\u003c/li\u003e\n\u003cli\u003eSheppard JP, Lagman C, Nguyen T, et al. Analysis of academic publishing output among 1634 successful applicants in the 2011\u0026ndash;2018 neurosurgery residency match. \u003cem\u003eJ Neurol Sci\u003c/em\u003e. 2021;420:117186. doi:10.1016/j.jns.2020.117186\u003c/li\u003e\n\u003cli\u003eKashkoush A, Prabhu AV, Tonetti D, Agarwal N. The Neurosurgery Match: A Bibliometric Analysis of 206 First-Year Residents. \u003cem\u003eWorld Neurosurg\u003c/em\u003e. 2017;105:341-347. doi:10.1016/j.wneu.2017.05.129\u003c/li\u003e\n\u003cli\u003eHulou MM, Samaan CA, McLouth CJ, et al. Competitive neurosurgery residency programs: Predictors of matching outcome and research productivity. \u003cem\u003eClin Neurol Neurosurg\u003c/em\u003e. 2023;232:107884. doi:10.1016/j.clineuro.2023.107884\u003c/li\u003e\n\u003cli\u003eWadhwa H, Shah SS, Shan J, et al. The neurosurgery applicant\u0026rsquo;s \u0026ldquo;arms race\u0026rdquo;: analysis of medical student publication in the Neurosurgery Residency Match. \u003cem\u003eJ Neurosurg\u003c/em\u003e. 2020;133(6):1913-1921. doi:10.3171/2019.8.jns191256\u003c/li\u003e\n\u003cli\u003eAAMC. Report on the State of Research in Medical Education. Published online 2022. https://www.aamc.org\u003c/li\u003e\n\u003cli\u003eGupta R, Chen J, Roth S, et al. Preresidency research output among US neurological surgery residents. \u003cem\u003eJ Neurosurg\u003c/em\u003e. 2024;141(1):63-71. doi:10.3171/2023.12.jns231029\u003c/li\u003e\n\u003cli\u003eBanko L, Riesenburger N, Patel RV, Gilligan C, Cosgrove GR, Chiocca EA, Proctor MR, Patel AJ, Bi WL. Predictive Value of Neurosurgery Applicant Metrics on Resident Academic Productivity. Neurosurgery. 2025 Jun 1;96(6):1206-1216. doi: 10.1227/neu.0000000000003251. Epub 2024 Nov 11. PMID: 39526786.\u003c/li\u003e\n\u003cli\u003eKremer, T. R., Kremer, M. J., Kremer, K. P., \u0026amp; Mihalic, A. (2022). Publication matters: First‐author publications associated with match success in the United States residency match. \u003cem\u003eMedical Education, 56\u003c/em\u003e(5), 529\u0026ndash;537. https://doi.org/10.1111/medu.14303\u003c/li\u003e\n\u003cli\u003eHeros RC. Editorial: Misrepresentation among neurosurgery residency applicants. J Neurosurg. 2016 Jan;124(1):190-1. doi: 10.3171/2015.1.JNS142803. Epub 2015 Jul 24. PMID: 26207603.\u003c/li\u003e\n\u003cli\u003eKistka HM, Nayeri A, Wang L, Dow J, Chandrasekhar R, Chambless LB. Publication misrepresentation among neurosurgery residency applicants: an increasing problem. J Neurosurg. 2016 Jan;124(1):193-8. doi: 10.3171/2014.12.JNS141990. Epub 2015 Jul 24. PMID: 26207605.\u003c/li\u003e\n\u003cli\u003eAllen, A. J., O\u0026rsquo;Connell, D., de Araujo, O., Ullman, L. J., \u0026amp; Carolyn Quinsey, M. D. (2024). 816 Comparing Match Data for Neurological and Orthopaedic Surgery Applicants From 2016-2022: Is There a Point of Diminishing Return for Research Experiences and Publications? Neurosurgery, 70(Supplement_1), 170.https://doi.org/10.1227/neu.0000000000002809_816\u003c/li\u003e\n\u003cli\u003eBanko, L., Riesenburger, N., Patel, R. V., Gilligan, C., Cosgrove, G. R., Chiocca, E. A., Proctor, M. R., Patel, A. J., \u0026amp; Bi, W. L. (2025). Predictive Value of Neurosurgery Applicant Metrics on Resident Academic Productivity. Neurosurgery, 96(6), 1206.https://doi.org/10.1227/neu.0000000000003251\u003c/li\u003e\n\u003cli\u003eBassett, M., Dyess, G., Aljabi, Q., Thomas, A., Bolus, H., Ghalib, M., Butler, D., Shahid, A., Suggala, S., Thakur, J., \u0026amp; Menger, R. (2024). Senior Mentorship and Scholarly Success: Assessing Influences on Successful Neurosurgery Residency Applicant\u0026rsquo;s H-Index. World Neurosurgery, 190, e41\u0026ndash;e45. https://doi.org/10.1016/j.wneu.2024.06.135\u003c/li\u003e\n\u003cli\u003eBowers, C. A., Covell, M. M., Levy, E. I., Segura, A. C., Varela, S., Soliman, M. A. R., Mullin, J. P., Courville, E., Quiceno, E., Roy, J., Moisi, M., Delashaw, J., Hall, D. E., Chambless, L. B., Piccirillo, S. G. M., \u0026amp; Kogan, M. (2025). Arms Race Control Score Standardizes Residency Applicant Publication Assessment. Neurosurgery, 97(1), 250\u0026ndash;258. https://doi.org/10.1227/neu.0000000000003372\u003c/li\u003e\n\u003cli\u003eCole, K. L., Carter, A., Rawson, C., Tenhoeve, S., Orton, C., Zeinali, M., \u0026amp; Karsy, M. (2025). The impact of NIH funding and program reputation score on research output and residency matches in neurosurgery: A bibliometrics analysis. Journal of the National Medical Association, 117(2), 115\u0026ndash;122. https://doi.org /10.1016/j.jnma.2025.03.002\u003c/li\u003e\n\u003cli\u003eGupta, R., Chen, J., Roth, S. G., Kamal, N., Reisen, B., Ortiz, A., Feldman, M., Mummareddy, N., Jo, J., \u0026amp; Chambless, L. B. (2024a). 819 Pre-residency Research Output Amongst U.S. Neurological Surgery Residents. Neurosurgery, 70(Supplement_1), 171. https://doi.org/10.1227/neu.0000000000002809_819\u003c/li\u003e\n\u003cli\u003eGupta, R., Chen, J., Roth, S., Kamal, N., Reisen, B., Ortiz, A., Feldman, M., Mummareddy, N., Jo, J., \u0026amp; Chambless, L. (2024b). Preresidency research output among US neurological surgery residents. Journal of Neurosurgery, 141(1), 63\u0026ndash;71. https://doi.org/10.3171/2023.12.JNS231029\u003c/li\u003e\n\u003cli\u003eHahamyan, H. A., Vasireddi, N., Burns, B., Bousquet, S. A., Gould, H. P., Hahamyan, H. A., Vasireddi, N., Jr, B. B., Bousquet, S., \u0026amp; Gould, H. P. (2024). Increasing Trends in Matriculant Publications in the Residency Match: A Scoping Review. Cureus, 16(10). https://doi.org/10.7759/cureus.72569\u003c/li\u003e\n\u003cli\u003eHasley, H. L., O\u0026rsquo;Malley, G. R., Bala, S., Weisman, H. E., \u0026amp; Roth, P. A. (2023). Realistic Assessment of Research Publications by Neurosurgery Residency Applicants. World Neurosurgery, 172, e372\u0026ndash;e377. https://doi.org/10.1016/j.wneu.2023.01.030\u003c/li\u003e\n\u003cli\u003eHulou, M. M., Samaan, C. A., McLouth, C. J., Madri\u0026ntilde;\u0026aacute;n-Navia, H. J., Benner, D., Park, M. T., Essibayi, M. A., Howshar, J. T., Dornbos, D., Graffeo, C. S., \u0026amp; Lawton, M. T. (2023). Competitive neurosurgery residency programs: Predictors of matching outcome and research productivity. Clinical Neurology and Neurosurgery, 232, 107884. https://doi.org/10.1016/j.clineuro.2023.107884\u003c/li\u003e\n\u003cli\u003eJaikumar, V., Raju, B., Jumah, F., Nanda, A., Sreenivasan, S. A., Roychowdhury, S., \u0026amp; Gupta, G. (2023). 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. World Neurosurgery, 175, 130-136.e2. https://doi.org/10.1016/j.wneu.2023.04.051\u003c/li\u003e\n\u003cli\u003ePrice, G., Lakomkin, N., Kamat, S., Baron, R. B., Scherschinski, L., \u0026amp; Hadjipanayis, C. (2021). Medical Student Publications in Neurosurgery: At Which U.S. Academic Institutions Do Medical Students Publish Most? World Neurosurgery, 147, 181-189.e1. https://doi.org/10.1016/j.wneu.2020.12.045\u003c/li\u003e\n\u003cli\u003eSheppard, J. P., Lagman, C., Nguyen, T., Yokoi, H., Jeong, S. H., Luong, P., Chen, C. H. J., Ong, V., French, A., Franks, A. M., Kwan, I., Mekonnen, M., Ng, E., Evans, A., Preet, K., Udawatta, M., \u0026amp; Yang, I. (2021). Analysis of academic publishing output among 1634 successful applicants in the 2011\u0026ndash;2018 neurosurgery residency match. Journal of the Neurological Sciences, 420. https://doi.org/10.1016 /j.jns.2020.117186\u003c/li\u003e\n\u003cli\u003eWang, A. F., Wetzel, E. A., West, T. R., Muzyka, L., Runde, A. C., Nasser, A. M., Batsaikhan, U., Shankar, G. M., Choi, B. D., \u0026amp; Nahed, B. V. (2025). Quantity versus quality: Analysis of research publications in the 2023 neurosurgery match. Journal of Neurosurgery, 142(6), 1818\u0026ndash;1825. https://doi.org/10.3171/2024.10.JNS242070\u003c/li\u003e\n\u003cli\u003eYaeger, K. A., Schupper, A. J., Gilligan, J. T., \u0026amp; Germano, I. M. (2021). Making a match: Trends in the application, interview, and ranking process for the neurological surgery residency programs. Journal of Neurosurgery, 135(6), 1882\u0026ndash;1888. https://doi.org/10.3171/2020.11.JNS203637\u003c/li\u003e\n\u003cli\u003eYu, N., Hoch, J. S., Martin, A. R., \u0026amp; Shahlaie, K. (2023). Trends in successfully matched neurosurgery residency applicants. Journal of Neurosurgery, 139(5), 1456\u0026ndash;1462. https://doi.org/10.3171/2023.3.JNS222397\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neurosurgery Residency Match, Research Productivity, Medical Education, Residency Application, Research Year, Publications","lastPublishedDoi":"10.21203/rs.3.rs-7901202/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7901202/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eWith the recent change to pass/fail USMLE Step 1 assessment and increasing reliance on other metrics of applicant ability, neurosurgery residency programs face challenges in evaluating the academic potential of applicants. This study examines the relative contributions of first-author publications, research year completion, and total publication volume to match success.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eData were drawn from the Texas STAR (Seeking Transparency in Applications to Residency) survey between 2022 and 2025, including 2,674 U.S. MD applicants and a detailed 2025 sub-cohort (n\u0026thinsp;=\u0026thinsp;58) with authorship data. Logistic regression models, Chi-squared tests, and t-tests were used to examine associations between publication patterns and match outcomes. Covariates included Step 2 CK score (categorized), geographic connection, and away rotation participation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWhen mutually adjusted, first-author publication count was strongly predictive of match success (OR\u0026thinsp;=\u0026thinsp;2.76 per additional first-authored paper, 95% CI: 1.82\u0026ndash;4.67, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while total publication count was negatively associated with matching when controlling for authorship (OR\u0026thinsp;=\u0026thinsp;0.64, 95% CI: 0.46\u0026ndash;0.84, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Completion of a research year was associated with a significantly higher number of first-author publications (mean\u0026thinsp;=\u0026thinsp;3.96 vs. 2.53, p\u0026thinsp;=\u0026thinsp;0.0023), but not with greater total publication volume (mean\u0026thinsp;=\u0026thinsp;8.04 vs. 6.41, p\u0026thinsp;=\u0026thinsp;0.07). A greater number of research experiences was inversely associated with match success (OR\u0026thinsp;=\u0026thinsp;0.53 per experience, 95% CI: 0.38\u0026ndash;0.68, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eFirst-authored papers better predict match success than total publication count in neurosurgery residency applications. Dedicated research years appear to support meaningful productivity rather than sheer volume. These findings delineate how research experience is weighted in neurosurgery residency selection and may be helpful for medical students applying into neurosurgery.\u003c/p\u003e","manuscriptTitle":"Redefining Research Productivity in Neurosurgery Residency Applications Through the Predictive Value of Authorship Order and Research Year Engagement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-27 14:17:12","doi":"10.21203/rs.3.rs-7901202/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6462866-3bad-453a-a285-ce38aac5e2db","owner":[],"postedDate":"November 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T09:09:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-27 14:17:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7901202","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7901202","identity":"rs-7901202","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}