INTRODUCTION
As neurosurgery grows in complexity, research plays an increasingly crucial role in shaping and progressing the field. Neurosurgical research training is critical to career development for trainees and fosters more complex investigation pathways for clinician-scientist neurosurgeons. The Accreditation Council for Graduate Medical Education (ACGME), which oversees post-MD accreditation in the United States (U.S.), requires its residents to be “established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences.”1 Studies demonstrate that improved training, structured mentorship, and comfort with scientific methodology contribute significantly to more successful academic careers.1–3 Despite the recognized importance of research training, significant gaps persist in how neurosurgical trainees learn essential research skills. Current training approaches remain heterogeneous across institutions, with substantial variation in curriculum structure, mentorship availability, and educational resources.4,5 Many trainees enter research programs without formal instruction in foundational competencies such as study design, biostatistics, scientific writing, and grant development.6,7
The apprenticeship model, while valuable for hands-on experience and mentor-mentee relationships, cannot fully compensate for the absence of standardized instruction.8 Trainees frequently struggle with fundamental tasks including identifying research questions, conducting comprehensive literature reviews, and applying appropriate statistical methods.2,9–11 These difficulties often persist well into their research involvement, suggesting that informal learning through mentorship alone leaves critical knowledge gaps.12 The lack of systematic instruction in these areas may limit trainees’ ability to critically evaluate literature, design independent studies, and successfully compete for research funding, all of which are essential capabilities for those pursuing academic careers in neurosurgery. This evidence becomes increasingly important as research output steadily increases and as greater emphasis is being made on the quality of research conducted and papers published.13,14
Virtual research training offers a promising solution to neurosurgical research education. Online platforms allow trainees at programs with limited research infrastructure to benefit from expert instruction and collaborative learning opportunities.15,16 This democratization is particularly important in neurosurgery, where programs have variable access to research-active faculty and comprehensive curricula, with approximately 30% of U.S. medical schools lacking home neurosurgery programs and only 58.4% of U.S. neurosurgery programs report having a formal evidence-based medicine curriculum.1,17–19 Asynchronous modules allow flexible engagement, while synchronous sessions enable real-time mentorship and peer collaboration across geographic distances.20,21
This study evaluated research training among neurosurgical trainees and identified critical areas for curriculum development through three related aims. Specifically, we characterized trainees’ research backgrounds, identified persistent challenges and skill gaps at various stages, and gathered their recommendations on effective teaching formats, essential resources, and appropriate study designs for novice researchers.
METHODS
An online survey was provided to current and graduated research fellows at 5 attending providers’ neurosurgery trainee research programs spanning multiple institutions including the University of Michigan, University of Utah, Johns Hopkins School of Medicine, University of Florida, and University of New Mexico. Each included provider demonstrated known collaboration with trainees on research publications, as evident by publication record, regular research meetings, structured research curricula, and an average H-index of 39.2. Survey results were obtained from September 2025 to November 2025. Multiple-choice, Likert-based, and free-text style survey questions were generated by attending providers and informed by a review of relevant literature.
All surveys were completed anonymously by participants using Google Forms (Google LLC, Mountain View, CA, USA) and studied in aggregate. Survey results were aggregated into descriptive statistics with means and standard deviations for continuous variables and frequencies for discrete variables. Word clouds were generated online using Free Word Cloud Generator (FreeWordCloudGenerator.com). Institutional Review Board approval was not necessary for non-clinical, quality improvement surveys. Similarly, informed consent was not required.
RESULTS
Respondent Demographics
Forty-five individuals completed the survey. Medical students (62.2%), basic researchers (17.8%), residents (11.1%), and attending physicians (11.1%) completed the survey. Research experience varied widely, with an average of 3.62 years of experience at the time of the survey (SD 1.79; range 1-10). Most participants reported working within medical schools affiliated with academic hospitals (75.6%), while others reported being affiliated with community hospitals, research centers, medical schools without academic hospitals, or emerging academic partnerships without established neurosurgery residency programs (Table 1).
Research Training Background
Respondents reported diverse levels of formal research preparation (Table 2). Roughly half (53.3%) had received formal training in research methodology through coursework. Most commonly, participants began engaging in research during college or medical school. Research involvement varied, with many reporting participation in one research group. Remote research opportunities were widely utilized, with most respondents (82.2%) indicating participation in virtual collaboration of data analysis activities via video conferencing. Some components of in-person research were also common (86.7%), with the majority reporting experience in wet-lab, dry-lab, or clinical data environments, suggesting that hybrid participation models were predominant among the sample.
Skills and Challenges
Respondents identified several skills as particularly challenging during their initial involvement (Table 3): writing and publishing manuscripts (77.8%), designing research studies (73.3%), conducting biomedical analyses (71.1%), identifying meaningful research questions (64.4%), and performing literature reviews (64.4%). Over time, some of these skills improved while certain challenges persisted. The most common ongoing difficulties included biostatistics (64.4%) and grant writing (62.2%), followed by challenges related to identifying collaborators (33.3%) and designing projects (24.4%).
Curriculum Recommendations
Several recommendations for strengthening research training for novice neurosurgical researchers were offered. The most frequently recommended software was for statistics and reference management (Figure 1A). Respondents expressed strong interest in training curricula that combined practical, mentorship-based learning with structured teaching formats (Figure 1B). The mentorship model/apprenticeship model emerged as the most frequently endorsed format, followed by small-group workshops, structured datasets for hands-on analysis, lecture-based instruction, and self-paced online modules (Figure 1C). Regarding study designs, respondents recommended beginning with retrospective chart reviews and case series / case reports because they offer approachable starting points for developing foundational research skills (Figure 1D).
DISCUSSION
In this multi-institutional survey of neurosurgical research trainees, respondents reported heterogeneous prior research preparation and variable access to formal research training, despite active engagement in research across hybrid, virtual, and in-person settings. Improvement in research skills could be seen in areas of designing research studies and writing, while other skills such as grantsmanship and biostatistics remained challenging. Needs for continued mentorship as well as opportunities and guidance on scientific methodology were consistently reiterated by participants. These findings suggest that participation in research alone does not ensure adequate research skill development, and that meaningful training may require a more structured educational approach.
This study’s results have widespread implications that could potentially transform the design of research curricula moving forward. First, the self-reported difficulties in foundational research skills early on highlight the need for a structured curriculum that incorporates these essential competencies in study design, biostatistics, and dedicated training in writing and grant development. An additional critical implication of our findings of persistent difficulties in biomedical research skills despite involvement with research-active faculty is that, despite strong mentorship being critical for research success and development, it cannot solely overcome the absence of standardized instruction. Subsequently, a tiered and scalable mentorship system that incorporates collaboration and faculty supervision, along with structured teaching, would allow for an ideal research training curriculum. Our results also emphasize the potential efficacy of a hybrid curriculum that relies on virtual components for opportunities such as journal clubs, peer mentoring, and skills workshops, while augmenting this with in-person components for hands-on skills labs and faculty-led workshops. This not only allows for effective and feasible implementation of the curriculum but also facilitates standardization across multiple institutions.
A key finding of this study is that early research involvement does not consistently translate into confidence or competency in foundational research skills, including fundamental tasks such as identifying research questions, conducting literature reviews, designing studies, utilizing biostatistics, and writing scientific papers. Notably, these difficulties were often experienced by researchers with many years of training, which highlights the heterogeneous nature of neurosurgical research training and the impact of individual mentorship on research skills. This observation aligns with previous literature demonstrating that although statistical literacy and writing papers are among the most critical skills for academic writing in neurosurgery and in all surgical fields, they are skills that are often neglected in formal research instruction and training.22,23
The survey results also indicate that exposure to biomedical research very rarely begins earlier than during undergraduate studies or during medical school, with 86.4% of respondents indicating that their first participation in biomedical research began in one of these two settings. Other studies have previously shown that an earlier introduction to research is directly correlated with greater scientific literacy and academic productivity.24 Thus, introducing structured research education during these timeframes may better prepare trainees for meaningful engagement throughout their research careers. This could be implemented through summer research initiatives, pre-matriculation programs, onboarding research bootcamps, and so on.
Respondents commonly reported active engagement in multiple research groups, participating in an average of 2.05 ± 1.29 research groups. This involvement could mean multiple things. First, students may be diversifying their research experiences to gain exposure to different methodologies. Second, participation in multiple groups may provide students with broader networking opportunities and access to varied mentorship styles, which can be particularly valuable given the competitive nature of medical education and careers. These patterns may also reflect a deliberate strategy to gain exposure to different research methodologies, clinical questions, and publication opportunities. However, the moderate standard deviation (1.29) indicates variability in research engagement patterns, with some students focusing deeply on a single research group while others distribute their efforts across three or more concurrent projects.
When asked about involvement in research in virtual or in-person settings, most respondents indicated participation in both settings, highlighting an increasing role of hybrid training for research in neurosurgery. Recent medical education literature demonstrates that hybrid instructional models combining virtual didactics with hands-on practice can achieve learning outcomes comparable to or exceeding traditional formats.25–27 Such findings support the feasibility of delivering standardized research education across institutions with varying infrastructure.
Limitations of Remote Research and Hybridizing it with In-Person Settings
While virtual research collaboration has proven highly beneficial to those with limited neurosurgical research opportunities and infrastructure, it is not without its limitations, including its restriction to systematic reviews, narrative reviews, and analyses of public data.28,29 Exposure to this type of research, while highly beneficial for teaching evidence synthesis and analytical skills, falls short in its inability to properly prepare trainees for academic research careers. Indeed, many critical skills are essential for academic neurosurgery: designing institution-specific databases, coordinating prospective data collection with research coordinators and laboratory personnel, implementing sophisticated statistical methodologies on real clinical or pre-clinical datasets, and navigating institutional review board protocols, most of which require hands-on experience that cannot be adequately replicated in virtual settings alone.30 Our survey findings support this concern, as persistent difficulties in biostatistics and data collection were reported by 64.4% and 15.6% of respondents respectively, despite years of research involvement. These ongoing challenges likely reflect limited exposure to the practical aspects of data management and statistical implementation that are best learned through direct engagement with institutional datasets and research infrastructure.31,32
We propose a developmental model for formal research programs that strategically combines the accessibility of virtual research with the essential hands-on experiences required for academic career preparation. This model conceptualizes research training as a progressive pathway rather than a dichotomous choice between virtual and in-person participation.33 Trainees would ideally begin their research involvement through virtual collaborations, which provide low-barrier entry points for learning fundamental skills such as literature review, manuscript writing, and basic data analysis, while building professional networks across institutions. As trainees develop foundational competencies and demonstrate a commitment to neurosurgical research, they should transition toward hands-on experiences at regional or local academic centers where they can engage with site-specific clinical and laboratory data.34
Virtual platforms offer scalability, accessibility, and standardized instruction in foundational competencies, while in-person experiences provide irreplaceable training in the operational, technical, and interpersonal dimensions of conducting independent research.35 By establishing formal pathways that guide trainees from initial virtual engagement toward progressively sophisticated hands-on experiences, research programs can maximize both accessibility and training quality.36
Research programs should therefore consider their role not merely as isolated training opportunities, but as nodes within a broader educational ecosystem. By actively cultivating relationships with regional and institutional partners, virtual research collaborations can evolve into referral networks that strategically place trainees in environments optimized for their developmental stage and career goals.24
Current Formalized Programs and Future Directions
Formalized research training programs with structured mentorship, protected research time, and financial support significantly impacted the future of those pursuing neurosurgical careers.37 In the U.S., these programs operate at institutional and national levels, offering standardized pathways for research and mentorship.5 National initiatives like the American Association of Neurological Surgeons (AANS) Medical Student Chapters and the Neurosurgery Research and Education Foundation (NREF) Medical Student Summer Research Fellowship (MSSRF) provide collaborative platforms and funded opportunities,37 though access is limited by funding constraints. Institutional programs vary but may offer more comprehensive support, such as Weill Cornell’s pediatric neuro-oncology fellowship.38
Our findings suggest several critical directions for the future of neurosurgical research curricula. Respondents consistently reported early difficulties with foundational research competencies, indicating the need for standardized instruction that complements mentorship. Notably, our results demonstrate that even sustained involvement with research-active faculty does not fully mitigate these challenges, emphasizing that mentorship alone, while essential, is insufficient in the absence of formalized training. As such, an ideal curriculum would incorporate a mentorship framework that integrates faculty supervision, peer collaboration, and structured didactic instruction. Respondents further supported the development of a hybrid curriculum model, combining virtual components (e.g., journal clubs, peer mentoring, and skills workshops) with in-person experiences. This approach offers a feasible pathway toward curricular standardization across institutions while preserving the individualized mentorship that remains central to successful research training. Together, these strategies provide a clear roadmap for translating our findings.
Limitations
Limitations of this study include a relatively small sample size among five research-active institutions and mentors, along with the potential for selection bias among the respondents, as these participants who are actively involved in research may not accurately reflect the overall neurosurgery trainee population. Respondents also were largely from affluent research-active programs, which may underestimate training gaps in less resourced settings. Further, our cross-sectional survey relies on self-reported data, which introduces the possibility of recall bias and subjectivity.
CONCLUSION
This study highlighted clear gaps in neurosurgery research training, with many survey respondents reporting early and persistent difficulties in essential skills such as study design, biostatistics, and scientific writing. Despite the presence of mentorship, the continued challenges in these areas demonstrate that mentorship alone cannot replace the need for structured, standardized research instruction. The strong preference for hybrid learning models indicates that a flexible curriculum that can be employed across institutions is both practical and well-aligned with learner needs. Implementing such a curriculum earlier in training may improve research readiness and better prepare trainees to lead independent research efforts. Future work should focus on piloting and assessing this hybrid curriculum across a diverse trainee population to evaluate its long-term impact on research development.
ACKNOWLEDGEMENTS
None.
CONFLICT OF INTEREST
None.
DISCLOSURE OF FUNDING
None.
DATA AVAILABILITY
The data that support the findings of this study are available from the corresponding author upon reasonable request.