Editorial: The best and the brightest

Abstract

I n this issue, Renfrow and colleagues report positive trends in neurosurgery residency enrollment and attrition in the decade 2000-2009, particularly for women. 5 Attrition during residency is important to examine for at least two reasons. During neurosurgical training, both the resident and the training program make a substantial investment in time and resources. First, when a resident leaves a residency, it can cause significant disruption and hardship for both the trainee and the program. Second, attrition during residency is the first indicator along the long path to successful neurosurgical practice and board certification where the outcomes for men and women diverge. As the authors note, throughout undergraduate education and medical school, women and men each comprise approximately 50% of incoming classes, and they score equally well on standardized examinations. Moreover, women effectively compete for the most prestigious residency positions (see https://www.aamc. have shown that 15% is the minimum threshold for when a minority becomes a group rather than a collection of isolated individuals. In recent years there has been a greater awareness that attracting the "best and the brightest" to neurosurgery means demonstrating a welcoming attitude to the entire medical school class.6 Dedication to the inclusion of women in neurosurgery should be explicit, both in words and actions. In 2008 the American Association of Neurological Surgeons (AANS) requested the White Paper on the recruitment and retention of women in neurosurgery.1 The report by Renfrow et al. addresses one of the four major recommendations from the White Paper, to characterize the barriers to women successfully completing training, obtaining board certification, and entering practice.8 The other three recommendations were to identify and eliminate any discriminatory practices, to promote women into leadership positions, and to foster the development of female role models. During the past several years, women have begun to emerge in leadership positions in organized neurosurgery.The authors note an overall positive trend, which is a decline in the attrition of women neurosurgery residents from 2000 to 2009, 5 compared to an earlier cohort from 1990 to 1999. 4 Of the individuals who matched into a neurosurgery residency in the 1990s, 63% of the 146 women and 81% of the 1215 men eventually became board certified in neurosurgery. 4 In the 1990s, most of the difference between matching and board certification in neurosurgery occurred because of attrition during residency rather than attrition after residency completion. In the 1990s, 76% of women and 87.2% of men who matched into a neurosurgery position completed a neurosurgical residency. By contrast, in the 2000s, 83% of women and 94.7% of men who matched ended up completing a neurosurgical residency. Note that attrition for both men and women declined. The attrition of women declined from 24% in the 1990s to 17% in the 2000s, a 25% reduction. 5 A change of 25% in 1 decade is a significant leap,...