Plastic Surgery Residency Applicants Research Articles

Predictors of Plastic Surgery Applicant Success: An Analysis of the Texas STAR Database.

Integrated plastic surgery residency is one of the most competitive medical specialties. Although previous studies have surveyed integrated plastic surgery residency program directors regarding desired applicant characteristics, there is a paucity of literature assessing detailed application characteristics and reported match outcomes from applicants in recent application cycles. This study examines application characteristics associated with matching into integrated plastic surgery residency from 2017 to 2023. The authors accessed the Texas Seeking Transparency in Application to Residency database, which contains survey information from graduating medical students nationwide regarding residency application characteristics and specialties/programs to which applications were submitted. Characteristics of matched versus unmatched applicants between 2017 and 2023 were compared using χ 2 and 2-sided, independent t tests. Univariate logistic regression models were used to assess predictors of a successful match. A total of 381 integrated plastic surgery residency applicants responded to the Texas Seeking Transparency in Application to Residency survey from 2017 to 2023. Mean United States Medical Licensing Exam Step 2 CK scores; the number of away rotations, interview offers, and honored clerkships; and Alpha Omega Alpha membership rate were significantly associated with and predictive of matching. Preference signaling of programs was associated with an increased interview offer rate. Higher board examination scores, increasing numbers of honored clerkships, away rotations, and Alpha Omega Alpha membership were identified as statistically significant predictors of matching into integrated plastic surgery residency. Prospective applicants should use this information to help guide their efforts in these areas that appear to be associated with a successful transition to residency.

D66. Linguistic Analysis of Race and Gender Bias in Narrative Letters of Recommendation for Plastic Surgery Residency Applicants

D66. Linguistic Analysis of Race and Gender Bias in Narrative Letters of Recommendation for Plastic Surgery Residency Applicants

Preference Signaling and the Integrated Plastic Surgery Match: A National Survey Study

Rooted in economics market strategies, preference signaling was introduced to the Plastic Surgery Common Application (PSCA) in 2022 for integrated plastic surgery residency applicants. This study surveyed program and applicant experience with preference signaling and assessed how preference signals influenced likelihood of interview invitations. Two online surveys were designed and distributed to all program directors and 2022-2023 applicants to integrated plastic surgery. Opinions regarding the utility of preference signaling were solicited, and the influence of preference signals on likelihood of interview offers was assessed. All integrated plastic surgery programs. All 88 program directors and 2022-2023 applicants to integrated plastic surgery. A total of 45 programs and 99 applicants completed the survey (response rates, 54.2% and 34.2%, respectively). Overall, 79.6% of applicants and 68.9% of programs reported that preference signals were a useful addition to the application cycle. Programs reported that 41.4% of students who sent preference signals received interview offers, compared to 84.6% of home students, 64.8% of away rotators, and 7.1% of other applicants; overall, students who signaled were 5.8 times more likely to receive an interview offer compared to students who were not home students and did not rotate or signal. After multivariable adjustment, programs with higher Doximity rankings, numbers of away rotators, and numbers of integrated residents per year received more preference signals (all p < 0.05). Applicants and programs report that preference signaling was a useful addition to the integrated plastic surgery application cycle. Sending preference signals resulted in a higher likelihood of interview offers among nonrotators. Preference signaling may be a useful tool to reduce congestion in the integrated plastic surgery application cycle.

35. Linguistic Analysis of Race and Gender Bias in Narrative Letters of Recommendation for Plastic Surgery Residency Applicants

35. Linguistic Analysis of Race and Gender Bias in Narrative Letters of Recommendation for Plastic Surgery Residency Applicants

Socioeconomic Disparities in Research Participation: Bias in Plastic Surgery Residency Match.

Integrated plastic surgery residency applicants have increased at a rate disproportionate to available positions. Research productivity has become a surrogate marker for competitiveness, and many applicants pursue it to distinguish themselves. To date, no study has investigated socioeconomic disparities in extended research experience (ERE) participation. A 35-question cross-sectional survey was distributed to applicants to United States-based integrated plastic surgery residency programs during the 2019-2022 application cycles. Summary tables, student t test, and chi-square tests were used for statistical analysis. A total of 161 responses (response rate: 20.9%) were recorded. Fifty-nine (40.7%) respondents participated in an ERE. The most common reason for ERE participation was strengthening one's application. The most common reason against participation was avoiding delays in career progression. A greater percentage of respondents from Northeastern medical schools participated in EREs (P = 0.019). There were no significant differences in debt burden between those who did or did not participate in an ERE. A greater percentage of applicants whose parents had advanced degrees participated in EREs (P = 0.053). There may be geographic and socioeconomic biases present in access to ERE for students interested in plastic surgery. The growing popularity of EREs may have unintended consequences for applicant diversity. As most plastic surgeons ultimately practice in nonacademic settings, applicants and plastic surgeons may consider the financial hardships and possible socioeconomic disparities in research opportunities before participating in or recommending them.

Distinguishing Authentic Voices in the Age of ChatGPT: Comparing AI-Generated and Applicant-Written Personal Statements for Plastic Surgery Residency Application: Erratum.

Distinguishing Authentic Voices in the Age of ChatGPT: Comparing AI-Generated and Applicant-Written Personal Statements for Plastic Surgery Residency Application: Erratum.

Having Social Media among Integrated Plastic Surgery Applicants: Is It Needed to Match?

Little information exists on the perceptions of integrated plastic and reconstructive surgery (PRS) residency applicants on the need for having social media (SoMe) during the application process. A cross-sectional survey study was conducted during the 2022 match cycle to assess integrated PRS residency applicants' perceptions on the role of SoMe during the match. Univariate and multivariate analyses were performed on variables of interest. Qualitative analysis was conducted on free-form responses. Seventy-nine surveys were completed (response rate: 24%). The majority of respondents were educated in the United States (92%). Instagram was the most commonly used SoMe platform (92%). Of those surveyed, 18% thought that SoMe was beneficial to the application process. Twenty-nine percent of respondents agreed that a SoMe presence increases one's chances of matching into PRS residency (41% disagreed and 30% responded neutrally). Forty-four percent endorsed stress about maintaining a SoMe presence in PRS. Having mentors who recommended maintaining a SoMe presence was associated with the belief that SoMe increases one's chances of matching [odds ratio (OR) 8.1, 95% confidence interval (CI) 1.1-40.4, P = 0.011] and stress about maintaining a SoMe presence (OR 6.3, 95% CI 1.2-33.3, P = 0.030). Applicants who did research years had lower odds of experiencing stress (OR 0.16, 95% CI 0.04-0.70, P = 0.015). The growing role of SoMe in the residency selection process may be exacerbating applicants' stress and anxiety. PRS programs may consider establishing clear policies for how SoMe will be used in evaluating candidates.

Distinguishing Authentic Voices in the Age of ChatGPT: Comparing AI-Generated and Applicant-Written Personal Statements for Plastic Surgery Residency Application.

ChatGPT, a generative artificial intelligence model, may be used by future applicants in the plastic surgery residency match. Ten personal statements (5 generated by ChatGPT, 5 written by applicants) were rated by 10 reviewers, blinded to the source of the essay. A total of a 100 evaluations were collected. There was no significant difference in ratings for readability, originality, authenticity, and overall quality (all P > 0.05) when comparing computer-generated and applicant essays. Personal statements prepared by ChatGPT are indistinguishable from essays written by actual applicants. This finding suggests that the current plastic surgery application format be reevaluated to better aid in holistic evaluation of students.

Rise Above the Competition: How Do Plastic Surgery Residency Applicants with NCAA Experience Fare in the Residency Match?

The integrated plastic surgery residency match continues to be highly competitive. Every year, some candidates are former NCAA athletes. While it is challenging to balance academic and athletic responsibilities, participation in NCAA sports may be predictive of continued success. This study aimed to evaluate the impact of participation in collegiate athletics on applicant anticipated rank and academic success. All applications received from 2017 to 2020 at a single institution were reviewed for participation in NCAA athletics (Division I-III). Our primary outcome of interest was applicant anticipated rank by letter of reference writers. Applications were also examined for demographic information, membership in AOA, number of research publications, and USMLE board certification examination scores. After reviewing 885 applications, 61 applicants (6.89%) were former NCAA athletes. Former NCAA involvement was associated with the highest effect on anticipatedranking (- 0.22, p=0.001). Former NCAA involvement demonstrated the highest odds of receiving an anticipated ranking in the top 5 (OR 1.83, p=0.025). We found no significant difference in research productivity between the two groups, including first authorships or USMLE Step 1 board certification exam scores. A significant difference was seen in race distribution, with forty-five (80.4%) of athlete applicants identifying as Caucasian, while 430 (56.5%) of non-athletes identified as Caucasian (p=0.012). Former athletes applying to become integrated plastic surgery residents overcome the challenges of balancing athletic and academic pursuits with a higher anticipated rank in the integrated plastic surgery match while having comparable academic achievement. Former collegiate athletes have demonstrated greater success in and after residency. Former NCAA participation demonstrated the highest odds of receiving a top-5 rank. Former NCAA applicants showed no difference in academic productivity LEVEL OF EVIDENCE V: Case series study. This journal requires that authors assign a level of evidence to each article. 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 .

PC26. Predicting a Successful Plastic Surgery Residency Applicant - The Linear Rank Model

PURPOSE: Linear rank modeling (LRM) is an algorithm that uses relevant inputs to model expert judgment. Our institution previously described how LRM improves consistency and fairness in resident selection. We have utilized LRM over the last five years to assist with ranking integrated plastic surgery residency (PRS) applicants. The primary aim of this study was to determine if LRM predicts applicant match success. Our secondary aim was to assess if LRM demonstrates bias against groups of underrepresented gender or self-identified race categories. METHODS: The LRM scores for applicants who applied to a single institution between 2018-2022 were calculated. Data was collected on applicant demographics, Step 1 & 2 scores, number of publications, extracurricular activity scores, letter of recommendation scores, global intuition rank, and match success. RESULTS: The mean LRM score of 231 applicants was 59. With every one-point increase in LRM score, there was a significant 8.3% increase in the likelihood of applicant match success (p <.001). An algorithm was developed to estimate the probability of match success based on the LRM score. No significant difference in average LRM scores was found between gender (p =.285) or self-identified race groups (p =.137). CONCLUSION: LRM is a valuable tool to help create rank lists by providing an objective assessment of residency applicants. This model can rank applicants based on a holistic set of criteria and estimate an applicant’s probability of successfully matching into an integrated PRS residency.

23. The Utility of the Standardized Letter of Recommendation Form in Assessing Integrated Plastic Surgery Residency Applicants

PURPOSE: Identifying the right applicants to train as plastic surgeons is critical for both programs and our specialty. The ACAPS Standardized Letter of Recommendation (SLOR) form serves as an adjunct to narrative letters and is meant to provide objective, comparable data across applicants. The SLOR assesses applicants in 10 domains and asks the evaluator where they would place the applicant on their rank list (Question 6). The utility of the SLOR in predicting Match outcomes has not been studied. METHODS: From the 2020-21 cycle, 100 first-time applicants from US medical schools were randomly selected. Application characteristics were collected from applications submitted to one integrated program. Match outcomes were determined from publicly available data. Logistic regression modeling identified variables that were significant in predicting Match outcomes. RESULTS: The Match rate for this cohort was 69%, consistent with the specialty norm. None of the 10 SLOR domains contributed significantly (p>0.05) to predicting Match outcomes. There were no differences in SLOR scores based on gender or race. However, female gender (p=0.018), older age (p=0.025), higher Step 1 score (p=0.0005), more publications (p=0.0003), and Question 6 (p<0.0001) had a significant role in predicting Match outcomes. These variables alone successfully predicted matching in 93% of applicants using the logistic regression model. CONCLUSIONS: Based on these results, it is time to reconsider the questions and structure of the SLOR form to minimize data overload on evaluators. Further work should be done to identify questions that better stratify applicants in meaningful, unbiased ways.

Objective Residency Applicant Assessment Using a Linear Rank Model

Residency applicant assessment is imperfect, with little objectivity built into the process, which, unfortunately, impacts recruitment diversity. Linear rank modeling (LRM) is an algorithm that standardizes applicant assessment to model expert judgment. Over the last 5 years, we have used LRM to assist with screening and ranking integrated plastic surgery (PRS) residency applicants. This study's primary objective was to determine if LRM scores are predictive of match success and, secondarily, to compare LRM scores between gender and self-identified race categories. Data was collected on applicant demographics, traditional application metrics, global intuition rank, and match success. LRM scores were calculated for screened and interviewed applicants, and scores were compared by demographic groups. Univariate logistic regression was used to evaluate the association of LRM scores and traditional application metrics with match success. University of Wisconsin, Division of Plastic and Reconstructive Surgery. Academic institution. Six hundred seventeen candidates who applied to a single institution over 4 application cycles (2019-2022). Using area under the curve modeling, LRM score was the most predictive indicator for match success. With every one-point increase in LRM score, there was an 11% and 8.3% increase in the likelihood of screened and interviewed applicant match success (p < 0.001). An algorithm was developed to estimate the probability of match success based on LRM score. No significant differences in LRM scores were appreciated for interviewed applicant gender or self-identified race groups. LRM score is the most predictive indicator of match success for PRS applicants and can be used to estimate an applicant's probability of successfully matching into an integrated PRS residency. Furthermore, it provides a holistic evaluation of the applicant that can streamline the application process and improve recruitment diversity. In the future, this model could be applied to assist in the match process for other specialties.

Changes in Subspecialty Interest of Plastic Surgery Residents With Progression of Training: Impact on Academic Attrition.

Plastic surgery residency applicants often express interest in academic subspecialties, but only a small percentage of graduating residents pursue academic careers. Identifying reasons for academic attrition may help training programs address this discrepancy. A survey was sent to plastic surgery residents through the American Society of Plastic Surgeons Resident Council to assess interest in 6 plastic surgery subspecialties during junior and senior years of training. If a resident changed their subspecialty interest, the reasons for change were recorded. The importance of different career incentives over time were analyzed with paired t tests. Two hundred seventy-six plastic surgery residents of 593 potential respondents (46.5% response rate) completed the survey. Of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial and microsurgery were identified as the specialties with the highest attrition of interest, while interest in esthetic, gender-affirmation, and hand surgery increased. For residents who left craniofacial and microsurgery, the desire for higher compensation, to work in private practice, and the desire for improved job opportunities significantly increased. The desire for improved work/life balance was a prominent reason for subspecialty change among senior residents who changed to esthetic surgery. Plastic surgery subspecialties associated with academia, such as craniofacial surgery, suffer from resident attrition due to a variety of factors. Increased retention of trainees in craniofacial surgery, microsurgery, and academia could be improved through dedicated mentorship, improved job opportunities, and advocacy for fair reimbursement.

30. Rise Above the Competition: How Do Plastic Surgery Residency Applicants with NCAA Experience Fare in the Residency Match?

Background: The integrated plastic surgery residency match continues to be highly competitive. Every year, some candidates are former NCAA athletes. While it is challenging to balance academic and athletic responsibilities, participation in NCAA sports may be predictive of continued success. This study aimed to evaluate the impact of participation in collegiate athletics on applicant anticipated rank and academic success. Methods: All applications received from 2017 to 2020 at a single institution were reviewed for participation in NCAA athletics (Division I-III). Our primary outcome of interest was applicant anticipated rank by letter of reference writers. Applications were also examined for demographic information, membership in AOA, number of research publications, and USMLE board certification exam scores. Results: After reviewing 885 applications, 61 applicants (6.89%) were former NCAA athletes. Former NCAA involvement was associated with the highest effect on anticipated (-0.22, p= 0.001) rank. Former NCAA involvement demonstrated the highest odds of receiving an anticipated ranking in the top 5 (OR 2.05, p=0.01). We found no significant difference in research productivity between the two groups, including first authorships or USMLE Step 1 board certification exam scores. A significant difference was seen in race distribution, with forty-five (80.4%) athlete applicants identifying as Caucasian, while 430 (56.5%) non-athletes identified as Caucasian (p=0.012). Conclusion: Former athletes applying to become integrated plastic surgery residents overcome the challenges of balancing athletic and academic pursuits with a higher anticipated rank in the integrated plastic surgery match while having comparable academic achievement.

40. An Update on the Independent Plastic Surgery Match: Recent Trends and Predictors of Successful Match (2019-2022)

Background: The number of independent plastic surgery residency programs and applicants have consistently declined over the past decade. A prior study by the authors demonstrated trends and predictors associated with increased match success up until 2018. The purpose of this study was to analyze recent match trends and predictors to aid prospective applicants. Methods: After approval from the American Council of Academic Plastic Surgeons, the San Francisco Match provided data for the independent match (2019-2022). Applicant variables were analyzed to determine correlation with a successful match. Outcomes were compared between candidates utilizing chi square tests, t-tests, univariate and multivariate logistic regressions. Results: 428 applicants participated in the independent plastic surgery match from 2019 to 2022, of whom 243 matched. In this period, the number of independent plastic surgery residency programs and positions decreased from 40 to 36 (10%), and 63 to 57 (9.5%), respectively. The number of applicants increased from 90 in 2019 to 124 in 2022 (37.8%), and match rate decreased from 82% to 56%. Osteopathic and international medical graduates increased from 9 to 21 (133%), and 20 to 28 (40%) respectively. A successful match was associated with US medical school graduates, prerequisite training at a university-affiliated general surgery program, greater number of interviews (13 ± 6 vs. 3 ± 3), higher USMLE step 1/2 scores, and AOA status (p<0.05). By multivariate regression, number of interviews completed (odd ratio [OR] 1.40 95% confidence interval [CI] 1.23-1.59 p <0.001) and allopathic medical school background (OR 3.65 95% CI 1.1 – 12 p = 0.003) were predictive of a successful match. Conclusion: Despite residency review committee’s ongoing support of the independent plastic surgery track, program participation during the period examined has decreased while applicant interest increased, likely contributing to a decreased match rate. Although more interviews and allopathic medical school background correlate with a successful match, continued support for the independent plastic surgery track is encouraged.

13. PREPPED: Plastic Surgery Research, Education, and Preparation Promoting Equity and Diversity

Background: Addressing healthcare disparities in plastic surgery requires improving physician workforce diversity. Evidence has emerged that despite an interest in plastic surgery, minority applicants face bias, socioeconomic barriers, and lower access to mentors that results in overall lower matriculation into plastic surgery. This study describes the creation and initial outcomes of the PREPPED (Plastic Surgery Research, Education, and Preparation Promoting Equity and Diversity) course, aimed at supporting under-represented students with their transition to sub-interns and residency applicants. Methods: The PREPPED course was a 2-day course hosted in San Diego, CA in 2022. Students received a 40-question survey both before and after the event. Qualitative and quantitative data analysis was performed. Results: Forty students participated, of which 72.7% identified as ethnically under-represented in medicine (UIM) and 48.5% of students did not have a home integrated plastic surgery program. Students reported significantly greater confidence describing a successful sub-intern and understanding the plastic surgery residency application process following the event (p<0.001). Students were significantly more comfortable identifying resources in plastic surgery education and identifying at least 3 mentors in the field following the event (p<0.001). Students showed significant improvement in the post PREPPED assessment in all subspecialties (p<0.05) except for the hand category, which trended towards improvement but was not significant (p=0.10) Conclusion: The PREPPED program is a promising avenue to improve recruitment of UIM students into plastic surgery. Further investigation as well as future PREPPED events will elucidate how this program may be effective in improving sub-internship performance and match outcomes.

Perspectives on the Plastic Surgery Common Application (PSCA): A Survey of 2021-2022 Integrated Plastic Surgery Applicants.

An anonymous survey was distributed to integrated plastic surgery residency applicants from the 2021-2022 application cycle. Participants were asked to provide basic demographic information, their perspectives of the PSCA, and overall application preference. One hundred forty (43.1%) applicants completed the survey. Nearly, 63% of applicants responded "slightly well" or "not well at all" regarding their ability to highlight at least one aspect of their application. Forty-one percent of applicants believed ERAS best highlighted the strengths of their application compared with 27% who believed their strengths were better highlighted by the PSCA. Seventy-nine percent reported the cost savings associated with the PSCA were "very" or "extremely important." Overall, 63% of respondents reported a preference to apply with the PSCA alone. This is the first study to provide insight on applicants' perspectives of the PSCA. Although the majority preferred applying with the PSCA, there may be challenges with transitioning to this application solely. Future iterations of the PSCA may aim to ameliorate functionality concerns, optimize application content, and incorporate plastic surgery-specific information that may be important to selection committees.

Impact of COVID-19 on the 2020/2021 Integrated Plastic Surgery Residency Application Cycle.

Jabori, Sinan Kallo MD1; Pandya, Shivani BS1; Epstein, Anabel BS1; Weber, Lee MD1; Panthaki, Zubin MD; Singh, Devinder MD1; Thaller, Seth R. MD, DMD1 Author Information

A Leadership Perspective on the Plastic and Reconstructive Surgery Residency Application Cycle During the COVID-19 Pandemic

IntroductionThe purpose of this study was to identify leadership perspective on the impact of COVID-19 Plastic and Reconstructive Surgery (PRS) residency application cycle in 2020 and its future implications. MethodsA survey was sent to residency program leaders (RPL), consisting of program directors and division chiefs/chairs. The survey was sent weekly for 4 weeks and remained open for 28 days. ResultsA total of 156 PRS RPL were emailed. Response rate was 24% (38/156). A total of 68% were division chiefs/chairs, and 42% were program directors. Ten percent were both division chiefs/chairs and program directors. Among them, 78% were male. Eighty-seven percent of RPLs reported changes in the number of away rotations, of which 91% reported less away rotations. Only 27% of programs provided virtual away rotations (VAR), and 88% of RPLs were not comfortable writing letters of recommendation after VARs. Hundred percent of cases reported that VARs influenced whether an applicant received an interview. A total of 24 RPLs (63%) reported no changes in how they viewed applications due to the pandemic. However, 5 (13%) reported USMLE scores were more important, 4 (11%) reported research was more important, and 4 (11%) reported LORs were more important. Sixty-six percent did not feel they relied heavily on home institution candidates. Seventy-six percent found virtual interviews to be effective in evaluating applicants, and 71% reported they would add virtual interviews in future interviews. ConclusionsDuring the 2020-2021 PRS residency application cycle, fewer away rotations were offered, and formerly in-person activities were moved to virtual platforms. Virtual activities caused difficulty assessing candidates for many residency programs.

Plastic Surgery Residency Applicants' Perceptions of a Virtual Interview Cycle.

The 2020 to 2021 residency application cycle marked the first year of fully virtual integrated plastic surgery interviews. The virtual format was a double-edged sword for applicants with several advantages, such as reduced costs and time lost from travel, and disadvantages as the novel format introduced new stressors on top of an already demanding process. Concerns included unfair interview invitation distribution, interview "hoarding," and assessing "fit" virtually. In this study, the authors aimed to understand applicants' experiences of the 2020 to 2021 virtual plastic surgery interview cycle. A survey was sent to 330 applicants in the 2020 to 2021 integrated plastic surgery application cycle. The survey included questions about participant demographics, preinterview preparation, virtual interview experiences, and postinterview process. Statistical comparisons were performed on responses using IBM SPSS Statistics version 25.0 (IBM, Armonk, N.Y.). Eighty-nine participants responded to the survey, representing a 27 percent response rate. Applicants received an average of 13.3 interview invitations (range, 0 to 45) and attended an average of 11.4 interviews (range, 0 to 30). Almost half (48.2 percent) did not feel interview invitations were distributed equitably, and more than half (68.2 percent) reported that there should be a limit on the number of interview invitations an applicant can accept. The majority of respondents (88.1 percent) reported spending $500 or less on virtual interviews. Half (50.6 percent) participated in virtual subinternships, of which 30.4 percent became significantly less interested in a program afterward. The inaugural virtual interview cycle had several advantages and disadvantages. Lessons learned from this year could be utilized toward building a more equitable, fair, and effective potential virtual cycle in years to come.