The Impact of the COVID-19 Pandemic on Plastic Surgery Match Rates.

The COVID-19 pandemic has been the impetus for many changes in medical education, including in the 2021 plastic and reconstructive surgery residency match process. Clerkships were postponed, leaving students with abbreviated, ad hoc schedules and nonstandardized grading policies.[1] Disruptions also occurred nationally, with suspension of United States Medical Licensing Examination testing and the discontinuation of Step 2 CS. Perhaps most importantly for the plastic and reconstructive surgery match process, students were restricted from visiting other institutions, thus eliminating in-person interactions with programs and requiring interviews to be virtual.[2] It is not clear what impact these changes had on the 2021 plastic and reconstructive surgery match process.

Given that most students who match into integrated plastic and reconstructive surgery programs have a combination of excellent clerkship grades, high board scores, and several publications, other aspects of the application have been deemed critical for distinguishing applicants, such as letters of recommendation and prior personal knowledge of the applicant.[3] This has been the impetus for many applicants participating in two or three subinternship rotations at programs outside their home program, spending a mean period of 9.2 weeks on these rotations.[4] These experiences have been shown to be critical to the match process; in a 2016 survey of plastic and reconstructive surgery program directors, 16.7 percent reported that an away rotation at their institution would guarantee an interview.[4] In an analysis of the 2013 and 2014 integrated plastic and reconstructive surgery match, 29 percent matched at a program where they had completed a visiting clinical rotation.[5] However, with COVID-19 restrictions eliminating this key factor, both programs and applicants have been left with a paucity of information about one another, with only virtual modalities (virtual subinternships and interviews) to address this deficit.

Integrated plastic and reconstructive surgery residents were identified and recorded between 2015 and 2021 to determine whether they matched at residencies affiliated with their medical school. Public domain information search tools were used (e.g., residency program websites and social media accounts). Independent-track residents were excluded. Following the public release of the 2021 match data, trends from the 2015 through 2021 years were calculated. Only four programs had absent or incomplete public information that was not fully recoverable with additional public domain search. A total of 82 programs and 1197 integrated residents were included, and the chi-square statistic was used.

More applicants matched at their home program in 2021 (26.9 percent) than in the previous six years (17.2 percent, p = 0.001) (Fig. 1). Furthermore, 2021 was the only year with a greater than 25 percent match rate at a home institution. (See Table, Supplemental Digital Content 1, which shows that the 2021 match cycle demonstrated a 156 percent increase in the rate of home institution–matched integrated plastic surgery applicants compared with the previous 6 years, http://links.lww.com/PRS/F93.)

Fig. 1.

A significantly greater proportion of 2021 applicants matched into residencies affiliated with their home program compared with the previous 6 years (p = 0.001).

It is notable that in an application cycle when in-person interaction was severely limited, the national match trend significantly favored home applicants who were able to participate in live subinternships. More than one in four plastic and reconstructive surgery applicants matched at their home program. While further investigation is clearly warranted, these findings suggest that in the setting of limited information about applicants, firsthand knowledge of an applicant’s potential “fit” for a residency may supersede even standardized metrics such as examination scores and publications. With the advent of changes such as the introduction of pass/fail to Step 1 of the United States Medical Licensing Examination, the significance of these findings cannot be understated.

DISCLOSURE

None of the authors has a financial interest to declare in relation to the content of this article.