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talk with the chair/PD at your school; get to know the residents. do research. write up case reports. transfer into the md-phd program. ace step 1. make sure you're certain, as NS is the toughest specialty there is. good luck.
Do the best you can in your classes so that you can do well on Step 1. I wouldn't worry about transferring into an MD/PhD program unless something else draws you to that. You can match fine without a PhD.
How soon do you have to set up your 4th year SubI's etc.? I just got my rotation schedule and won't be on a Neurosurgery service until dead last in May/June of my 3rd year. Given that Neurosurgery is an early match, how soon do you have to decide to go into it? Has anyone decided on any of the early match specialties late in their 3rd year and still been fine?
During your second year do you have time to do some shadowing and so forth. This way you'll get some idea if this is what you want. Then, when is your surgery rotation? If that is early enough then you'll know if surgery is for you or not at least somewhat early. And finally, the real important thing to know, are you sure you are not more keen on the things that are more competitive than neurosurgery (dermatology, ENT, radiation oncology, ortho, urology, possibly radiology). Because if you might be into one of those, then it is more critical that you figure out that neurosurgery is not for you early so you can start doing the things you need to do to match well into those fields.
Mliszews....Everyone is posting excellent advice with the exception of transferring into a MD/PhD which you do not need to match. I do not have a PhD and most of my firends that matched this year did not have a PhD. My advice is make it know to your program that you are interested in NS. Go to every conference or grand rounds you can make. It's important to learn about the field. Good luck.