Visiting Subinternships in Wake of the COVID-19 Crisis: An Opportunity for Improvement.

The COVID-19 pandemic has created unanticipated challenges for our nation’s healthcare systems. With current models projecting the disease burden to increase in the coming weeks, hospitals have adopted policies to liberate vital resources to mitigate the impact of the outbreak. Per American College of Surgeons guidelines, many hospitals have suspended or significantly curtailed elective surgeries[1]. Medical students have not been spared from the fallout. In accordance with the AAMC, medical student rotations have been temporarily suspended, with many schools going further and officially cancelling rotations through the summer months[2]. In response to this evolving situation, plastic surgery programs must prepare to deal with the ramifications this will have on the Match process this year and potentially next.

Currently, completing both home and away rotations is crucial to a successful plastic surgery application, with over 90% of applicants completing at least one away rotation[3]. These rotations provide opportunities for students to evaluate training offered at various programs and earn letters of recommendation. Similarly, both home and away rotations enable programs to select candidates who are the best “fit” for their residency. Underscoring the significance of this process, it is estimated that over half of applicants match at either their home institution or a program where they completed an away rotation[3,4].

While it may seem premature with the peak of away rotation season still months away, the COVID-19 outbreak has already put the away rotation system in jeopardy, and programs must quickly adapt[5]. When looking at applicant and program motivations during away rotations, interacting with residents and faculty was deemed to be the single most important activity[6]. While not ideal, virtual meetings between applicants and residents could give both parties a chance to interact before interview day. Similarly, broadcasting conferences and grand rounds in addition to web posts displaying the interests and backgrounds of current residents could give applicants insight into the culture of a given program. Programs should begin to explore these options now so that they are ready for applicants to utilize by the summer months.

On a separate note, the challenges posed by this pandemic provide an opportunity to reevaluate the equity of the plastic surgery match process. The away rotation system disadvantages applicants without the financial means to be able to freely rotate at programs across the country. In a recent survey of applicants, it was estimated that candidates spent over $3500 alone for away rotations before facing the costs of a lengthy interview season, and cost was an important factor when selecting where to complete away rotations[6]. Beyond even cost, scheduling differences between medical school’s advantage students who finish core clerkships early in their third year over students who have to wait until after July to schedule away rotations. At first glance, making short-term changes, like being more accommodating to visiting students and extending the application deadline, may seem like the simplest solution for the current predicament. Yet, this would do nothing to address the persistent issues of travel, access and financial inequity, inherent to the away rotation system. Developing more creative solutions, like virtual mentoring and online educational platforms, may offer a long-term solution to this problem. Rising to this challenge could reduce the need for away rotations and create a more equitable plastic surgery match process for all.