Background: Neurosurgical education is one of the most exciting topics in contemporary neurosurgery. Passing the final boards is a real challenge. Methods: We conducted a prospective study of 48 candidates who attended the hot-seat sessions during CCN review over three years. Detailed statistical analysis was conducted. Those who attended the Hot seats (Group 1) and those who didn’t (Group 2). The neurosurgery exam simulation was conducted using both MCQ and Oral simulated exams with clinical cases led by world expert faculty in a lecture format for the MCQ and 15-minute mock oral sessions which was video-taped scoring candidates in a standardized fashion for their performance. Results: Group 1 had a better MCQ performance (83 %) compared to group 2 (61 %). Candidates were better in data gathering, differential diagnosis and management. They were worst in simulating surgical techniques and follow-up plans. Geographical characterization showed a big range of intra and inter variability in performances. Interestingly, candidates with excellent MCQ performance had moderate hot seat performance while those with moderate MCQ performance did much better during the hot seat session. Conclusions: Our preliminary results showed that simulation of board exams is a method that will help neurosurgery residents not only pass their board exams, but also achieve the best marks.