by Shuja Shafqat, Amanda Silva, Sammy Sinno
“What makes a plastic surgery residency program attractive?” Certainly, the question posed in the title of the article by Atashroo et al is loaded (1). Can one determine these factors in one of the most competitive surgical subspecialties? How can these variables be teased out in a field where close to 100% of the spots are matched? Understanding this process is a colossal task with such highly sought after positions in some of the best institutions in the country. A seemingly endless string of elements may play into each individual’s rank list. A majority of these factors have been outlined previously (2). Whether case volume, focus on a cosmetic versus reconstructive surgery, research, geography, clinic support, interpersonal relationships, or just a gut feeling, these all have an intricate interplay on where a program may be at the top of a candidate’s mind. Therefore, it seems crucial that these features be investigated further.
Studies have examined which criteria are important for matching in a plastic surgery residency program (3). With the ever-changing structure in residency training, including the recent boom in integrated programs, it is becoming increasingly important to look at the Match from multiple viewpoints. Atashroo and colleagues sought to determine which key aspects of plastic surgery residency programs are most important to applicants. In the process, they provided very valuable information for program directors and department chairs in order to improve their recruitment strategies.
The authors created a 21-item online survey with questions on demographics, ranking of importance of program attributes, and an open-ended discussion section through the collaboration of plastic surgery faculty and a statistician. This was sent to plastic surgery program coordinators after the 2012 and 2013 Match to distribute to their newly matched residents, and was to be completed during their 1st month of residency.
This study had a 38% survey response rate (92 of 245). Residents stated that the most important factor to them during the application process was the perception of resident happiness. This was followed by high operative volume, faculty mentorship, strong research infrastructure, and resident benefits such as funds for loupes, books, and conferences. Applicants who had a step 1 score greater than 245 or were AOA did not value resident happiness as much. Additionally those with higher step 1 scores did not place as much value on faculty mentorship, and were more likely to consider geography important in their decision process. Applicants with a strong research background (defined as greater than 2 publications) were more likely to value a strong research infrastructure and program reputation. Additionally if the applicant had greater than 10 interviews, research infrastructure became more important in the decision making process. The most common negative factor according to applicants was the perception of a malignant program.
Over 75% of residents had matched into one of their top 3 choices. 43% of residents had completed an away rotation at the program they matched to, and these applicants were more likely to have matched higher on their rank list. Factors involved in deciding where to do an away rotation were location and the ease of communication with the program coordinator.
Certainly, there has been a need for a study that examines the Plastic Surgery Match from the applicant’s perspective. Since Janis et al. detailed the competitiveness and selectivity of the Match from the program director’s perspective in 2008, the landscape of plastic surgery residency has changed significantly.3 Most importantly, there are more total integrated and combined programs as the number of independent programs decreases. In 2011, there were 70 integrated and combined positions in the Match, which has increased to 148 positions available in 2015. This shift has resulted in program directors accustomed to interviewing residents near the end of their training now having to select medical students for their programs. Additionally, the average number of ranked applicants per position needed to fill all positions within programs has increased from 2.8 to 5.8. For programs wishing to recruit the best applicants, an understanding of what applicants desire is vital.
Favorable program attributes such as resident rapport, training environment, and amount of time spent on plastic surgery rotations were found to be consistent with another recent study (4). While the 38% response rate is certainly above average for electronically based questionnaire studies, and demographics were similar to those reported by the NRMP, this sample may not accurately represent the entire applicant pool. For instance, the authors released the questionnaire well after the Match results had been announced and it is possible that residents who were satisfied with their Match responded to a greater degree than those who were less satisfied. It may be most interesting to survey applicants before and after the Match, in integrated versus independent programs, and throughout the course of residency training as factors may become more or less important with time. This would also be valuable information to the applicant, who may think they know what they want in a program during the interview process, but realize throughout their training other factors that they had not considered previously are more important.
Overall, this paper is one of few that give insight into the plastic surgery applicant’s perspective. It is a must read for any prospective applicant, but perhaps more importantly for residents, fellows, and faculty as a guide to highlight their programs positive attributes to attract the best applicants.
- Atashroo DA, Luan A, Vyas KS, et al. What Makes a Plastic Surgery Residency Program Attractive? An Applicant’s Perspective. Plastic and reconstructive surgery. Jul 2015;136(1):189-196.
- Naghshineh N. Choosing a residency program. Plastic and reconstructive surgery. Jan 2010;125(1):33e-34e.
- Janis JE, Hatef DA. Resident selection protocols in plastic surgery: a national survey of plastic surgery program directors. Plastic and reconstructive surgery. Dec 2008;122(6):1929-1939; discussion 1940-1921.
- Sinno S, Mehta K, Squitieri L, et al. Residency characteristics that matter most to plastic surgery applicants: a multi-institutional analysis and review of the literature. Annals of plastic surgery. Jun 2015;74(6):713-717.