To the Editor:We value the perspective outlined in Still's Letter to the Editor 1 regarding our recent article 2 and concur with many of the concerns raised regarding a volume-based approach to quantifying resident "academic productivity." It is for this reason that we selected the resident index by Khan et al 3 as the primary measure of resident productivity in our study. This index comprises"the h-index divided by the number of years since the author's first publication during residency" which is then multiplied by a weighted average of the resident's authorship number. While still imperfect, this index quantifies the objective academic impact of a resident's publications and places a greater emphasis on fewer high-impact works rather than a "quantity over quality" approach. Our finding of a significant positive correlation between resident academic stipend and resident index seems to support this notion as conceivably residents with access to more resources would be better equipped to produce higher-impact work.We are in agreement regarding the importance of grant-writing and other forms of academic enrichment when assessing a resident's productivity. A more holistic approach is indeed needed when quantifying the degree of a resident's impact. It will be important for future work to explore how advanced degrees, success in grant writing, entrepreneurial efforts, and other projects outside of the traditional academic publishing process contribute to a resident's education and to the neurosurgeon that they will ultimately become. Still's Letter highlights real and important concerns regarding recent trends in neurosurgical publishing and resident education. We believe that our recent article not only aligns with this perspective but also provides program directors with essential background knowledge that can be leveraged to enhance resident productivity and increase the quantity of highquality research being produced by neurosurgery residents.
