Letter: Addressing Barriers to Student Participation in Neurosurgical Conferences: Experiences From the Inaugural Early Career Neuroscience Virtual Research Symposium

To the Editor: The stresses of the COVID-19 pandemic and changes in standardized examinations have compounded the growing pressure for medical students to gain early experience with neurosurgery research and remain highly productive throughout training.1-3 Despite this, significant barriers to achieving high research productivity remain pervasive, particularly for international graduates and those without home programs.1,4-6 Previous conferences hosted by student interest groups at Brown and Weill Cornell have laid the groundwork for student-centered symposia, including establishing the benefits of a virtual format to facilitate student-faculty interaction.7,8 Recognizing the advantages highlighted by these single-institution efforts, we sought to extend their impact by hosting a multi-institutional, medical student-oriented neurosurgery research conference, the Early Career Neuroscience Virtual Research Symposium. SYMPOSIUM SCOPE AND GOALS The Early Career Neuroscience Virtual Research Symposium was developed to provide an equitable forum for students to present their research without geographic or financial barriers. We envisioned this as a milestone for students early on in their medical school careers to prepare for presenting scientific research at future national and international meetings. In addition to amplifying the voices of student researchers, we sought to educate participants on the value of neurosurgical research and practical methods for maintaining productivity throughout training. Encouraging national and international participation required grassroots outreach, which was aided by our large network of event registrants. We also engaged American Association of Neurological Surgeons Medical Student Chapters across the United States to participate as partners for the event. To participate in this capacity, American Association of Neurological Surgeons Student Chapters were asked to submit at least 1 abstract, assist with local marketing, and invite at least 1 resident or faculty to participate in the review process for abstract and presentation selection. Ultimately, chapters from 14 institutions contributed to these efforts. SYMPOSIUM LOGISTICS AND SCHEDULE The symposium was held on March 12, 2022, through Zoom. Morning sessions consisted of 2 keynote lectures followed by an interactive panel comprising residents from participating programs. Afternoon scientific sessions included 2 distinct formats: live, synchronous poster presentations and 3 synchronous oral presentations (Table 1). Abstract submissions were managed through Qualtrics which remained open from December 2021 through January 2022. Peer review was a 2-stage process beginning with quality assurance and preliminary scoring to identify top abstracts for synchronous presentations. This screening process was performed by members of the editorial board associated with our online peer review publication Brain and Spine Report. Selected abstracts were then reviewed and rated by 13 resident and faculty experts representing a range of subspecialties using a scoring rubric modified from Musial et al8 and Zappi et al9 (Supplemental Table 1, https://links.lww.com/NEU/D559). Top scoring abstracts were selected for live, synchronous presentations, while the remainder were selected for 3-minute recorded presentations. All live poster presentations occurred concurrently in breakout rooms through which attendees could freely navigate, while oral presentations concluding the symposium were delivered in the main room. TABLE 1. - Schedule of the Inaugural Early Career Neuroscience Virtual Research Symposium Time (All EST) Session Speaker Format Morning sessions 11:00-11:15 am Welcome and introduction Student leadership Zoom webinar 11:15 am-12:00 pm Asking the right questions: finding and realizing your research interests David J. Daniels, MD, PhD Mayo Clinic School of Medicine 12:00-12:45 pm Rigor and reproducibility: the role of the peer review process Michael L.J. Apuzzo, MD Weill Cornell College of Medicine 12:45-1:30 pm Resident research panel Afternoon sessions 1:30-2:30 pm Live Interactive Poster Sessions Zoom meeting Breakout rooms 2:30-2:40 pm Oral presentation no 1In vivo MR spectroscopy can detect the Warburg effect and blood-brain barrier disruption in patients with recurrent glioblastoma to distinguish between pseudoprogression and disease progression First-year medical student Zoom meeting Main room 2:40-2:50 pm Oral presentation no 2Trends in practice characteristics and Medicare reimbursements of rural neurosurgeons First-year medical student 2:50-3:00 pm Oral presentation no 3Elucidating the relationship between wild-type transthyretin amyloid and ligamentum flavum thickness in spinal stenosis Research-year medical student SYMPOSIUM OUTCOMES We received a total of 98 abstracts from 90 individuals affiliated with 61 institutions across 28 US states or territories and 13 countries (Supplemental Figure 1, https://links.lww.com/NEU/D560). Moreover, there were 313 individuals from 46 countries who registered to attend or participate in the symposium. This international conference seems to be larger than other previously reported student research conferences.7,8 Notably, more than 40% of submitting authors were first-year or second-year students, and the majority had never previously presented at a neurosurgical conference (Table 2). The large representation of junior medical students and first-time presenters was reflective of the symposium's mission to amplify the efforts of early-stage researchers. Abstract topics spanned the major neurosurgical subspecialties, in addition to education, global health, and socioeconomics. Thirty abstracts receiving scores ≥12 (per the scoring criteria described above) were invited for synchronous poster presentations, and the top 3 were selected for oral presentations (Table 3). TABLE 2. - Demographics and Experiences of Submitting Abstract Authors N (%) Total no. 90 (100) Geographic regions represented US Northeast 27 (30.0) US Midwest 17 (18.9) US South 22 (24.4) US West 9 (10.0) US Territories 1 (1.1) International—all 14 (15.6) International—LMIC 8 (8.9) Degree program MD 65 (72.2) DO 10 (11.1) MD/PhD 8 (8.9) MD/DO international equivalent 3 (3.3) Other 4 (4.4) Current academic level M1 11 (12.2) M2 26 (28.9) M3 20 (22.2) M4 3 (3.3) PhD or research year 21 (23.3) Other 9 (10) Prior research experiences Member of the NERVE Research Group for Disadvantaged Students a 12 (13.3) Never presented at neurosurgical research conference in past 49 (54.4) LMIC, low- and middle-income country.aNeurosurgery Virtual Education and Research Group (NERVE) is a national virtual interest group designed to facilitate mentorship and research collaboration among disadvantaged students, such as those without home neurosurgical programs. TABLE 3. - Characteristics and Outcomes of Submitted Abstracts N (%) Total no. of submitted abstracts 98 (100) Category Cerebrovascular 10 (10.2) Functional and stereotactic 5 (5.1) Neuro-oncology and skull base 15 (15.3) Neurotrauma and critical care 5 (5.1) Pediatric 13 (13.3) Spine and peripheral nerve 25 (25.5) Education and other 25 (25.5) Outcomes Accepted for oral presentation 3 (3.0) Accepted for live poster presentation 27 (27.6) Accepted for prerecorded presentation 39 (39.8) LESSONS LEARNED AND FUTURE DIRECTIONS Our experience demonstrates the success of a virtual platform in providing equitable access to presentation opportunities for student researchers domestically and internationally, particularly for those without prior presentation experience. For trainees, particularly from resource-limited regions, cost of travel, lodging, and registration represent significant barriers to their engagement in health-related conferences.10,11 While many meetings transitioned to a virtual format throughout the pandemic, a return to in-person programming may reinstitute these geographic and financial barriers. Although we appreciate the value of in-person interactions, we believe that continued virtual opportunities are also imperative to incorporating medical students in neurosurgery research in an equitable manner. Hosting symposia through a virtual platform poses numerous benefits to both medical students and residents looking to enhance their fund of knowledge and conceptualize their research interests. Such a virtual space improves access to education and research opportunities for trainees across the globe and provides a catalyst for aspiring neurosurgeons to develop multi-institutional collaborations with residents and faculty. Given that most attendees were of junior medical student status, future efforts should consider incorporating formal instruction related to research fundamentals into the program, such as study design, methods, and data analysis, as students at this stage may benefit greatly from such education.