Home Sweet Home: The Integrated Plastic Surgery Residency Match during the COVID-19 Pandemic.

The COVID-19 pandemic has led to inevitable changes in plastic surgery training and the residency application process. Following guidance from the American Council of Academic Plastic Surgeons, plastic surgery residency programs in the United States conducted virtual interviews and online subinternships for the 2021 match cycle.[1]

In previous years, one-fifth of plastic surgery residents matched into their home institution’s residency programs,[2] with approximately 43 percent matching at programs where had they completed an away rotation.[3] Moreover, in a 2020 survey of program directors, 42 percent cited “audition elective/rotation within [one’s] department” as a major factor for determining whether an applicant should be interviewed.[4]

Several constraints exist to the traditional recruitment process, including difficulty with organizing interviews and budgets. The integration of virtual options for applicants in the 2021 match cycle allowed students to engage in “virtual away rotations” and virtual interviews, thereby mitigating expenses and improving interview schedule coordination. However, virtual interviews have morphed a traditionally intimate experience into a digital one, and their benefits come at the price of other challenges – both for applicants and programs. Some reported and perceived drawbacks include: less familiarity with the applicant/faculty, limited program culture insight, and decreased comfort with rank list structuring.[5]

Despite the necessity of the virtual recruitment transition in these unprecedented times, is it possible that programs were more likely to favor their own students/research fellows, or that applicants “up-ranked” their own institutions? We reviewed publicly available match data from Electronic Residency Application Service–participating integrated U.S. plastic surgery residencies between 2018 and 2021. Information was collected on residents’ medical school affiliation for U.S. medical graduates or most recent clinical or research affiliation for international medical graduates (total, n = 734) (Table 1).

Table 1.

Resident Match Data between 2018 and 2021*

Year of Match	No. of Programs with Identified Match Data	Average No. of Available Positions	Total No. of Program Positions	No. of Residents Identified	% Home Matches (Average)
2021	74	2.24 ± 0.98	N/A†	166	31.3
2020	83	2.31 v 1.23	192	191	20.1	17.0
2019	82	2.30 v 1.11	189	188	14.5	17.0
2018	82	2.32 ± 1.10	190	189	16.5	17.0

N/A, not available.

*Data were collected from publicly available information.

†Ten programs had not released 2021/2022 trainee information at the time of data collection.

Results revealed a statistically significant (t test, p = 0.0002) increase in the proportion of home matches in 2021 as compared to the aggregated three previous matches (2018 through 2020) (Fig. 1). Specifically, our data show applicants in the 2021 match were 2.24 times more likely to match at their home institutions than in previous years (CI, 1.32 to 3.8; p = 0.0027).

Fig. 1.

Comparison of the average percentage of positions given to home applicants by integrated plastic surgery residency programs across a sample of years before the virtual interview cycle (2018 through 2020) and during the virtual interview cycle (2021). A two-sample t test was used to evaluate the difference in means (*p = 0.0002).

Such results are significant for several reasons. First, it demonstrates that when confined to a virtual approach, institutions successfully implemented virtual interview processes, albeit with some perceived drawbacks. Second, this suggests corroborative information supporting recent literature citing that applicants were less comfortable ranking unfamiliar programs after virtual interviews.[4] Applicants, as a result, were perhaps more likely to hedge their bets by “up-ranking” their home institution, with which they were presumably more familiar. If correct, understanding what this means for applicants at schools without plastic surgery residencies becomes even more important. Furthermore, with the possibility of future hybrid interview models, it will be important to determine whether in-person interviews, if offered, play an advantageous role over virtual ones.

We hope upcoming studies with qualitative survey elements can address these questions, including how 2021 applicants and home programs ranked each other, and delineate the motives for selecting programs in an atypical cycle. Overall, the landscape of residency applications was transformed in 2021. The particulars of how best to conduct virtual recruitment and interviews require thorough investigation.

DISCLOSURE

The authors report no funding sources, financial interests, or conflicts of interest concerning the materials or methods used in this study or the findings specified in this study.