University of Toronto - Neurosurgery - Toronto

2023 R-1 Main Residency Match - first iteration
IMG Stream for IMG

Last approved on December 13, 2022

Summary of changes

Approximate Quota:


Accreditation status : Accredited

Provincial Criteria

Dr. Nir Lipsman
Division of Neurosurgery 
Sunnybrook Health Sciences Centre 
2075 Bayview Ave., Room A1 39
Toronto, Ontario, M4N 3M5
PGME at U of T
Toronto: The World at Your Doorstep

Program Contacts

Program Director
Dr. Nir Lipsman
Program Director

Ms. Sandi Amaral
Program Coordinator
(416) 603-5503

Important Information

Please be aware that most, if not all, hospitals and Universities in Ontario have mandatory COVID-19 vaccination policies in place that require, in the absence of a valid medical or human rights exemption, proof of vaccination. Acceptable vaccination must be in accordance with Health Canada. You will be required to provide documentation of COVID-19 vaccination to the appropriate institution if matched. Failure to comply and provide the appropriate documentation may result in the termination of the contract. These guidelines could change at any time in accordance with future direction from the Ministry of Health or the Universities based on information from Public Health. 

The University of Toronto has deferred the use of the CaRMS Self-Identification Questionnaire (CSIQ) responses until the 2024 R-1 Match. PGME is seeking to learn from the experience of other schools in the 2023 CaRMS match with a view to piloting this initiative in 2024 R-1 Match. 

For the 2023 R-1 Match - If you assign the CSIQ to any University of Toronto program the programs will NOT be able to view the content of your CSIQ response. There are programs which provide applicants other opportunities to self-identify as a member of an equity seeking group. Please see individual program descriptions for details.


Royal College of Physicians and Surgeons of Canada

Royal College of Physicians and Surgeons of Canada:  Applying competency-based practices to residency education

To contribute to the success of Canadian physicians and the delivery of high-quality patient care, the Royal College of Physicians and Surgeons of Canada has embarked upon an initiative to introduce competency-based medical education (CMBE)  in Canadian postgraduate specialty training and in professional practice in Canada. This initiative, called Competence by design (CBD), aims to enhance patient care by aligning medical education and lifelong learning with evolving patient needs and empowering learners to more fully engage in their education process.

CBD will use time as a framework rather than the basis for progression.  It is not anticipated that the duration of training will change for the majority of trainees.  Residency programs will be broken down into stages, and each stage will have a series of milestones based on required competencies. These milestones will create more targeted learning outcomes and involve more frequent, formative assessments within the clinical workplace to ensure residents are developing and receiving feedback on the skills they need.

The Royal College anticipates that all specialty and subspecialty programs in Canada will adopt CBD in gradual phases.  All disciplines have been divided into seven cohort groups, each of which will adopt CBD at different times.  National implementation of CBD within certain, individual programs has commenced in July 2017, with more disciplines to follow in subsequent years.

Neurosurgery has implemented these changes as of July of 2019.

All programs implementing CBD will continue to undergo the same rigorous accreditation processes as traditional programs.  All CBD programs (and traditional programs) will continue to lead to Royal College approved certification.  Certification for trainees in both CBD and traditional programs will include the completion of a Royal College examination; however, residents in CBD programs will also be assessed against program milestones throughout their training.  Within a CBD program, all milestones (documented within an electronic portfolio) and the Royal College examination must be successfully completed to achieve certification.

For more information, please contact

Return of Service

The Ministry requests all ROS agreements before June 1 of the year they were matched. All agreements should be returned to the Ministry prior to the start of residency training. It is the responsibility of the applicant to confirm eligibility with respect to THE ROS requirements of other provinces.


Information about the Ministry’s ROS programs is available at the Return of Service Program

A letter of release from existing return of service agreements must be submitted as part of the application.

General Instructions

Program application language: English

Supporting Documentation / Information

Applicants are advised to only provide the documents requested by the program. No other documents submitted will be reviewed.
Canadian citizenship
CaRMS partners with third-party organizations to verify your citizenship or permanent resident status. If your status is verified by one of these organizations, you will not need to provide citizenship documents in your application. If your citizenship status is not verified, you must provide one of the documents listed below.
Document must be notarized/certified
Submit one of the following documents to verify your Canadian citizenship:
• Canadian Birth Certificate or Act of Birth
• Certificate of Canadian Citizenship
• Confirmation of Permanent Residence in Canada
• Passport page showing Canadian Citizenship
• Canadian Permanent Resident Card (both sides of card)
• Canadian Citizenship Card (both sides of card)

Legal Status

Proof of valid current citizenship or permanent resident status must be provided by submitting one of the following verifications to CaRMS by the File Review Opening deadline. Failure to provide valid proof will result in your application being removed. No other forms of verification are acceptable:

  1. Notarized/certified photocopy of Birth Certificate/Act of Birth issued by an authority in Canada accompanied by photo ID (must be Canadian government-issued photo ID).
  2. Failure to provide proof of citizenship will result in the removal of your application. No other forms of verification are acceptable.
  3. Documents must be notarized/certified photocopies. Notarized/certified copies must be dated and not older than two years from the date of application submission deadline; otherwise, a new notarized/certified copy is required.
  4. Confirmation of permanent residence must be accompanied by a photo ID (must be a Canadian government-issued photo ID).

CaRMS is partnering with third-party organizations to automate the verification of citizenship/legal status required by postgraduate offices for entry into residency. Third-party verification simplifies the process for applicants and programs. All applicants who do not receive third-party citizenship verification will be required to upload and assign an acceptable proof of citizenship document. Please see additional information here.

Language proficiency
Submit one of the following documents to verify your language proficiency:
• Letter of language proficiency
• Occupational English Test (OET) - Medicine
• Canadian English Language Proficiency Index Program (CELPIP) - General

Language assessment document accepted: TOEFL-iBT


  • Document validity (not expired) by: Must be valid up to the assignment of applications and documents deadline
  • Minimum score: 93 with a minimum score of 24 on the speaking section

Language assessment document accepted: IELTS Academic

  • Document validity (not expired) by: Must be valid up to the assignment of applications and documents deadline
  • Minimum score: 7 in each component

Language assessment document accepted: Occupational English Test (OET) -Medicine

  • Document validity (not expired) by: Must be valid up to July 1, 2023
  • Minimum score: Minimum grade of B in each component

Language assessment document accepted: Canadian English Language Proficiency Index Program (CELPIP) – General

  • Document validity (not expired) by: Must be valid up to July 1, 2023
  • Minimum score: Minimum score of 9 in each component

Language assessment document accepted: Letter of language proficiency*

*Alternatively, candidates can submit a printout from the World Directory of Medical Schools which clearly states that the language of instruction is English or French.

The IELTS Indicator will be accepted as a substitute for the Academic Version of the IELTS.

The TOEFL iBT Home Edition will be accepted as a substitute for the TOEFL iBT.

Applicants must be able to communicate proficiently in the language of instruction and patient care of the matching school and training site. Please review specific program descriptions for more information.

Reference documents
Number requested: 3

Three letters of reference are required. If possible, one or more letters from a faculty member in Neurosurgery is helpful but not required.

We are looking for very strong reference letters, ideally based on referee's direct observation of the applicant’s performance in a clinical setting with responsibilities at least equivalent to a senior medical student, within the last 3 years. 

We will accept a reference from a senior resident but faculty references are strongly preferred.

Additional documents
Medical School Transcript 

Your medical school transcript can be submitted through one of the methods below:

  1. Obtain your medical transcript from your school and upload it directly to your CaRMS Online account. Follow your school’s policy regarding accessing or requesting your transcript;
  2. Ask your medical school to upload your medical transcript through their CaRMS Undergraduate Portal account; or
  3. International (IMGs) and United States (USMGs) medical graduates can transfer their transcript from their account.

[Note: Photograph is used as memory aid only]

Photo required for memory aid

Medical Student Performance Record 

For International (IMGs) and United States (USMGs) medical graduates, you can submit your MSPR through either of the methods below:

  1. Upload your MSPR directly into your CaRMS Online account; or
  2. Ask your medical school to upload your MSPR through their CaRMS Undergraduate Portal account.
If your MSPR is in a language other than the program language of English or French, you are required to have the document translated.

Personal Letter 
Word count
Minimum : None
Maximum : 1000

The letter is an opportunity for the candidate to describe personal characteristics and information that are not elsewhere in the application (education, research or references). Most importantly, the candidate must explain why neurosurgery is their career choice and why the University of Toronto would ideally suit their training requirements. 

Maximum word count: 1000 (no minimum)

MCCQE Part I - Statement of Results 

  • Date/milestone assessment submission required: File review opening
  • Requirement: Mandatory

For more information on the MCCQE Part 1 click on the following link

NAC examination - Statement of results 

  • Date/milestone assessment submission required: File review opening
  • Requirement: Mandatory with exceptions*

* MCCQE part II can be used to apply instead of the NAC

For more information on the NAC OSCE click on the following link National Assessment Collaboration | Medical Council of Canada

NAC examination - Supplemental Information Report 

  • Date/milestone assessment submission required: File review opening
  • Requirement: Mandatory with exceptions*

* MCCQE part II can be used to apply instead of the NAC

For more information on the NAC OSCE click on the following link National Assessment Collaboration | Medical Council of Canada

Review Process

Applications submitted after file review has opened on January 10, 2023

Supporting documents (excluding letters of reference) that arrive after file review has opened  on  January 10, 2023

Letters of reference that arrive after the unmasking date on January 10, 2023

The selection process below is carried out by the CaRMS Selection Committee, which generally consists of up to 10 members: Program Director, Division Chair, 3-4 faculty RPC representatives, 4 resident RPC representatives, plus potentially 1 ad hoc invited faculty member.



File Review Process (February):

What is assessed?

Attributes assessed and relative weighting

Applicants providing evidence of the following in the CaRMS application file will be prioritized for further consideration:

Full CaRMS application, incl. provided reference letters

· Academic achievement (33%)


· Interest in neurosurgery (33%)


· Reference letters (33%)

·  Where available, university and medical school transcripts demonstrating high academic standing

·  Where available, high scores on standardized medical examinations (e.g., NBME or MCCQE1)

·  Academic awards and scholarships based on academic achievement

·  Record of research achievement in neurosurgery

·  North American neurosurgical experience, within the last 3 years, of at least 4 weeks in total duration in a neurosurgical clinical teaching unit or equivalent with direct exposure to a neurosurgery residency program, involving actual clinical responsibilities in an in-patient setting with on-call responsibilities - We recognize that the COVID-19 pandemic has impacted candidates’ opportunities to arrange and complete electives and would like to reassure applicants that a lack of elective activity this year will not negatively impact their application to our program.

·  Very strong reference letters - see "Reference documents" for details.

Based on this assessment, at the end of the file review process, all candidates who have received sufficient endorsement from at least a majority of Committee members will be offered interviews. Interview offers will be sent mid-late February.

Interview Process (March):

What is assessed?

Attributes assessed and relative weighting

Successful applicants will be able to demonstrate the following:

Formal interviews, plus further review of full CaRMS application.

· Interview performance (35%)

· General fit with the Program (30%)

· Academic achievement (10%)

· Reference letters (25%)


· Strong general communication skills at the time of the interviews

· Strong extemporaneous thought processing skills at the time of the interviews

· Strong interpersonal skill and suitable temperament

· Good judgement, guided by principles of ethics and compassion

· Superior academic achievement as measured by grades, academic awards, or research accomplishment

· Strong letters of reference

Based on the assessment above, at the end of the interview process, a final ranking of all candidate will be made and submitted to CaRMS. The selection committee reserves the right to adjust final rankings by consensus to address issues of program priority or diversity.




  • February 24, 2023
  • February 25, 2023
February 24-25, 2023

All candidates felt to be competitive for a residency position will be invited for a two-day virtual visit on February 24-25, 2023.  

The first day (Friday, February 24th), candidates will have the opportunity to attend the virtual morning academic half day, followed by an information session with the Chair and Program Director.  Depending on the number of applicants invited for interview, some interviews may take place following the information session.

The second day (Saturday, February 25th) is interview day and interviews will be conducted virtually.  

Full details will be provided to the candidates closer to the interview date, including important information regarding virtual interviews.

Program will notify all applicants through CaRMS Online and will send email invitations directly to applicants selected for an interview.
Each candidate will have five 15-minute interviews with faculty (6) and resident (4) members of the RPC.  Interview themes can include interest in neuroscience and neurosurgery, interpersonal skills and conflict resolution, work/life balance, personal goals and research.  A preliminary rank order is generated after the interviews are complete.

Selection Criteria

Program goals

The specific goals of our Program are to produce fully trained neurosurgeons who

  • have passed the Royal College of Physicians and Surgeons Specialty Examinations in Neurosurgery
  • are ready to assume the position of a consultant neurosurgeon
  • are clinically competent with:

o   excellent technical competence

o   excellent judgment

o   a thorough knowledge of related disciplines, including basic neuroscience, clinical research methodology, neurology, neuropathology and neuroradiology

o   superior managerial, professional, communication, and health advocacy skills

  • for those with academic research interests:

o   have obtained a higher research degree, such as an M.Sc. or Ph.D., in order to develop research interest, ability and training

o   have teaching interest, ability and training

As such, our Program seeks a cohort of residents who have demonstrated superior academic standing, strong work ethic, dedicated interest in neurosurgery, strong interpersonal and communication skills, and characteristics of empathy and compassion. These are the personal attributes that are the foundation of an exemplary neurosurgeon and what we strive for in our trainees.

Selection process goals

Neurosurgery is a very demanding field and places stringent requirements on candidates’ intellect, stamina, emotional fortitude, interpersonal skills, and ability to work under pressure. Given the high attrition rate seen in neurosurgery training programs, it is essential that candidates clearly demonstrate to the Selection Committee an adequate intellectual capacity, demonstrated interest in neurosurgery, demonstration of an understanding of what Canadian neurosurgery residency entails, with proven ability to work in a Canadian neurosurgical clinical teaching unit environment. The applicant must demonstrate that they have the potential to fulfill all CanMEDS competencies required of a Canadian neurosurgeon.

File review process

Review team composition : The CaRMS Selection Committee consists of 10 members: Program Director, Division Chair, 3-4 faculty RPC representatives, 4 resident RPC representatives, and possibly an additional ad hoc invited faculty member.

Average number of applications received by our program in the last five years : 0 - 50

Average percentage of applicants offered interviews : 76 - 100 %

Evaluation criteria :
File component Criteria
CV Academic awards and scholarships based on academic achievement.
Electives We recognize that the COVID-19 pandemic has impacted candidates’ opportunities to arrange and complete electives and would like to reassure you that a lack of elective activity this year will not negatively impact your application to our program.
Examinations High scores on standardized medical examinations.
Extra-curricular Reviewed.
Leadership skills Reviewed.
MSPRs Reviewed.
Personal letters See "Additional Documents" for details.
Reference documents See "Reference Documents" for details.
Research/Publications Record of research achievement in neurosurgery.
Transcripts Demonstrating high academic standing.

Elective criteria

We recognize that the COVID-19 pandemic has impacted candidates’ opportunities to arrange and complete electives and would like to reassure you that a lack of elective activity this year will not negatively impact your application to our program.
We do not require applicants to have done onsite electives.

Interview process

Interview format :

We may accommodate requests to re-schedule interviews for applicants due to weather, technology failure, or unforeseen circumstances.

Interview evaluation criteria :
Interview components Criteria
Collaboration skills See Interview Process details above
Collegiality See Interview Process details above
Communication skills See Interview Process details above
Health advocacy See Interview Process details above
Interest in the discipline See Interview Process details above
Interest in the program See Interview Process details above
Leadership skills See Interview Process details above
Professionalism See Interview Process details above
Scholarly activities See Interview Process details above
Other interview component(s) Full details provided in Interview Process section above.

Information gathered outside of CaRMS application

Specifically, we may consider:

Ranking process

The behavior(s) exhibited below during the interview process may prevent an applicant from being ranked by our program :

Program Highlights

Didactic Curriculum

The University of Toronto, Division of Neurosurgery, runs an active virtual didactic curriculum for residents every Friday morning (Brain School). Time to attend these teaching sessions is protected, with residents relieved of clinical and on-call duties during this time, to facilitate their attendance.  Lectures are organized by topic and sub-specialty and led by faculty representatives, and overseen by an educational and curriculum director.  The curriculum consists of lectures, videos, mock oral examinations, and case presentations and is a major component of neurosurgical education delivery. Lecture presentations are stored on a webpage for neurosurgery residents and is password protected. Residents studying for their written examinations or preparing for their Royal College Examination will review these lecture notes on a regular basis.

Quick Facts

The University of Toronto, Division of Neurosurgery has opportunity for electives for its residents. Three to six month elective may be possible if scheduling permits and planned in advance. This is usually taken during the PGY-4 to 5 year level. It can be in a neurosurgical subject or a non-surgical neuroscience topic. Examples of previous electives taken by residents include Canadian private practice, academic neurosurgery in other North American or international centres, and neurosurgical outreach in low income countries.

Currently, there are 38 residents enrolled in the University of Toronto Neurosurgical Residency Training Program, 32 faculty members with 7 affiliated neurosurgery scientists.

There are no mandatory rural rotations.


Program Curriculum

This residency program is for 6 years.

Program length of training does not exceed the Royal College or College of Family Physicians of Canada standard.

PGY-1 & 2 Surgical Foundations Objectives of Training

The Division of Neurosurgery is a participant in the Core Surgical Program at the University of Toronto. The PGY-1 year consists of 4 weeks of Surgery and Neurosurgery Prep Camp Orientation, 8 blocks of adult neurosurgery (includes neurotrauma/neurocritical care), 2 blocks of pediatric neurosurgery, 2 blocks of surgical elective (selected from orthopedic-spine, vascular, cardiac, thoracic, plastics or ENT), and 1 block of emergency medicine.  The PGY-2 year consists of 2 blocks of neurocritical care, 2 blocks of Neurology, and 9 blocks of neurosurgery.

Effective July 1, 2008 all University of Toronto PGY1 residents are required to complete the web based PGCorEd core competency modules as part of their residency program certification. These modules provide the foundation for the non-Medical Expert roles for the Royal College of Physician and Surgeons of Canada Specialty Programs.

These modules will be required for completion before the end of the PGY2 year. Failure to complete the modules required by their program will delay processing of their FITERs and may constitute professional misconduct.


PGY-3 to 6

The total amount of clinical neurosurgical experience required by the University of Toronto program and the Royal College is 42 months. Included in the 42 months of clinical neurosurgery are 6 blocks on pediatric neurosurgery and 13 blocks (12 months) as a Chief neurosurgical resident. Neurosurgical residents rotate through neuropathology for 1 block during PGY5.

Residents are expected to pass the Royal College Foundation of Surgery Examination in their PGY-2 year.  PGY1 and PGY2 residents attend the Department of Surgery, Foundation of Surgery Lecture Series on Tuesday mornings. Throughout the program, residents are expected to develop skills in microsurgical techniques, spinal neurosurgery, cranial neurosurgery and peripheral nerve and brachial plexus surgery. Financial support toward attendance at academic conferences is provided, especially for residents whose work has been accepted for presentation at the meeting.

Research and Courses

The description of research training in the Division of Neurosurgery at the University of Toronto can be found directly at the following source: Research (

Seminars and Other Formal Teaching Sessions

All residents have an opportunity to attend the Lougheed Microsurgical Course, and the ATLS Course.

The weekly 3-hour didactic neurosurgical and basic science lecture curriculum (Friday morning "Brain School") is supplemented with various formal rounds, journal clubs hosted at faculty residences, seminars, and annual visiting professorships.

The University of Toronto Surgical Skills Laboratory provides opportunities for technical training in Core and Specialized Neurosurgery at the PGY-1 level (see below), including an intensive "Neurosurgery Crash Course" held during the month of July of the PGY1 year. Numerous practical anatomy and dissection courses are held throughout the academic year for all residents.


PGY1 Prep Camp

As of July 1, 2013, the Department of Surgery and University of Toronto Surgical Skill Centre located at Mount Sinai Hospital introduced a new curriculum format for technical skills training for PGY1 surgical residents.  The new curriculum focuses on a 2-week summer training session incorporating both technical skill programs and didactic sessions.  All sessions are relevant to the Royal College CANMEDS design.

The Prep Camp program includes the following:

Each day begins at 0800 hrs with a 1 hr didactic lecture followed by hands on sessions in the Surgical Lab from 0900-1400 hrs.  Between 1400-1600 hrs, this time is dedicated to independent practice and research in education opportunities within the Surgical Lab environs.  Instructors for the summer sessions include nurses, residents, faculty, industry and associate health care partners.


PGY1 Neurosurgery Crash Course

Every summer, the Division of Neurosurgery runs an intensive practical introductory course for our new PGY1s to learn about the acute management of important neurosurgical conditions.  This is taught by faculty and senior residents and prepares our new residents for the acuity of patients seen in neurosurgery.

Training Sites


There are 31 full-time neurosurgeons, and 1 part-time neurosurgeon at the University of Toronto. The Program is conducted at 4 clinical sites (Toronto Western Hospital, St. Michael’s Hospital, Sunnybrook Hospital, and SickKids Hospital), each with its own personality and profile of excellence, performing over 6000 cases per year, and with international leaders in all subspecialties. The breadth, size, and diversity of our Program allow us to tailor every resident’s training to fit their individual career goals and aspirations. Residents are exposed to the following subspecialties during their training: Epilepsy (80 adult, 80 peds cases annually); Functional (70 neuromodulation & 50 non-neuromodulation cases annually); Oncology (1000 brain & spinal tumours cases per year); Pediatrics (over 500 cases annually); Radiosurgery (200 Gamma Knife cases annually), Skull Base (over 300 cases per year); Spine (over 2000 cases annually); Trauma (Sunnybrook, St. Michael’s, and SickKids each serve as the largest Level 1 trauma centres in Ontario); Vascular and Endovascular (over 250 open vascular and 500 neuroendovascular cases annually).


This program places special emphasis on the training of neurosurgeons for academic careers. Those interested in an academic career will be encouraged to have at least a two year research experience. Opportunities are available to do research leading to the M.Sc. or Ph.D. degree in the Department of Surgery's Surgeon Scientist Program

Additional Information

Pre-residency Orientation Programs

All IMG candidates accepted to all residency programs will be required to complete either the Pre-Residency Program (PRP) or the Pre-Residency Program for Family Medicine (PRPFM) prior to entering into a residency program. Matched IMGs will be expected to attend these programs in Toronto, several weeks in advance of the start of their residency program. In some cases, this may result in a delay of the start date of the residency. Additional information on the PRP and PRP FM programs can be found at the following link: Touchstone Institute.

Assessment Verification Period

All IMG candidates accepted to residency training programs will be required to undergo an Assessment Verification Period (AVP). This assessment period is normally 12 weeks in length and is required by the College of Physicians and Surgeons of Ontario to obtain an educational license to enter a residency program. CPSO – International Medical Graduates (IMGs).

IMGs that have failed an AVP and are reapplying through CaRMS are ineligible to apply for training in the same specialty in Ontario but may apply to a different specialty in the first and/or second iteration. IMGs who have withdrawn from a program prior to completion of an AVP must declare so upon application.

Additional Ontario Information:

  1. Permanent Residents: Successful applicants who hold Permanent Resident status in Canada will be required to disclose their Country of Citizenship to the postgraduate medical education office in order to comply with current reporting requirements of the Ontario Ministry.
  2. Matched applicants: CaRMS will provide their electronic data file to the matched university’s postgraduate education office. The postgraduate office will share the information as needed, but not limited to the Ontario Physician Human Resource Data Centre, Canadian Post-MD Education Registry, the College of Physicians and Surgeons of Ontario, the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, the Association of Faculties of Medicine of Canada, the Professional Association of Residents of Ontario, teaching hospitals and other training sites, Touchstone Institute and the Ontario Ministry of Health.
  3. Changes: The Ontario Faculties of Medicine and Ontario Ministry of Health reserve the right to make changes to the information published on the CaRMS website pertaining to Ontario postgraduate training without prior notice.
  4. Failure to meet or provide proof of any of the stated requirements may result in applicant file being removed at any point during the match.

Further information may be obtained by contacting the above address, telephone (416) 603-5503. The description of the Neurosurgical Training Program at the University of Toronto for current and prospective residents in neurosurgery is available at the following source: Division of Neurosurgery (

Summary of changes

SUMMARY ID Section Summary of changes Updated on NOTIFY APPLICANTS SECTION NAME Actions