Plastic Surgery Programs Research Articles

A Systematic Review of the State of Preclinical Mentorship Programs in Plastic and Reconstructive Surgery.

Plastic and reconstructive surgery is consistently one of the most competitive medical specialties in the match. The recent United States Medical Licensing Examination score reporting switch to pass-fail led to a change in metrics by which applicants are evaluated by plastic surgery programs. Applicant research productivity and the demand for plastic surgery mentorship will continue to rise. Given the competitive nature of the residency match and shift in metrics emphasis after the change in STEP 1 scoring, early exposure to plastic surgery and mentoring relationships are paramount to applicant success. However, most medical students are not exposed to plastic surgery until they begin clinical rotations. A literature review of plastic surgery mentorship programs available during preclinical years was conducted to identify preclinical mentorship opportunities in plastic surgery. Sixty-eight references were identified, but only two studies met the inclusion criteria of addressing mentorship programs in preclinical years. Examination of the included studies indicated that preclinical medical students achieve self-identified goals and generate longitudinal benefits in plastic surgery by participating in early and focused mentorship programs. The limited number of studies in this review highlights a lack of available, studied preclinical mentorship programs in plastic surgery and reveals a knowledge gap concerning the creation of successful preclinical mentorship programs. Early exposure to plastic surgery, combined with the development of structured preclinical mentorship programs, can potentially replicate successful outcomes seen in other surgical subspecialties' mentorship programs while addressing the lack of formalized mentorship opportunities for preclinical students in plastic surgery.

The Montreal Plastic Surgery Residency Bootcamp: Structure and Utility.

Transitioning from medical school to surgical residency is a difficult endeavor. To facilitate this period, the University of Montreal's plastic surgery program developed and implemented an intensive 1-month bootcamp rotation. It is the only one of its kind and length amongst plastic surgery residency programs in North America. It includes didactic teachings in anatomy, cadaveric dissections, and surgical approaches for an array of procedures. Clinical and technical skills are reviewed with senior residents and attending surgeons. Research opportunities and case scenarios are also covered. An anonymous online 30-question survey was sent to all residents who participated in the bootcamp rotation between 2013 and 2020. Questions evaluated residents' knowledge of anatomy, basic surgical skills, common approaches, flap knowledge, and on-call case management, before and after the bootcamp. Seventeen plastic surgery residents responded to this questionnaire (81%). The majority confirmed that the bootcamp helped them prepare for residency, research, and on-calls, and also helped them expand their knowledge of anatomy and surgical skills. The residents responded positively to the bootcamp's structure and implementation. This study proposes that surgical programs could benefit from a bootcamp rotation at the beginning of their curriculum. The purpose is to facilitate the transition between medical school and postgraduate training, and to ensure a basic level of competence for all junior residents. Further prospective studies could demonstrate the bootcamp's impact in board certification rates and acceptance into fellowship training programs.

Analyzing the Visibility of Gender-Affirming Surgery Education on US Plastic Surgery Residency Program Web Sites.

As the demand for gender affirmation grows, teaching gender-affirming surgery (GAS) in plastic and reconstructive surgery (PRS) programs has become increasingly important. Residency applicants interested in GAS often use program web sites to explore potential training opportunities. Our study aimed to quantify the GAS training opportunities promoted on residency program web sites and determine the characteristics of programs likely to promote GAS training. An assessment of 88 integrated PRS residency programs' web sites was conducted between 2021 and 2022. Plastic and reconstructive surgery residency and institutional webpages were queried for geographical location, training opportunities in GAS through residency or fellowship, and the number of faculty performing GAS. Descriptive statistics and multivariable regressions were used to describe and identify factors associated with increased GAS residency training opportunities. Twenty-six percent of PRS residencies mentioned training opportunities for GAS on their web sites. Gender-affirming surgery fellowships were offered at 7% of institutions, and an additional 7% were available via adjunct academic programs. Programs with faculty practicing GAS were 54% more likely to mention GAS on their residency page (odds ratio, 1.54; 95% confidence interval, 1.14-2.21; P = 0.009). Few PRS residency programs mention GAS on their web sites. As GAS becomes a more robust component of plastic surgery, appropriate information about the extent of GAS training should be available for applicants. Determining how local, state, and federal policies impact programs' abilities to highlight GAS should be investigated in future studies.

Exploring Skin Tone Diversity in a Plastic Surgery Resident Education Curriculum

Background: Gaps remain in surgical education regarding the representation of skin tone diversity. To improve equity and prevent misdiagnosis leading to worsened health outcomes, efforts must be made to ensure educational photographs are representative of the diverse patient populations plastic surgery residents will be treated in their future practices. Methods: Four study investigators examined 96 h of recorded lecture seminars from a Canadian plastic surgery resident education curriculum from May 2020 to December 2021. Using Fitzpatrick skin type to codify skin tone, photographic images were individually classified and compared. Program lecturers and residents were invited to participate in an online anonymized survey to explore related perceptions of the curricula. Results: A total of 1990 images were included for analysis. Of these, 83.2% were Fitzpatrick types I to III, 13.1% were Fitzpatrick types IV to V, and 3.7% were Fitzpatrick type VI. There was a statistically greater proportion of Fitzpatrick I to III compared to types IV to V ( P < .01), and type VI ( P < .01). Fleiss’ Kappa was calculated to be 0.896, representing near-perfect agreement. In the survey, 61% (14/22) of faculty respondents believe they include enough diversity in their photographs, however, 46% (4 of 9) of resident respondents would like to see more diversity in lecturers’ photographs. Conclusions: There is an underrepresentation of medium (Fitzpatrick types IV-V) and dark (Fitzpatrick VI) images in plastic surgery resident educational images. Providing a curriculum that represents diverse patient populations is crucial to enabling competency and equity of care, particularly in a highly visual field. Incorporating skin tone diversity into educational curricula should be a priority for all plastic surgery programs.

Residency Training Pathways of Program Directors and Chiefs/Chairs in Plastic Surgery.

Medical students interested in plastic surgery may become discouraged by barriers to career development during residency training. This study surveyed plastic surgery program directors (PDs) and chiefs/chairs to highlight the pathway followed by academic leaders in these positions. A self-administered anonymous survey was sent to a list of 189 PDs and chiefs/chairs identified via plastic surgery residency programs' websites. Chi-squared tests assessed answer distributions. Of the 189 recipients (25.9%), 49 completed the survey. Respondents' medical school graduation range was 1973-2009. Seventeen respondents entered a plastic surgery residency directly after medical school, and 32 began in another specialty. Comparison between these two groups showed no significant differences in preference rank of their program (P = 0.671). A total of 18 respondents conducted an academic enrichment year, but timing of this year differed significantly based on the initial specialty match (P = 0.012). There was no significant perceived difficulty in gaining recognition by gender (P = 0.107) or race (P = 0.125). Six respondents did not match into the specialty of first choice; five did not complete their initial residency programs; three did not match into plastic surgery at first attempt. Information on residency training pathways and barriers to career development of current academic leaders will improve transparency as to potential stumbling blocks that current PDs and chief/chairs of plastic surgery residency programs have faced during their initial training. This will help current trainees anticipate these stumbling blocks and place these in perspective based on the experience of senior plastic surgeons.

Social Media Popularity and Academic Productivity in Academic Plastic Surgery: A Positive Correlation.

Social media is a powerful tool that has empowered plastic surgeons to easily collaborate with one another and rapidly publicize research progression. The present study investigates the relationship between academic productivity and social media presence among both integrated and independent plastic surgery programs and their faculty. Plastic surgery programs on the American Council of Academic Plastic Surgeons website were included. Faculty were identified via review of each program's website. Following metrics of academic productivity were collected for each faculty member: h-index, i10-index, number of publications, and number of citations. Online review was then conducted to identify faculty and program Instagram and Twitter accounts, and the number of associated followers and posts. Integrated plastic surgery programs were more likely to have an Instagram account (p < 0.001), have higher average faculty h-index (p = 0.027), i10-index (p = 0.027), and number of publications (p = 0.042). A number of Instagram followers were significantly associated with average faculty h-index (p < 0.001), i10-index (p < 0.001), and number of publications (p < 0.001). The number of posts on a program's Instagram significantly predicted average faculty h-index (p < 0.001), i10-index (p < 0.001), and number of publications (p < 0.001). Twitter followers were significantly associated with average faculty h-index (p = 0.0397), i10-index (p = 0.0432), and number of citations (p = 0.00737). The present study reveals a correlation between metrics of social media popularity and academic productivity of plastic surgeons. We propose that Instagram and Twitter are effective tools with which plastic surgeons may not only publicize their clinical practice, but also rapidly disseminate important innovations among the medical community. Integrated plastic surgery programs and their faculty have significantly higher utilization of social media platforms. The number of followers and posts on a program's Instagram have a significantly positive correlation with average faculty's academic productivity. Social media platforms may empower academic plastic surgeons to disseminate their innovations on a larger scale. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Review of Medical Student First-Author Publications in Plastic Surgery.

The integrated plastic surgery residency match is a highly competitive process.If performed wisely, medical research is an opportunity to differentiate applications from peers, and productivity is closely evaluated by residency programs.In this study, the authors aimed to characterize medical student research productivity for integrated plastic surgery residency programs and their respective medical schools. To this end, the authors performed a retrospective review of senior author publications from the 81 integrated plastic surgery programs from January 1, 2016, to December 31, 2020. The primary outcome was a publication with a medical student as the first author.Secondary outcomes included the number of faculty from each program, the geographic region of the program, and the ranking of associated medical schools. It was found that the average number of medical student first-author publications and faculty members per institution were 14.0 and 11.0, respectively.There was a positive correlation between the number of faculty members and several medical student first-author publications for a program (R = 0.54, P < 0.0001). The average number of medical student first-author publications was higher in the top 25 programs than for the remaining programs (P < 0.001), and most medical student first-author publications in the United States were produced by 10 plastic surgery programs. From these findings, it was concluded that these programs associated with higher-ranking medical schools produce greater numbers of medical student first-author publications.These analyses of medical student academic productivity should be a highly useful guide for current and future medical students as they strategize their successful match into plastic surgery.

Prevalence of International Medical Graduates in Integrated Plastic Surgery Programs.

The annual match reports from 2010 to 2020 were retrieved and summarized. Electronic surveys for program directors and program coordinators were distributed to US integrated plastic surgery programs. Each program's website was appraised for information regarding the eligibility of IMGs. Websites were also used to identify the number of IMG residents. The number of applicants who matched into integrated programs ranged from 69 to 180 per year, of which US applicants comprised 61-165. US IMGs filled one to three positions per year, whereas non-US IMGs filled two to seven. Although 48% of programs have matched non-citizen IMGs and 79% have not encountered difficulties during the visa process, 67% of coordinators reported that the onboarding process is more challenging for IMGs. There are no IMGs in 52% of programs, and most institutions offer information on their website regarding visa sponsorship. IMGs make up less than 10% of filled positions per cycle. Although most programs accept IMGs, a small number matriculate. This may be explained by the competitiveness of integrated programs and the volume of IMG applications. Further research is needed to identify contributing factors of low IMG representation in plastic surgery programs.

Perceptual Barriers to Becoming a Plastic Surgeon among Underrepresented Medical Students.

The field of plastic surgery has experienced difficulty increasing diversity among trainees, despite significant efforts. Barriers to recruitment of underrepresented in medicine (URM) students are poorly understood. This study assesses URM students' exposure to plastic surgery, access to mentors and research opportunities, and the importance of diversity in the field. A survey was designed and distributed to members of the Student National Medical Association over 3 months. Survey data were collected using Qualtrics and descriptive statistics, and logistical regressions were performed using SAS. Of the 136 respondents, 75.0% identified as Black (n = 102/136), and 57.4% (n = 66/115) reported a plastic surgery program at their home institution. Of the total respondents, 97.7% (n = 127/130) were concerned about racial representation in plastic surgery, and 44.9% (n = 53/114) would be more likely to apply if there were better URM representation. Most respondents disagreed that there was local (73.4%, n = 58/79) or national (79.2%, n = 57/72) interest in URM recruitment. Students whose plastic surgery programs had outreach initiatives were more likely to have attending (OR 11.7, P < 0.05) or resident mentors (OR 3.0 P < 0.05) and access to research opportunities (OR 4.3, P < 0.05). URM students feel there is an evident lack of interest in recruiting URM applicants in plastic surgery. Programs with outreach initiatives are more likely to provide URM students access to mentorship and research opportunities, allowing students to make informed decisions about pursuing plastic surgery.

The Association Between Interview Day and Rank Order in Plastic Surgery Match: Is Recency Effect to Blame?

Plastic and reconstructive surgery is among the most competitive specialties in the National Resident Matching Program match. Though efforts to institute unbiased and equitable measures of an applicant's success have been made, many barriers still hinder suitable applicants from successfully matching. We sought to identify whether interview day influenced applicants' likelihood of being ranked favorably in both independent and integrated plastic surgery residency programs at a single academic institution. Data from 10 years of independent plastic surgery applicants and 8 years of integrated plastic surgery applicants were queried. Data regarding whether applicants were interviewed on day 1, day 2, or during subinternships (integrated cohort only) and what number they were on the programs rank list were included in the analysis. A total of 226 independent applicants 237 integrated applicants were identified. For integrated applicants, those who interviewed on day 1 were weighted toward worse rank scores. Applicants who interviewed during their subinternship had a bimodal distribution either ranking favorably or poorly. Integrated applicants who interviewed on the second day were more likely to be ranked in the first quartile. For those who interviewed on day 1, the odds of being ranked in the last quartile was 2.34 times higher than those who interviewed on day 2 (p = 0.02). Our results demonstrating that interview day may influence an applicant's final rank in the MATCH. Further study is needed to determine if this effect is can be observed in other academic plastic surgery programs.

Prevalence of Prohibited Questions during Plastic Surgery Residency Interviews.

An anonymous 16-question REDCap survey was distributed to 2022 cycle applicants of a single PRS program. The applicants were queried about demographic information, interview experience, and questions deemed illegal by the AAMC/NRMP guidelines. One hundred survey responses were attained for a 33.1% response rate. The majority of respondents were aged 26-30 (76%), women (53%), and white (53%); 33% received 15+ interviews for the application cycle. Seventy-eight percent of respondents reported being asked a prohibited question during at least one interview, with the most common "illegal" question categories being number/ranking of interviews (42%), marital status (33%), career balance (25%), and race/ethnicity (22%). Only 25.6% of applicants considered the subject matter inappropriate, whereas 42.3% were unsure. Although no applicant took action to report the potentially illegal scenarios, 30% said that their experiences influenced their rank list. Our survey study revealed that prohibited interview questions in PRS residency interviews are common. Permissible lines of questioning and discussion between programs and applicants during residency interviews have been defined by AAMC. Institutions should provide guidance and training to all participants. Applicants should be made aware of and empowered to utilize available anonymous reporting tools.

66. Narrative Letters of Recommendation and Match Outcomes: How Words Differentiate Applicants

PURPOSE: Letters of recommendation (LORs) are an essential component of residency applications. As grades and Step scores have become pass/fail, programs have fewer objective measures to assess applicants. As a result, even greater emphasis may be given to LORs in residency applications. This study aims to evaluate the role of narrative LORs in Match outcomes. METHODS: From the 2020-21 Match, one hundred first-time applicants from US medical schools were randomly selected. Application characteristics and the narrative LOR text were collected from residency applications. Match outcomes and LOR author demographics were determined from publicly available data. Characteristics of LOR text, such as word count (WC) and word frequency percentages, were calculated using the linguistics software Linguistic Inquiry and Word Count 2015. A bag-of-words classification model designed in Matlab R2022b was used to predict Match outcomes based purely on word frequency variation. The text of 299 LORs was used to train the model, and its accuracy was assessed with 52 LORs. The bag-of-words classification model also identified the words most likely to predict Match outcomes, which were termed “differentiation words.” RESULTS: Of the one hundred applicants included in this study, 69% of applicants matched into a PGY-1 plastic surgery residency position. Although most (57%) applicants were female, only 18.7% of letter writers were female. On average, female applicants had LORs with higher WCs (453 vs. 417, p=0.0497). Additionally, female letter writers wrote higher WC LORs for applicants (475 vs. 429, p=0.045). No differences in WC were observed based on academic rank. For applicants who successfully matched, their LORs averaged a significantly higher WC (463 vs. 375, p<0.0001). The bag-of-words classification model was able to predict outcomes based on the LOR text alone with an accuracy of 91.4%. The word frequency of “differentiation words” was also significantly higher in the LORs of those who matched (2.59% vs. 2.22%, p=0.002). CONCLUSIONS: These results demonstrate that even in the absence of numeric data such as Step 1 scores and publication metrics, the written language in LORs can stratify applicants. This work suggests that highly descriptive and positive adjectives such as “bright” and “excellent” are important keywords for evaluators to include in LORs to indicate applicant strength. Finally, plastic surgery programs may consider using machine learning algorithms to assess LORs, not only to save residency programs time but also to mitigate individual reviewer bias.

69. Exponential Increases in Cost, Competitiveness, and Complexity: The Integrated Plastic Surgery Match Burden

PURPOSE: Integrated plastic surgery residency is now the dominant pathway for training future plastic surgeons. An increasing pool of applicants in conjunction with the transition of the Step 1 examination to pass/fail and the COVID-19 pandemic may have increased competitiveness and altered applicant behavior. We detail the current application burden, provide insights into the plastic surgery match, and posit a response to stabilize future cycles. METHODS: In total 2,166 applicants to integrated plastic surgery programs were included. The American Association of Medical Colleges and Electronic Residency Application Service databases were examined to determine applicant trends for the years: 2017, 2018, 2019, 2020, and 2021. The ERAS fee schedule for 2021 was used to estimate application cost and a conservative 4.3% interest rate was used to estimate future value of application costs. RESULTS: In 2017, there were 564 applicants and in 2021 there were 416, a 26% decrease. However, across this same time period the number of applications per applicant nearly doubled (97%) from 29.8 in 2017 to 58.7 in 2021. From 2017 to 2021, a 10% increase in the number of female applicants and a 43% decrease in the number of male applicants was observed. Applicants of all races other than Native Hawaiian decreased from 2017 to 2021. Cost of applications per applicant increased by 146%, from $514 in 2017 to $1,265 in 2021. Collectively, this represents an 81% increase in the total cost of applications despite fewer applicants. Total application costs in 2021 were $526,323. The future value of these expenditures equals an economic burden of $801,855, assuming a 10-year loan at a 4.3% interest rate. CONCLUSIONS: Despite a fluctuation in applicants to integrated plastic surgery within the past five years, the number of applications per applicant and resulting cost to apply has increased greatly. This is representative of the increasingly competitive application process, heightened in particular by the virtual application seasons of 2021 and 2022. Program personnel are already overwhelmed with the number of highly qualified applicants, and it will be detrimental to applicants and programs alike if the observed trends continue. Ideas to confront this issue include limiting the number of programs applicants can apply to or implementing a secondary application. We argue a secondary application is the most tangible mechanism to mitigate this escalating issue, as it will decrease the number of applications each applicant submits by raising the barriers to entry. It appears that more female applicants are applying to integrated plastic surgery residency positions, increasing their representation in the field. Increased cost may pose a barrier for socioeconomically challenged and/or underrepresented minority applicants. Intervention is needed to enhance application efficiency and reduce these issues for residency programs and applicants.

543 Diversity in Burn Surgery Programs

Abstract Introduction Racial and gender disparities have been longstanding in the fields of medicine and surgery. In the literature, underrepresentation has been highlighted in plastic surgery and general surgery programs, however few studies examine this within burn surgery. Two studies describe the gender and racial disparities that exist in burn surgery leadership. This study seeks to compare and highlight the representation of minority and female surgeons in burn surgery training at a major metropolitan burn center to other surgical programs. Methods Applicant data were reviewed for acceptance to the clinical burn surgery fellowship program from 2008 to 2022. Self-identification was used to categorize gender as male or female and race as Asian, African American, White, and other. The gender and race of each applicant was recorded. The data was analyzed and compared to data trends in female and minority representation among physicians in other training programs. Demographic data were also obtained from newly hired staff of the same metropolitan burn center. Results From 2008-2022, there have been 30 physicians enrolled in this institution’s burn surgery fellowship program. Fourteen (46.7%) were female. Twelve (40%) were White, ten (33.3%) were African American, six (20%) were Asian, and two (6.7%) were of unknown racial background. From 2018-2022, there have been 277 newly hired staff members for the burn center. There were 238 females (85.9%). There were 142 (51.2%) who were White, 82 (29.6%) who were African American, 30 (10.8%) who were Asian, and 23 (8.3%) who were Hispanic or Latino. Conclusions In 2022, the US graduating medical class was 52% female – a proportion that has slightly increased over the last four years. Furthermore, the US graduating medical school class was 58.8% White, 25.5% Asian, 10.6% Hispanic or Latino, 8.3% Black; these proportions of minority groups have also demonstrated a slow, but steady, increase over the last four years. Previous studies have demonstrated a lack of diversity among burn surgery leadership, but do not address diversity among burn surgery fellows or among newly recruited medical staff within burn centers. This institution’s burn surgical program has aimed to maintain a diverse minority representation to serve a community that is also diverse in race, gender, and socioeconomic status. Applicability of Research to Practice Increasing gender and racial representation in burn surgery programs is beneficial for supporting the burn patient population, which is frequently diverse in race, gender, and socioeconomic status.

A National Survey of Perspectives of Physician Assistants in Academic Plastic and Reconstructive Surgery

Background: Physician assistants (PAs) are an essential part of the healthcare team who improve access and efficiencies in patient care. A better understanding of the impact and current utilization of PAs in plastic and reconstructive surgery is needed. The purpose of this national survey was to evaluate the role and scope of practice of PAs in academic plastic surgery, as well as characterize current trends of PA utilization, compensation, and perceived value from a PA perspective. Methods: A voluntary, anonymous 50-question survey was distributed via SurveyMonkey to practicing PAs at 98 academic plastic surgery programs. The survey included questions about employment characteristics, involvement in clinical research and academic work, structural organization, academic benefits, compensation, and position held. Results: Ninety-one PAs from 35 plastic surgery programs completed the survey and were included (overall program response rate = 36.8%, participants response rate = 30.4%). Practice environments included outpatient clinics, the operating room, and inpatient care. Most commonly, respondents supported multiple surgeons as opposed to one surgeon’s practice. For 57% of respondents, compensation is based on a tiered system that accounts for specialty and experience. The reported mode base salary range corroborates national averages and most reported annual bonuses based on merit. The majority of respondents felt valued in their role. Conclusions: Through this national survey, we provide granularity as to how PAs are utilized and compensated in academic plastic surgery. We offer insight into the overall perceived value from a PA perspective that helps define the role and will ultimately help strengthen collaboration.

Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery? A National Survey of Microsurgery Fellowship-Trained Women.

The "leaky pipeline" phenomenon has caused women to remain underrepresented at higher levels of academic plastic surgery. No study has considered the availability of mentorship within any subset of academic plastic surgery. The purpose of this study was to evaluate the current representation of women in academic microsurgery and to determine the impact of mentorship on career progression. An electronic survey was designed to determine the availability and quality of mentorship respondents received at different stages of their career (from medical student to attending physician). The survey was distributed to women who completed a microsurgery fellowship and were current faculty at an academic plastic surgery program. Twenty-seven of 48 survey recipients participated (56.3% response rate). Most held an associate professor (20.0%) or assistant professor (40.0%) position. Respondents had an average of 4.1 ± 2.3 mentors throughout their entire training. A minority of mentors were microsurgery trained (28.3%), and only 29.2% of respondents reported female mentorship throughout their training. Attending physicians least often received formative mentorship (52.0%). Fifty percent of respondents sought female mentors, citing that they desired female insight. Of those who did not seek female mentors, 72.7% cited a lack of access to female mentors. Evidenced by female trainees being unable to find female mentors and low rates of mentorship at the attending physician level, there is currently not enough capacity to meet the demand for female mentorship by women pursuing academic microsurgery. Many individual and structural barriers to quality mentorship and sponsorship exist within this field.

How Consistent are International Rotations Between Plastic Surgery Training Programs?

All 101 integrated and independent plastic surgery program directors/coordinators were asked to participate. The survey identified the requirements and details of existing international rotations. In total, 57 programs responded (56% response rate) to the survey. An estimated 54% of all programs offered international rotations to their residents, and 94% of these programs obtained institutional approval. Additionally, 69% of these programs have received national approval. Institutional requirements for programs to provide international rotations vary significantly across institutions, which results in disparate experiences for residents and poses potential risks to international partners. This study will help promote transparency regarding international rotation requirements and better equip faculty to enhance international rotations that cater to the needs of the institution, residents, and most importantly, the host countries.

Educational and Clinical Outcome Measures in an Integrated Hand Service

BackgroundWe recently sought to integrate our orthopaedic and plastic hand surgeons with the goal of improving education, patient care, and providing seamless, continuous coverage for our trauma center. Our hypothesis was that integration could serve both the orthopaedic and plastic surgery training programs well and provide more consistent care for the trauma patients. Materials and MethodsProgram director approval was granted for blinded analysis of case logs from plastic and orthopaedic surgery programs from 2012 through 2019. Data on mean and total number of hand cases were analyzed and compared for both specialties. Institutional Review Board approval was granted for a retrospective review of patient outcomes. ResultsFor both orthopaedic and plastics resident trainees, the mean number of hand cases increased during this study period suggesting that the integration had a favorable impact on both programs. The mean number of hand cases for orthopaedic residents rose from 163 to 246. The mean number of hand cases for plastic surgery residents rose from 218 to 295. Patient outcomes as reflected in length of stay and time to consultation also improved. ConclusionTo improve hand surgical training and patient care, an integrated orthoplastics approach to hand surgery was implemented at our institution. Plastic surgery trainees are completing more hand surgery cases in an integrated model (p < 0.001), including fracture care (p < 0.047). Orthopaedic surgery trainees have doubled the percentage of integumentary and microsurgery cases in the integrated model (p < 0.001). The educational and clinical changes affected in an integrated model have changed the paradigm for educating future hand surgeons at our institution.

The Medical Student Race to Research: Who Presents More at National Plastic Surgery Conferences?

presentations increase research output and facilitate networking for medical students applying to plastic surgery. We aim to determine predictors of increased medical student presentation at national plastic surgery conferences, identifying disparities in access to research opportunities. Abstracts presented at the 2 most recent meetings of the American Society of Plastic Surgeons, American Association of Plastic Surgeons, and Plastic Surgery Research Council were extracted from online archives. Presenters without MDs or other professional credentials were classified as medical students. Presenter gender, medical school ranking, plastic surgery division/department, National Institutes of Health funding, number of total and first-author publications, H-index, and research fellowship completion status were recorded. Students with 3 or more (>75th percentile) presentations were compared with those with less by χ2 tests. Univariate and multivariable regressions identified factors associated with 3 or more presentations. Of 1576 abstracts, 549 (34.8%) were presented by 314 students. The gender distribution was 46.5% male and 53.5% female. Most were from the Northeast (36.9%), 35% came from top 20 medical schools, and 85% attended schools with home plastic surgery programs. While 61.8% presented once, 14.6% presented 3 or more times. Those who previously presented, completed research fellowships or had more publications or higher H-indices were likely to present more ( P ≤ 0.007). On multivariable-adjusted analysis, completing research fellowships (odds ratio [OR], 2.34-2.52; P = 0.028-0.045), affiliation with institutions having higher National Institutes of Health funding (OR, 3.47-3.73; P = 0.004-0.006), or having more total number of publications (OR, 3.81; P = 0.018) or first-author publications (OR, 3.84; P = 0.008) was associated with 3 or more presentations. Presenter gender, geographic region, medical school ranking, home program status, and H-indices were not significant predictors on multivariable analysis. There are several potential inequities in access to research opportunities for medical students, disadvantaging those with less well-funded plastic surgery programs and existing research experience. Improving the equitability of these opportunities is crucial for limiting bias in trainee recruitment and diversifying representation in the field.

The West Coast Plastic Surgery Mentorship Program: Successes, Failures, and Future Growth.

Students who are underrepresented in medicine experience limited access to mentorship throughout medical school and when applying to plastic surgery residency. This study describes the creation, growth, and results of the multi-institutional West Coast Plastic Surgery Mentorship Program (WCPSMP), specifically reflecting on barriers to implementation and room for future improvement. Students were eligible to apply to the plastic surgery mentorship program if they were first-, second-, or third-year medical students in a US medical school interested in plastic surgery. Preference was given to students who are (1) underrepresented-in-medicine racial/ethnic minorities; (2) first generation, low income; (3) lesbian, gay, bisexual, transgender, queer; and/or (4) without a home integrated plastic surgery program. Preprogram and postprogram surveys were analyzed. The 2021-2022 cycle of the WCPSMP included 30 resident mentors and 30 resident mentees, with a 1:1 mentor-to-mentee relationship. The second annual Mentor-Mentee Day was hosted on June 25, 2022, in San Diego, California, with attendance from 18 mentees. There was a 63% response rate in the presurvey and postsurvey. Most students endorsed gaining didactic skills, technical skills, and networking, but only a few gained research opportunities. The WCPSMP is a promising venue to offer underrepresented medical students valuable resident mentorship, as well as acquire surgical knowledge and skills. Further development of the program includes implementing a curriculum for residents on how to be an effective mentor and offering more research opportunities.