The Impact of the SARS-CoV-2 (COVID-19) Pandemic on the 2020 to 2021 Integrated Plastic Surgery Residency Cycle.

As the 2020 to 2021 residency application cycle commences, plastic and reconstructive surgery programs and applicants are adapting to various changes associated with coronavirus disease of 2019 (COVID-19).[1,2] We completed the first study assessing the impact of COVID-19 and related uncertainties on this year’s integrated plastic and reconstructive surgery residency cycle. Despite applicants’ expectations for a shift in the application process and applicant evaluation paradigm, program directors expected that changes were unlikely.

We developed and distributed two surveys: one for applicants and another for program directors. Surveys were distributed electronically by means of e-mail and online forums specific to plastic surgery. Seventy-six students applying this cycle responded to the survey, with 26 excluded from analysis because of incomplete submission. Twenty-seven program directors representing 32.1 percent of programs participated in the study, with seven excluded for incomplete submission.

Student responses confirmed the specific disruptions they have experienced in the application process. Sixty-four percent of applicants reported cancellations in Step 2 scheduling, and 80 percent of applicants experienced cancellations of their plastic and reconstructive surgery subinternships. Applicants also expected to have on average two fewer letters of recommendation from plastic surgeons.

Survey responses also highlighted several areas where applicants and program directors differed in their perceptions of the ways this year’s cycle would diverge from prior years. Applicants expected significant changes in the way certain aspects of their applications would be evaluated, specifically, letters of recommendation from plastic surgeons, personal knowledge of the applicant, and involvement in research. In contrast, program directors reported that such factors would be regarded with the same importance as they have in previous years (84 percent versus 50 percent, p = 0.006; 74 percent versus 25 percent, p < 0.001; 60 percent versus 20 percent, p = 0.003 for each criterion) (Table 1). Furthermore, program directors did not anticipate taking more applicants from the home institution (4.5 versus 3.5 on a Likert scale, p < 0.001) or increasing interview numbers (3.5 versus 2.6 on a Likert scale, p = 0.002) as a response to reduced away rotations.

Table 1.

Applicant and Program Director Survey Response Comparison for Common Questions

	Applicant Results (%)	PD Results (%)	p
No.	50	20
Survey question
Given the COVID pandemic, which of the following NRMP factors do you expect programs to evaluate differently?
USMLE Step 1/COMLEX scores	20 (40.0)	5 (25.0)	0.280
Letter of recommendation in specialty	42 (84.0)	10 (50.0)	0.006*
Personal statement	11 (22.0)	5 (25.0)	0.763
Grades in required clerkships	13 (26.0)	4 (20.0)	0.761
Personal prior knowledge of applicant	37 (74.0)	5 (25.0)	<0.001*
Audition elective	28 (56.0)	8 (40.0)	0.226
Evidence of professionalism	7 (14.0)	2 (10.0)	1
Alpha Omega Alpha Honor Medical Society membership	10 (20.0)	4 (20.0)	1
Demonstrated involvement in specialty/research	30 (60.0)	4 (20.0)	0.003*
Perceived commitment to specialty	28 (56.0)	7 (35.0)	0.185
Grades in clerkship for specialty	11 (22.0)	3 (15.0)	0.742
How likely is it that programs perception toward international graduate will change because of COVID-19?†	3.5	1.8	<0.001*
How likely do you think it is that programs will increase the number of interview spots to compensate for the lack of away rotations?†	3.5	2.6	0.002*
How likely do you think it is that programs are more likely to accept an applicant from the same institution as their program because of COVID-19?†	4.5	3.5	<0.001*
How likely do you think it is that letters from non-PRS physicians will be viewed more leniently than previous cycles?†	3.7	3.3	0.124
Students whose home institutions do not have a PRS program may have less of an opportunity to obtain LORs and clinical experience in the field. How likely do you think it is that this will be taken into consideration?†	3.7	4.1	0.164

PD, program director; NRMP, National Residency Matching Program; USMLE, United States Medical Licensing Examination; COMPLEX, Comprehensive Osteopathic Medical Licensing Examination; PRS, plastic and reconstructive surgery; LOR, letters of recommendation.

*Statistically significant.

†Scaled questions: 1 = very unlikely, 2 = unlikely, 3 = unsure, 4 = likely, and 5 = very likely.

Survey responses from program directors in our study showed that factors for extending interview invites and ranking applicants have not significantly changed with COVID-19. Four of the top five important factors for extending interview invites in our survey results were identical to that of the 2018 National Residency Matching program director survey results, except for a higher emphasis on grades in required clerkships compared to Alpha Omega Alpha Honor Medical Society membership (Fig. 1).[3] Similarly, the top five factors for ranking interviewees as reported by program directors in our study were unchanged from the 2018 survey.[3]

Fig. 1.

Top five current factors in selecting applicants for interview invites.

Overall, program directors and applicants were in concordance on several aspects of changes in the application process, including an understanding that students without home programs would have difficulty obtaining clinical experience and letters of recommendation from plastic and reconstructive surgery physicians. However, applicants expected a greater shift in the match process compared to program directors, who anticipated a relatively unchanged application cycle or weighting system compared to previous years. Although students expected increased interview invitations and home student selections as a response to reduced away rotations, program directors did not share the same sentiment. Direct messaging and transparency on the part of programs is imperative in dispelling other differences in perception between programs and applicants.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.