Preresidency Fellowships in Neurosurgery: A Multi-Institutional, Cross-Sectional Survey of Utility and Outcomes.

BACKGROUND AND OBJECTIVES: Neurosurgery remains one of the most competitive residency specialties in the United States. For applicants, particularly international medical graduates (IMGs), preresidency fellowships (PRFs) have emerged to strengthen applications through research, clinical exposure, and mentorship. However, data on the effectiveness of PRFs in improving residency match outcomes remain limited. This study aims to assess the utility of neurosurgery PRFs in enhancing applicant preparedness, clinical competency, and match success. METHODS: A cross-sectional survey was distributed to current and former neurosurgery PRF participants in the United States between October 2024 and March 2025. Data collected included demographics, match outcomes, and perceptions of PRF utility. Likert scales and composite rankings were used to evaluate experiences and factors contributing to successful or unsuccessful match outcomes. RESULTS: Of 58 publicly identifiable fellows, 33 responded (57% response rate), most of whom (61%) were non-US IMGs. Among those who participated in the match (n = 30), 57% successfully matched into neurosurgery. PRFs were rated as extremely or very useful by 68% of respondents, with the most valued factors for success being PRF experience, letters of recommendation, and research productivity. Respondents who did not match cited low board scores and lack of neurosurgery mentorship as primary barriers. Most participants (88%) reported that they would recommend PRFs to future applicants. CONCLUSION: PRFs serve as valuable preparatory programs that improve match outcomes, especially for IMGs. They enhance clinical exposure, academic productivity, and access to mentorship. Further standardization and expansion of PRFs could increase accessibility and support equity in neurosurgical training pathways.