Pediatric Surgery Match Research Articles

Language Differences by Race on Letters of Recommendation for the Pediatric Surgery Match

This study aims to evaluate if there is any significant linguistic difference in LoR based on applicant's race/ethnicity. Retrospective review of applications to pediatric surgery fellowship at a single institution (2016-2020). Race was self-reported by applicants. LoR were analyzed via the Linguistic Inquiry and Word Count (LIWC) software program. Johns Hopkins All Children's Hospital, St. Petersburg, Florida USA. A free-standing tertiary pediatric hospital. Pediatric surgery fellowship applicants from 2016 to 2020. A total of 1086 LoR from 280 applicants (52% female) were analyzed. Racial distribution was Caucasians 62.1%, Asian 12.1%, Hispanics 7.1%, multiracial 6.4% African Americans 5%, and other/unknown 7.1%. Letter writers were largely male (84%), pediatric surgeons (63%) and professors (57%). There was no difference in LoR word count across races. LoR for female multiracial candidates contained higher use of affiliation and negative emotion terms compared to Hispanic females (p = 0.002 and 0.048, respectively), and past focus terms when compared to Caucasian and Asian female applicants (p < 0.001 and p = 0.003, respectively). Religion terms were more common in LoR for Asian females when compared to Caucasian females (p < 0.001). This study demonstrates linguistic differences in LoR for pediatric surgery training programs based on applicant race/ethnicity. While differences are present, these do not suggest overt bias based on applicants race or ethnicity.

Assessing Trends in Supply and Demand for Pediatric Surgery Training

This study assessed the supply and demand for Pediatric Surgery training in the U.S. from 2008 to 2022. We hypothesized that in the Pediatric Surgery Match: match rates would increase over time; U.S. MD Graduates would have higher match rates than non-U.S. MD Graduates; and fewer applicants would match at one of their top fellowship choices. This was a retrospective cohort study of Pediatric Surgery Match applicants (2008-2022). Cochran-Armitage tests elucidated temporal trends and chi square tests compared outcomes by applicant archetype. Accreditation Council for Graduate Medical Education (ACGME)-accredited Pediatric Surgery training programs in the United States and non-ACGME-accredited programs in Canada. A total of 1,133 applicants for Pediatric Surgery training. From 2008 to 2012, growth in the annual number of fellowship positions (34-43, 27% increase) exceeded growth in number of applicants (62-69, 11% increase) (p < 0.001). Over the study period, the applicant-to-training ratio peaked at 2.1 to 2.2 in 2017 to 2018 and decreased to 1.4 to 1.6 in 2021 to 2022. The annual match rate for U.S. MD Graduates increased from 60% to 68% (p < 0.05), but decreased from 40% to 22% (p < 0.05) for non-U.S. MD Graduates. In 2022, there was a 3.1-fold difference in match rates between U.S. MD and non-U.S. MD Graduates (68% vs 22%, p < 0.001). The percentage of applicants that matched at their first choice (25%-20%, p < 0.001), second choice (11%-4%, p < 0.001), and third choice (7%-4%, p < 0.001) fellowships decreased over the study period. The percentage of applicants that matched at their fourth choice to least desirable fellowship increased from 23% to 33% (p < 0.001). The demand for Pediatric Surgery training peaked in 2017 to 2018 and has decreased since. However, the Pediatric Surgery Match remains competitive especially for non-U.S. MD Graduates. More research is needed to understand barriers to matching into Pediatric Surgery for non-U.S. MD Graduates.

Invited Commentary on Skinner S, et al.: Canadian Pediatric Surgeon Workforce: Characterization of Training, Trends Over Time, and 10-year Model for Pediatric Surgery Need

Canada, the second largest country in the world, consists of 10 provinces and three territories. Government-subsidized health service delivery to Canadians is a provincial or territorial responsibility, with federal subsidies for national health programs or as transfer payments to the provinces. Eight of 10 provinces host children’s hospitals in urban centres which offer tertiary/quaternary child health services. Pediatric heart surgery, ECMO and solid organ (liver and heart) transplantation are regionalized services with eastern and western centres. All Canadian children’s hospitals (n=16) are affiliated with a medical school and postgraduate training programs. The North American pediatric surgery match includes 8 Canadian programs: Vancouver, Calgary, Toronto, Ottawa, Hamilton, Montreal ( 2 Baird R Kisa P Muzira A Wesonga AS Sekabira J Butterworth S MacNeily AE Duffy D Blair G Training low-middle-income (LMIC) pediatric surgeons in a high-income country (HIC) program. Pediatr Surg Int. 2022 Feb; 38: 269-276 Crossref Scopus (2) Google Scholar ), and Halifax.

10 Year Analysis of Pediatric Surgery Fellowship Match and Operative Experience: Concerning Trends?

This paper aims to evaluate the pediatric surgery training pipeline vis-à-vis the pediatric surgery match and operative experience of pediatric surgery fellows. Pediatric surgery remains a competitive surgical subspecialty. However, there is concern that operative experience for pediatric surgery fellows is changing. This paper examines the selectivity of the pediatric surgery match, along with the operative experience of pediatric surgery fellows to characterize the state of pediatric surgery training. The pediatric surgery fellowship match was analyzed from the National Resident Matching Program data from 2010 to 2019. Selectivity among fellowships was compared using analysis of variance with Dunnett test. Operative log data for pediatric fellows was analyzed using the Accreditation Council for Graduate Medical Education case logs from 2009 to 2019. Linear regression analysis was used to evaluate trends in operative volume over time. Pediatric surgery had the highest proportion of unmatched applicants (47.2% ± 5.3%) and lowest proportion of unfilled positions (1.4% ± 1.6%) when compared to other National Resident Matching Program surgical fellowships. Accreditation Council for Graduate Medical Education case log analysis revealed a statistically significant decrease in cases for graduating fellows (-5.3 cases/year, P < 0.05). Total index cases decreased (-4.7 cases/year, P < 0.01, R 2 = 0.83) such that graduates in 2019 completed 59 fewer index operations than graduates in 2009. Although pediatric surgery fellowship remains highly selective there has been a decline in the operative experience for graduating fellows. This highlights the need for evaluation of training paradigms and operative exposure in pediatric surgery to ensure the training of competent pediatric surgeons.

Objective Personality Determination: A Useful Addition to the Traditional Process of Pediatric Surgical Fellow Selection.

Selection of pediatric surgical trainees is a multifaceted process heavily influenced by in-person interviews to determine personality makeup and institutional compatibility. We present our experience in utilizing a validated personality inventory in the selection of our candidates. All applicants selected for an in-person interview for the 2020 Pediatric Surgery Match were offered the Big Five Inventory (BFI) questionnaire. An initial rank order list (ROL) was formulated employing application information and in-person interview score. A reformulated ROL was created after incorporating BFI data. Correlation of specific personality characteristics vs position on the ROL was assessed for both the initial ROL and the reformulated ROL. Thirty-four applicants were interviewed and 24 (70.6%) were ranked. Linear regression analysis identified a lower neuroticism score directly related to a higher position on the initial ROL {R = .4626, P = .023}. The reformulated ROL identified a higher conscientiousness score {R = .5331; P = .007} and a lower neuroticism score {R = -.4383; P = .032} correlated with ascending the final ROL. The self-administered BFI adds objectivity to personality determination gleamed from the standard face-to-face interview. Conscientiousness and neuroticism had a significant impact on the final ROL position. Adding objective personality data appears to provide additional aid in this difficult process.

The pediatric surgery match from the applicant perspective

BackgroundPrevious studies have examined characteristics critical to make a successful applicant in the pediatric surgery match. No previous study has focused on what applicants consider important as they interview pediatric surgery training programs. Study DesignSuccessfully matched applicants to our training program from 2018 to 2020 were identified and a 49-question survey sent electronically. In addition to a descriptive analysis of responses, comparisons between those who matched into one of their top three programs and those who matched outside of their top three programs were made. A Likert scale was used and data are reported as mean (95% confidence intervals). ResultsOne hundred and thirty individuals were surveyed. Sixty-three (48%) responded. The most important characteristics identified were total index case volume 1.94 (1.87, 2.00), interactions with faculty on the interview day 1.84 (1.74, 1.94), neonatal case volume 1.75 (1.61, 1.88) and degree of autonomy 1.63 (1.50, 1.77). Respondents also placed a high importance on the in-person interview experience 1.63 (1.49, 1.77). The least important training program characteristics were quantity of vacation time -0.24 (-0.52, 0.05), opportunity to participate in medical mission trips -0.25 (-0.54, 0.06), paid accommodation at the interview -0.29 (-0.57, 0.00), and access to a simulation laboratory -0.51 (-0.78, -0.24). ConclusionClinical volume, neonatal volume, faulty interactions and the experience on the interview day are the most important characteristics to applicants. There were few, if any, characteristics applicants felt were truly unimportant as they weighed their rank lists. Applicants also placed a high level of importance on an in-person interview Level of EvidenceLevel IV

Letters of recommendation for pediatric surgery fellowship: Analysis of linguistic differences based on gender of the applicant

Background: Gender bias in letters of recommendation (LOR) has been reported for candidate selection in academic medicine, typically with females frequently described with communal terms (e.g. helpful, kind, interpersonal) and males described more with agentic terms (e.g. assertive, intellectual, ambitious). This study examined the presence of linguistic gender differences in LOR for Pediatric Surgery Fellowship. Methods: LOR submitted to a single pediatric surgery fellowship program between 2014 and 2018 were retrospectively reviewed and analyzed using a previously validated Linguistic Inquiry and Word Count Software (LIWC) program. Descriptive statistics and bivariate analysis were employed in our analysis. Multivariable logistic regression models were built to assess independent association of LIWC variables with applicant gender, LOR writer gender, and applicant-writer gender concordance. Results: 1264 LOR from 325 applicants (51% female) were analyzed. Of the letter writers, 83% were male, 57% were professors, and 7.6% were Pediatric Surgery Fellowship Program Directors. The overall median average word count was 518 words, with no significant difference in LOR word count between applicant genders. Compared to male applicants, female applicants were described significantly more with work words (e.g. excellent, work; p = 0.04). Male LOR writers used authentic words (e.g. honest, humble; p = 0.006) and home words (e.g. family, house; p = 0.04) significantly more than female LOR writers. There were no significant differences in the use of agentic and communal words between genders. Conclusion: While there are linguistic differences in LOR for candidates in the Pediatric Surgery match based on gender, previously described overt gender bias was not seen in this study. Interestingly, female candidates were described more with work words, like excellent; a reversal of previously described gender bias in academic medicine. These findings may be due to the unique interpersonal and multidisciplinary skills required in pediatric surgery and may represent a unique form of gender bias that warrants further study.

Disrupting the Fellowship Match: COVID-19 and the Applicant Arms Race

Resident and fellow selection carried out via "the Match" has historically relied upon in-person interviews to evaluate and rank candidates. However, the COVID-19 pandemic has required fellowship matches and the upcoming Main Residency Match® to become wholly virtual. The 2020 pediatric surgery match offers a unique case study in the benefits and shortcomings of a virtual process and begins a much-needed conversation regarding opportunities for innovation in candidate selection. For many candidates, the application cycle imposes considerable costs - financial, professional, and personal - which have only escalated over time. We draw on our experience from the most recent match cycle to discuss limitations of the traditional Match® and suggest potential solutions to improve the subspecialty interview process moving forward.

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

The pediatric surgery match by the numbers: Defining the successful application

BackgroundPediatric surgery remains the most competitive general surgery subspecialty. The authors suspected significant inflation in academic metrics since the last published paper. This study aimed to identify factors associated with applicant success in the match. MethodsAfter IRB approval, all applications to a single accredited pediatric surgery fellowship program were reviewed for match years 2014–2018. Matched and unmatched applicants were compared in an unadjusted and adjusted analysis. ResultsThis training program received 414 of 425 total applications (97%). Match results were available for 388 (94%). Matched applicants were more likely to train in programs with pediatric surgery fellowships (64% vs. 28%) and to have dedicated research time (55% vs. 21%; all p < 0.01). Matched applicants had more total publications (median: 12 vs. 7, p < 0.01) and higher ABSITE scores (median: 64th vs. 59th percentile, p < 0.01). Training in multiple programs negatively impacted the chance to match (p < 0.01). The median number of publications per applicant increased over the study time period from 7 to 11 (p < 0.01). ConclusionsThe likelihood of matching into a pediatric surgery fellowship was related to the type of residency attended, dedicated research time, ABSITE scores, and number of publications. Overall, the total number of publications reported by all applicants increased. Type of StudyRetrospective Comparative Study. Level of EvidenceLevel III.

Efficacy of Videoconference Interviews in the Pediatric Surgery Match

The pediatric surgery match is highly competitive with the interview process requiring significant resources. The purpose of this study was to evaluate the efficacy of videoconference interviewing (VI) as a screening tool in the pediatric surgery match process. During the 2017 interview season, applicants participated in VI prior to on-site interviews. Applicants and faculty completed 15 and 8-question surveys, respectively, regarding their experiences. Both faculty and applicants agreed VI was easily workable and allowed them to accurately represent themselves. Faculty agreed VI would change how they rank candidates and that it is a helpful screening tool. Most disagreed VI could substitute for on-site interviews. Most applicants reported the cost and time required for on-site interviews was a hardship. Overall, applicants moved an average of 5.5 ± 2.9 (median 3) positions from the pre-VI to post-VI rank list. Thirty-seven percent of applicants moved out of the top ten rank list following VI. Of the lowest 5 applicants on the post-VI rank list, only 20% matched successfully. The pediatric surgery match requires a significant investment of time and money that creates a hardship for most applicants. VI may be an effective screening tool that could potentially reduce on-site interviews and alleviate the burden on applicants and general surgery training programs.

Laparoscopic skills assessment: an additional modality for pediatric surgery fellowship selection

AimThe Pediatric Surgery fellow selection is a multi-layered process which has not included assessment of surgical dexterity. Materials and methodsData was collected prospectively as part of the 2016 Pediatric Surgery Match interview process. Applicants completed a questionnaire to document laparoscopic experience and fine motor skills activities. Actual laparoscopic skills were assessed using a simulator. Time to complete an intracorporeal knot was tabulated. An initial rank list was formulated based only on the ERAS application and interview scores. The rank list was re-formulated following the laparoscopic assessment. Un-paired T-test and regression were utilized to analyze the data. ResultsForty applicants were interviewed with 18 matched (45%). The mean knot tying time was 201.31s for matched and 202.35s for unmatched applicants. Playing a musical instrument correlated with faster knot tying (p=0.03). No correlation was identified between knot tying time and either video game experience (p=0.4) or passing the FLS exam (p=0.78). Laparoscopic skills assessment lead to significant reordering of rank list (p=0.01). ConclusionsLaparoscopic skills performance significantly impacted ranking. Playing a musical instrument correlated with faster knot tying. No correlation was identified between laparoscopic performance and passing the FLS exam or other activities traditionally believed to improve technical ability. Type of studyProspective study. Level of evidenceLevel II.

Use of computerized interview scheduling program for pediatric surgery match applicants

BackgroundPediatric surgery fellowship applicants and programs coordinate over 20 interviews per cycle. We hypothesized that replacing e-mail and phone communication with a computerized-scheduling program (CSP) could benefit both parties. MethodsWe used a CSP to schedule 2016 interviews. Time to schedule and e-mail communication per applicant was compared to 2015, when traditional scheduling was used. Additionally, 2016 interviewees were surveyed about their experience with the CSP vs. traditional means. Analysis was performed using descriptive statistics and a Student's T-test. ResultsWe found a significant decrease in mean scheduling time from 14.4 to 1.7h (p<0.001) and in e-mails exchanged from 3.4 to 1.0 (p<0.0001). Survey respondents reported 92% satisfaction with the CSP, and 87% found it easier to schedule interviews. Applicants also reported quicker finalization of interview dates (96%), improved access to interview slots (71%), and easier coordination of additional services and time off (63%). Notably, the mean longest time reported to schedule interviews using traditional methods was 7days (range 1–30). Overall, 84% supported widespread adoption of CSPs. ConclusionsUsing CSPs improved the scheduling process for the significant majority of interviewees, and our program. If widely adopted, this could greatly improve the efficiency of pediatric surgery interview scheduling. Level of evidenceN/A.

The effort and outcomes of the Pediatric Surgery match process: Are we interviewing too many?

PurposeIncreasing numbers of programs participating in the pediatric surgery match has resulted in economic and logistical issues for candidates, General Surgery residencies, and Pediatric Surgery training programs (PSTP). We sought to determine the ideal number of interviews conducted by programs based on resultant rank order lists (ROL) of matched candidates. MethodsPSTPs received 4 online surveys regarding interview practices (2011–2012, 2014), and matched candidate ROL (2008–2010, 2012, 2014). Program directors (PD) also provided estimates regarding minimum candidate interview numbers necessary for an effective match (2011–2012, 2014). Kruskal–Wallis equality-of-populations rank tests compared ROL and interview numbers conducted. Quartile regression predicted ROL based on the interview numbers. Wilcoxon signed rank-sum tests compared the interview numbers to the minimal interview number using a matched pair. p Values<0.05 were significant. ResultsSurvey response rates ranged from 85–100%. Median ROL of matched candidates (2–3.5) did not differ between programs (p=0.09) and the lowest matched ROL for any year was 10–12. Interview numbers did not affect the final candidate ROL (p=0.22). While PDs thought the minimum median interview number should be 20, the number actually conducted was significantly higher (p<0.001). ConclusionThese data suggest that PSTPs interview excessive numbers of candidates. Programs and applicants should evaluate mechanisms to reduce interviews to limit costs and effort associated with the match.

Utility of Onsite Interviews in the Pediatric Surgery Match

Purpose: The value of onsite interviews for the pediatric surgery match remains undefined despite substantial cost to applicants. This study assesses the impact of onsite interviews on the rank order lists submitted to the match by pediatric surgery residency training program directors (PDs). Methods: PDs were asked prospectively to evaluate pediatric surgery residency candidates based solely on their ERAS application and generate a “pre-interview rank list.” Interviews were then held based on the usual practice of each program. PDs then submitted de-identified pre-interview and final rank lists. The impact of the interview process upon rank list movement of candidates was assessed. Results: Of 44 programs, 16 (36%) provided data for analysis. Onsite interviews resulted in candidates moving a mean of 5.2 ± 1.2 rank positions, whereas candidates ranked in the first 5 positions moved an average of 4 ± 2 places, 81% of the initial top-ranked candidates moved out of this position, and 36% of top 10 candidates moved out of the top 10. Conclusions: Onsite interviews are high-stakes events which substantially affect the final rank order list in the pediatric surgery match. Programs should take these data into account when determining the number of interview invitations.

Pediatric surgical critical care fellowship experience and career paths: Results of a survey of program graduates

PurposeThe purpose of this study was to examine motivations, fellowship experiences, and careers of graduates of the 10 accredited pediatric surgical critical care fellowships (PSCCF). MethodsQueries to PSCCF directors yielded a list of 86 graduates (2003–2013), each of whom received a 23-question survey. ResultsOf the 86 graduates contacted, 82 (95.3%) replied. Among graduates who applied, 62 of 74 (83.8%) matched into pediatric surgery (PS) fellowships. On average, the respondents were 33 years old and PGY6 when beginning PSCCF. Half had failed initial attempts to match into PS fellowship. Of the matched respondents, 39 are pediatric surgeons and 21 PS fellows or residents awaiting fellowship. Two additional respondents did not complete fellowship. Among the pediatric surgeons, 13 identified their positions as heavily involved with critical care. The critical care boards pass rate was 94.4% (67/71). Rotations during fellowships were varied, with 74 fellows (90.2%) rotating in the pediatric intensive care unit (ICU), 71 (86.6%) in the neonatal ICU, 54 (65.9%) in the adult surgical ICU, and 36 (43.9%) on the pediatric surgical ward service. ConclusionsCompletion of a PSCCF is highly predictive of a successful PS match. Only a third of PSCCF graduates continue critical care work in a formal fashion after PS fellowship.

Ghost publications in the pediatric surgery match

IntroductionPediatric surgery fellowship is considered one of the most competitive subspecialties in medicine. With fierce competition increasing the stakes, publications and first authorship are paramount to the success rate of matching. We analyzed Electronic Residency Application Service applications for verification of authorship to determine rate of misrepresentation. MethodsAfter institutional review board approval, the bibliographies of fellowship applications from 2007–2009 were reviewed to allow time for publication. Only peer-reviewed journal articles were evaluated. A Medline search was conducted for the article, by author or by title. If the article could not be found, other authors and journal were used as search parameters. If the article was still not found, the website for the journal was searched for abstract or manuscript. Finally, an experienced medical sciences librarian was consulted for remaining unidentified articles. Differences between misrepresented and accurate applications were analyzed, including: age, gender, medical and undergraduate school parameters, advanced degrees, other fellowships, number of publications, first author publications, American Board of Surgery In-Training Examination scores, and match success. ResultsThere were 147 applications reviewed. Evidence of misrepresentation was found in 17.6% of the applicants (24/136), with 34 instances in 785 manuscripts (4.3%). Manuscripts classified as published were verified 96.7% of the time, were not found in 1.4%, and had incorrect authors or journal in less than 1% each. “In press” manuscripts were verified 88.3% of the time, 6.4% could not be found, and 4.3% had an incorrect journal listing. Number of publications (P = 0.026) and first author publications (P = 0.037) correlated with misrepresentation. None of the remaining variables was significant. ConclusionsThe pediatric surgical pool has a very low incidence of suspicious citations; however, authorship claims should be verified.

Success in the Pediatric Surgery Match: a survey of the 2010 applicant pool

Background/PurposeTraditionally, basic science research and publication record have led to a successful Pediatric Surgery Match. With changing applicant research backgrounds, we evaluated if these or other factors still apply. MethodsA SurveyMonkey questionnaire was distributed to 57 applicants with known contact information. We assessed demographic/financial data, application details and match results, research experience, publications, presence of a pediatric surgery fellowship at their home program, and applicant ranking criteria. ResultsForty-three (75%) responses were received. Twenty-five candidates matched, 12 (48%) to 1 of their first 3 choices. The median number of programs applied to was similar for matched and unmatched candidates (30), but matched candidates attended more interviews (21 vs 14.5; P = .03). Matched applicants had more publications (9.5 vs 5.1; P = .03), although research experience was similar to unmatched candidates. Research focus for matched vs total applicants included basic science (5 vs 12), clinical (4 vs 6), and both (11 vs 16). Five candidates matched without research experience. Ten (40%) applicants matched to institutions where they completed residency/research/fellowship training. Twelve (49%) applicants matched from programs without a fellowship program. ConclusionA strong publication record remains important, although clinical research is being valued more. Candidates from nonfellowship programs can be successful. This information may be useful to mentor future applicants and lays the foundation for a critical evaluation of the match process.

Analysis of the pediatric surgery match: factors predicting outcome

Applicants in the NRMP for pediatric surgery have little objective data available regarding factors predicting successful matching. We analyzed data from applicants at our institution to attempt to identify parameters correlated with three outcomes: successfully matching, or attaining either a top ten or top three ranking in our final submitted match list. After IRB approval, we reviewed ERAS documents for all applicants (n = 146) over 3 years (candidates for the 2007, 2008, and 2009 fellowship years). An interview was offered to 75% of the applicants (Table 1). We analyzed over 20 factors; including demographics, number of publications and first author publications, number of book chapters, national presentations, prior match attempts, advanced degrees, quality of recommendation letters, and ABSITE scores. Significant variables were evaluated with multiple logistic regression analysis to identify independent predictors. Variables correlated with successful outcome for each of the three endpoints are shown in Table 2. The number of peer-reviewed publications and first author publications, and AOA membership were highly correlated with a favorable outcome for all three endpoints. High ABSITE scores were significantly correlated with top ten rank. Research experience and outstanding letters of recommendation were significantly associated with a top ten ranking and overall match success. Variables associated only with overall match success included number of book chapters, graduation from a US medical school, quality of recommendation letters, and being granted an interview at our institution. Logistic regression analysis demonstrated no independent factors for overall match success; number of publications was significant for both top ten and top three ranking (P = 0.006 for each); number of first author publications (P = 0.002) and AOA membership (P = 0.03) were independent predictors for top three ranking. Applicant variables associated with success in the match included quality of letters, number and type of publications, research experience, graduation from a US medical school, and AOA membership. Factors not correlated with outcome included advanced degrees (PhD, Masters), other fellowship training, and community-based versus university-based residency training. Logistic regression analysis demonstrated no independent factors for overall match success.

Cost considerations and applicant characteristics for the Pediatric Surgery Match

Background/Purpose Formal training in pediatric surgery is highly competitive. The limited number of accredited positions has historically favored applicants with basic science experience, numerous publications, national presentations, and exposure to well-known pediatric surgeons. This review analyzes characteristics of successful applicants and cost associated with the Match. Methods A survey was e-mailed to 45 applicants after the 2003 Match. Geographic provenance, demographics, qualifications, costs, and valued program characteristics were assessed. Statistics were formulated by χ 2 and Student's t test. Results Thirty-six applicants (80%) responded. Successful characteristics for matched vs unmatched included number of publications, 11.2 vs 5.7 ( P < .01); first-author designation, 6.4 vs 3.1 ( P = .02); basic science papers, 5.7 vs 1.7 ( P < .01); national presentations, 5.8 vs 2.4 ( P = .02); and presentations at pediatric surgical meetings, 2.0 vs 0.6 ( P = .04). Ninety percent of matched applicants took time off to perform basic science research ( P < .01). Average candidate expense was $6974, which represented 14% of pretax salary. Forty-one percent of applicants noted that cost limited the number of interviews taken. Fifty percent preferred a regional interview process to limit expense. Candidates ranked case diversity, volume, and mentor's advice as the most valued program characteristics. Successful applicants matched at their fifth rank on average. Eighty-six percent of unsuccessful applicants will reapply. Conclusions Results of this study are important to those interested in the future of pediatric surgery. Successful applicants were shown to have several national presentations and multiple scientific publications, especially in basic sciences. Applicant costs are high, totaling more than $236,000 for survey respondents.