So You Want to Become a Plastic Surgeon? What You Need to Do and Know to Get into a Plastic Surgery Residency

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Sir: Plastic surgery is a highly sought-after surgical specialty that attracts some of the most accomplished candidates. The competitive landscape, endless medical school opportunities, and varied advice from colleagues and mentors make it difficult for students trying to focus their efforts on activities most likely to help them achieve a plastic and reconstructive surgery residency position. “So You Want to Become a Plastic Surgeon?” outlines key areas where medical students should focus their energies by demystifying some of the rumors surrounding the plastic surgery match process with objective data on the most relevant factors considered for residency.1 Every medical student knows the objectives: scoring well on Step 1, publishing articles, and achieving outstanding grades. Still, the article provides useful benchmarks for students as they study for Step 1 or rotate through the wards. However, as the article explains, matching in plastic and reconstructive surgery takes more than excellent test scores—letters of recommendation, subinternships, and interviews are just as important. With the statistics outlined in the article, medical students interested in plastic and reconstructive surgery can build better, more focused plans and goals for residency. Another interesting aspect of plastic surgery program placement involves international medical graduates. From an international medical graduate perspective, “So You Want to Become a Plastic Surgeon?” could be discouraging. There is no university ranking pool or Alpha Omega Alpha membership to help a program director scrutinize this type of applicant. Thus, the tendency of an international medical graduate to match into a plastic surgery program, especially an integrated one, is very rare (0.1 percent, to be precise).2 The medical field values multiculturalism and diversity along with the effort, hard work, and passion an international medical graduate brings from abroad. However, as a foreigner, “fitting the bill” of the ideal candidate seems nearly impossible. An international medical graduate applying does so as a knowingly imperfect applicant, even though he or she may possess all of the skills necessary to be an effective plastic surgery resident. Even after hard work, multiple publications, and strong letters, an interview often seems like a shot of luck—a miracle that brings you closer to that 0.1 percent matching rate. The standards required to achieve admittance into plastic surgery programs can be onerous; however, few studies have examined whether these criteria correlate with residency performance. Colleagues in orthopedic surgery searched for correlations between preresidency factors and residency performance later on.3,4 They found only a few. Grades during clinical rotations were the most consistent predictor of excellent faculty evaluations.3,4 In addition, United States Medical Licensing Examination scores and graduation from a highly ranked medical school as reported by the U.S. News & World Report were the best predictors of in-training and board examination scores during residency.3,4 This may not be surprising given that students who graduate from highly ranked medical schools are usually excellent test takers. Most of these studies were small and retrospective, and may be limited by range restriction. Thus, assessing only the top candidates matching into orthopedic surgery may have masked any correlations that might have existed between preresidency factors and residency performance. Although orthopedic surgery and plastic and reconstructive surgery are different fields, many similarities can be seen. Both are highly competitive surgical specialties that value the same applicant characteristics (e.g., United States Medical Licensing Examination Step 1 scores, letters of recommendation, and research publications) to select incoming residents. It is still unclear whether selection factors correlate with performance during residency, which is why selecting medical students for residency programs is just as much an art as it is a science. Articles such as this provide an evidence-based blueprint for students to structure their medical school experience and build their resume around to maximize their opportunities for residency. Just as important, though, as medical students, we must always remember why we chose plastic and reconstructive surgery in the first place and not get lost in the fray of publications, letters of recommendation, and Alpha Omega Alpha membership. Sadly, stiff competition has led to increasing percentages of plastic surgery applicants who claim so-called phantom publications on their application.5,6 As stressful as matching in plastic surgery might seem, a true passion for the field, hard work, and respect from your peers and superiors will undoubtedly go a long way toward achieving a position in a plastic and reconstructive surgery program. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Andre Alcon, B.A. Miles J. Pfaff, B.A. Yale University School of Medicine New Haven, Conn. Oriana Haran, M.D. Central University of Venezuela Caracas, Venezuela