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Objective: Doctors of Osteopathic Medicine (DOs) are sparsely represented within plastic and reconstructive surgery (PRS) and recent changes including the elimination of step 1 scoring have further disadvantaged DO applicants. The demographics, degrees, and scholarly output of DO PRS trainees were compared to that of Doctors of Medicine (MDs) to identify areas of focus which could be used to increase competitiveness of DO applications., Design: A cross-sectional study was created, including ACGME-accredited PRS program trainees during the 2020 to 2021 academic year. DO and MD trainee demographics and scholarly accomplishments were compared using t-test and chi-squared analysis., Setting: Web-based publicly available information was collected for subjects., Participants: A total of 1092 PRS MD and DO trainees were identified. DOs made up only 2.7% (n = 30) and MDs made up 97.3% (n = 1062)., Results: More DOs trained in independent programs (63.3%) than integrated (36.7%) compared to MDs (88.2% v. 11.8%, p < 0.001) and more DOs trained at lower ranked PRS programs (60.0% of DOs and 18.1% of MDs trained at Q4 programs, p < 0.001). DOs had fewer publications (median, IQR: 1, [0-2]) compared to MDs (3, [1-8]), fewer citations (0, [0-6]) vs. (10, [1-56]) and lower H-index (1, [0-1]) vs. (1, [1-3])., Conclusion: DO candidates should consider research years in the field of PRS and optimize clinical experience opportunities to increase the competitiveness of their PRS applications. Special attention should be paid to providing networking and research opportunities to DOs who lack home institutions., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The cancellation of clinical rotations (CRs) and implementation of virtual interviews (VIs) profoundly affected the residency selection process leading up to the 2021 NRMP Match. The authors investigated how these changes influenced the caliber of applicants taken by general surgery (GS) residency programs from the perspectives of program directors (PDs)., Methods: A 14 question, web-based electronic survey was emailed to PDs of ACGME-accredited GS residency programs. Questions sought program characteristics and PDs' perspectives regarding potential differences in subjective characteristics and clinical skills demonstrated by their 2021 Match class relative to previous resident classes., Results: A total of 75 PDs (27.2%) responded to our survey. Most respondents observed no changes in residents' fit with their program (72.0%), communication skills (68.0%), responsiveness to clinical instruction and feedback (73.3%), work ethic (73.3%), and rotation evaluations (68.0%). Only 21.3% of PDs believed that VIs negatively impacted their ability to accurately assess applicant intangibles. Conversely, 56.0% of PDs reported that the cancellation of CRs in 2020 negatively affected residents' clinical competency at the start of residency. At 1-year following the 2021 NRMP Match, 30.7% of PDs reported that the clinical skills exhibited by their 2021 Match class were poorer than previous resident classes., Discussion: Our findings suggest that VIs limited selection committees' ability to accurately assess applicant's subjective characteristics to a lesser degree than previously described in the literature. Canceled CRs adversely affected the 2021 Match Class's clinical skills at the start of residency and at 1 year following the 2021 NRMP Match., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Virtual interviews (VIs) for the 2020 residency application season were mandated as a result of the COVID-19 pandemic. We aimed to determine the perspectives of general surgery (GS) program directors (PDs) on the benefits and drawbacks of VIs., Methods: A 14-item survey was emailed to all GS PDs from programs identified on the American Council for Graduate Medical Education website. Program directors were asked about the cost-time benefit of VIs, its ability to assess candidates, and their thoughts on the future of VIs for evaluating residency applicants., Results: 60 PDs responded corresponding to a response rate of 21%. While 93% agreed/strongly agreed that VIs were less expensive, only 35% found VIs to be less time-consuming. 75% and 67%, respectively, disagreed/strongly disagreed that VIs allowed for an easier assessment of an applicant's fit, and personality and communication skills. Almost one-half of our survey respondents suggested that VIs made the selection committee rely more heavily on objective applicant data. Almost two-thirds of GS PDs suggested that they would adopt both VI and in-person interview formats for future application cycles. The median [interquartile range] cost saved through the implementation of VIs was US$ 4500 [1625 - 10 000]., Conclusion: Remarkably, VIs have been swiftly imbibed by all residency programs and many aspects of the VI experience were positive. While MATCH 2021 has definitely proved to be one of its kind, the implementation of VIs has been met with overall broad success and a promising future awaits this novel modality of resident selection to GME programs in the United States.

The technology of artificial intelligence (AI) has made significant in-roads into the field of medicine over the last decade. With surgery being a discipline where repetition is the key to mastery, the scope of AI presents enormous potential for resident education through the analysis of technique and delivery of structured feedback for performance improvement. In an era marred by a raging pandemic that has decreased exposure and opportunity, AI offers an attractive solution towards improving operating room efficiency, safe patient care in the hands of supervised residents and can ultimately culminate in reduced health care costs. Through this article, we elucidate the current adoption of the artificial intelligence technology and its prospects for advancing surgical education.

Background: The 2020 to 2021 residency and fellowship application cycles were profoundly affected by the introduction of virtual interviews. The authors investigated the impact the virtual format had on plastic surgery residency and fellowship interviews from the perspectives of program directors., Methods: Surveys were sent to program directors of integrated plastic surgery residency and fellowship programs to ascertain their perspectives regarding the virtual format's impact on residency and fellowship interviews. Program directors were stratified into residency and fellowship cohorts, and comparative analysis was performed., Results: Ninety-two program directors, 28 from integrated plastic surgery residency programs and 64 from fellowship programs, completed our survey (35 percent). Compared to in-person interviews, virtual interviews were reported to be more economical and time efficient by program directors of residency (100 percent and 46 percent, respectively) and fellowship programs (97 percent and 48 percent, respectively). Consequentially, 36 percent and 47 percent of residency and fellowship programs were able to interview more applicants, respectively. Program directors of residency and fellowship programs reported that virtual interviews hindered their ability to assess applicants' fit with the program (75 percent and 63 percent, respectively), personality and communication skills (75 percent and 64 percent, respectively), and commitment to the field, along with their ability to function as a trainee (57 percent and 50 percent, respectively). Overall, 71 percent of program directors of residency and 58 percent of program directors of fellowship programs preferred in-person interviews. The majority of residency (71 percent) and fellowship (56 percent) program directors intend to conduct both in-person and virtual interviews in future application cycles ( p = 0.12)., Conclusions: Despite preferring in-person interviews, program directors intend to host both in-person and virtual interviews in future application cycles. It remains to be seen how virtual interviews will be used moving forward., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Abstract: Humanitarian mission trips have been organized by several residency programs and organizations to cater to surgical care in underdeveloped countries. While there is cross-talk on the existence of such opportunities, there is a paucity of guidance to residents on participation in such trips, their benefits, and the myriad of intangibles to consider while planning to pursue such opportunities. Through this article, the authors highlight the background and utility of humanitarian surgical missions and summarize the clinical and surgical experiences that these trips offer for residents choosing to embark on these altruistic journeys., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Background: MATCH 2021 was short of the classic "in-person" component. Herein, we assess the impact of virtual interviews (VIs) on resident selection, from the perspectives of program directors (PDs) across all surgical specialties., Materials and Methods: We conducted a cross-sectional survey-based study of ACGME-accredited US residency program directors (PDs) of all surgical specialties. The survey was designed based on a review of relevant literature and inquired about the strengths, limitations, and overall utility of VIs., Results: A total of 365 PDs responded to our survey. Almost all respondents (90%) found VIs to be less expensive than in-person interviews, while only 34% agree that VIs were less time-consuming. Only a median of 5% of interviews was complicated by technical difficulties. Most PDs found it more challenging to assess applicants' fit (75%), personality and communication skills (71%), and commitment to specialty (60%). Only 14% found VIs to be overall better for assessing residency applicants. In future cycles, most PDs are planning to host both virtual and in-person interviews (57%), while 35% and 8% will host exclusive in-person and virtual interviews, respectively., Conclusions: VIs are a novel way of dealing with the restrictions imposed by COVID-19. Despite their cost and time benefit, they present particular challenges in evaluating residency applicants. A combination of both virtual and in-person interviews will likely be implemented in the coming cycles., (Copyright © 2021 Elsevier Inc. All rights reserved.)

As the decision to permanently suspend the USMLE Step 2 Clinical Skills exam resonates across the medical education landscape, it has different implications for the graduates of American allopathic (US-MD), osteopathic (DO) medical schools and international medical graduates (IMGs). Through this perspective, we as authors who represent each of these three diverse cohorts highlight the changes that resulted from the COVID-19 pandemic and delve into the multitude of ramifications that could ensue as a result of this decision. Our propositions are geared towards a standardized objective structured clinical examination for evaluating US-MDs and DOs, and a call for novel evaluation strategies to assure the minimum clinical standards of IMGs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: In 2020, Step 1 of the United States Medical Licensing Examination (USMLE) changed to a pass/fail reporting. Step 1 has been one of the main factors for both inviting applicants for interviews and for ranking in Plastic Surgery. Due to this change, we hypothesize that Step 2 CK - currently the only remaining, universal quantitative metric - will become the main factor in the residency selection process., Methods: A survey-based cross-sectional study of United States (US) integrated plastic surgery program directors (PSPDs) investigated the factors that would assume importance following the change in the reporting pattern., Results: Respondents reported that personal prior knowledge of the applicant, Letters of recommendation (LORs), Step 2 CK scores, and away rotation at the institution of interest would become the most important factors (median ratings of 5, 4.5, 4.5, 4.5, respectively on a 5-point Likert scale). Eighty-three percent of respondents were strongly dissatisfied with the conversion to pass/fail reporting. LOR's received the highest ranking (median,1; IQR,1-2) as the component used for offering away rotations after the implementation of the pass/fail reporting, followed by the applicant's medical school (median, 3; IQR, 3-4), and grades obtained during medical school (median,3; IQR,1.75-4). Standardized assessment during rotations are recommended by 67% of PSPDs., Conclusions: Future emphasis will be placed primarily on subjective metrics, including applicant familiarity. Step 2 CK, LORs, and away rotation at the institution of interest are other factors of importance. PSPDs welcome the adoption of objective assessments of patient care and medical knowledge to improve the current selection process., Competing Interests: Conflicts of Interest The other authors have no conflicts of interest/financial relationships to disclose with reference to the contents of this manuscript. This work did not receive any funding., (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest and sources of funding: none declared.

The COVID-19 pandemic has presented unique challenges to medical education. With the lack of in-person away rotations for the 2020-2021 residency application cycle, virtual rotations have surfaced as an alternative. The virtual rotations that the authors participated in allowed for active participation in various resident educational activities such as journal club, grand rounds, and morning conferences. One critical aspect of virtual rotations was the one-on-one meetings with the program leadership. In addition to a virtual tour of the hospital and campus, many programs offered virtual social hours with the residents to converse about the program, the city, and the match process. A few programs even allowed applicants to attend virtually live-streamed surgeries. These rotations offer students, especially those without a corresponding home program, an invaluable opportunity to express their interest in a particular program and gain foundational knowledge about the specialty. Virtual rotations also provide underrepresented minorities and international medical graduates with clinical exposure, mentorship, and networking opportunities, mitigating some of the challenges presented by COVID-19., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: International medical graduates (IMGs) are often relegated to preliminary positions in general surgery (GS) owing to uncertainties about the candidate's performance in the American healthcare setting. We aimed to determine the comparative performance of IMGs and American medical graduates (AMGs) at baseline and assess these trends over the course of their GS internship., Methods: Evaluations of all IMG preliminary and AMG categorical interns from 2013 to 2017 at our GS residency program were obtained from three faculty members to score overall performance, technical skills, interpersonal communication, and medical knowledge on a 10-point Likert scale. Scores on the American Board of Surgery In-Training Exam, an in-house preparation test, United States Medical Licensing Exam, and performance during the biannual multistation objective assessments were compared between the two resident groups., Results: Seventy-two interns (28 [39%] AMG categorical and 44 [61%] IMG preliminary) met inclusion criteria. The AMG group had significantly higher median Step 1 and Step 2 scores compared with our IMG group (243 versus 231, P = 0.002, and 250 versus 246, P = 0.03, respectively).Although in-house preparation test scores were higher among IMGs (median [interquartile range] of 36 [33-40] among AMGs and 38 [34-45] among IMGs; P = 0.002), there were no statistically significant differences between the American Board of Surgery In-Training Exam scores of the two groups. The median scores for the four faculty evaluation components were similar between the AMG (7, 8, 7, 7) and IMG resident groups (7, 7, 7, 7; P = nonsignificant). IMGs scored significantly higher in both biannual multistation objective assessments than AMGs (median [interquartile range] July: 59 [47-91] versus 55 [37-62], P = 0.005; January: 103 [86-116] versus 91 [87-104], P = 0.03)., Conclusions: It is reassuring to confirm that no matter where they are from, great candidates can perform well as surgical interns in a GS training program., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The recent consensus from the Invitational Conference on USMLE Scoring has recommended a transition to a binary pass/fail reporting on the USMLE Step 1 exam to be implemented from January 22, 2022. While this change was instituted in an effort to decrease medical student stress and re-iterate the importance of the Step 1 as merely a licensing or qualifying exam, this decision has profound implications for medical graduates of both United States and foreign medical schools. In addition to compounding the difficulties of resident selection by residency programs, the new system could exert significant mental and financial burden on medical students, and potentially affect the diversity of graduate medical education in the United States. This article draws attention to the downstream effects of a pass/fail system on the future of medical and surgical education., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

The COVID-19 pandemic has posed unique challenges for evaluating general surgery residency applicants to MATCH 2021. In the absence of away rotations, programs are likely to afford greater importance to objective data to stratify the applicant pool and medical students are likely to experience difficulty in thoroughly assessing each program. Virtual rotations, meet-and-greet events conducted before the application submission deadline, personality testing before extending interviews, standardized letters of recommendation, and skills testing can serve as valuable adjuncts for determining the best applicant-program fit. Finally, an interview limit which sets the bar for the maximum number of accepted interviews per applicant per specialty can offer a level playing field in the absence of time and cost limitations associated with travel., Competing Interests: The authors report no conflicts of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: While dedicated research time (DRT) offers international medical graduates (IMGs) exposure to the US healthcare system and helps boost their residency application, it can lengthen time away from clinical activity. We aimed to determine the value of DRT/protected research time for an IMG applying to general surgeryresidency (GSR)., Design: Cross-sectional survey., Setting: Academic, tertiary care center with a large GSR program (Mayo Clinic, Rochester, MN)., Participants: IMG applicants to our GSR program (2015-2018) and general surgery program directors (PDs) in the United States., Methodology: Separate surveys were emailed to all IMG applicants to our GSR program (2015-2018) and general surgery PDs. Surveys to the applicants focused on the details of DRT spent in the US prior to residency and match outcomes. Surveys to the PDs focused on the importance of different aspects of an IMG applicant's research experience., Results: Applicants: 320 applicants responded of which 148 (46%) applicants spent DRT in the US prior to residency. Among the research group, the median (interquartile range [IQR]) number of first author podium and poster presentations from the DRT were 1 (0-4) and 2 (1-5), respectively. At the time of match application, the median (IQR) number of published manuscripts among the research group was higher than that among the applicant group which did not pursue DRT (5[2-12] vs 1[0-2], p < 0.0001). Pursuing DRT and/or the duration of the research did not affect the match outcomes (p > 0.05)., Program Directors: Seventy-six PDs responded to our survey. A median (IQR) of 2.5 (2-3) publications, and 2 (2-3) presentations per year of DRT were considered "productive." Sixty-three percent of PDs did not recommend IMGs take time off to engage in research; only 54% attributed some importance to an IMG's research experience., Conclusions: DRT does not seem to be associated with better outcomes for IMGs targeting GSR. Most PDs advocate against taking time off after graduation to engage in research activity. Decisions to pursue DRT should be individualized., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The nondesignated preliminary (NDP) position in general surgery (GS) offers a 1-year surgical training opportunity for medical school graduates prior to obtaining categorical residency positions. Given that there is little long-term follow-up on the experiences of NDP residents, we sought to determine how NDPs felt about their intern year in GS., Design: A cross-sectional survey of all NDP GS interns from 1993 to 2018., Setting: Academic, tertiary care center with a large GS residency program (Mayo Clinic, Rochester, MN)., Participants: NDP GS interns (n = 151)., Results: Two-hundred and four surveys were emailed and 151 (62%) former NDP residents responded. Exposure to diverse pathology (85%), opportunity to work with experts (85%) and operative experience (72%) were the top 3 positive experiences from the NDP year. The uncertainty of being an NDP resident (78%) and experience compared to categorical counterparts (32%) were cited as the top 2 negative experiences. While 73% (n = 110) considered their NDP year to have laid a "strong" foundation for their future career, most respondents felt that the year was stressful and suggested improving mentoring and support for preliminary residents. Eighty-two percent (n = 124) of respondents stated that, they would be willing to redo their preliminary year. Fifty-four percent (n = 82) of respondents stated that they might have preferred a categorical position at a smaller institution versus a preliminary year. Forty percent of respondents (n = 60) reported fewer interviews and 24% (n = 36) reported a similar number of interviews offered when applying to the Match as a PGY1 prelim resident., Conclusions: Pursuing the NDP year is difficult, given the uncertainty that looms and the immense pressure to perform well. While the vast majority of our NDPs obtained categorical residency spots following their 1 year of training, feedback from this survey using 25 years of experience suggests that we can and should do more to mentor, support, and assist these residents., (Copyright © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Non-designated preliminary, general surgery interns have no job security after year 1. Understanding how such non-designated preliminary, general surgery interns fare at any single institution might help future prelim applicants make better ranking decisions. We aimed to analyze the outcomes of residents pursuing a non-designated preliminary year in general surgery at a single institution., Methodology: A retrospective cohort analysis of non-designated preliminary interns, who completed a preliminary year at our institution from 1993 to 2017, was conducted to understand their career path after the preliminary general surgery year., Results: Three hundred and fifteen non-designated preliminary interns (232 international medical graduates and 83 American medical graduates) were identified. Two hundred and thirty-five (75%) matched into categorical residency spots (115 [49%] in general surgery, 18 [8%] each in orthopedic surgery and anesthesiology) after their preliminary year, 58 (18%) matched into a second year preliminary spot, and 22 (7%) left graduate medical education. American medical graduates (90%) more commonly matched into categorical spots than international medical graduates (69%; P < .0001). One hundred and fifty-four (49%) of our total nondesignated, preliminary resident cohort eventually garnered categorical general surgery residency positions. Importantly, 33 (65%) of our non-designated, preliminary residents who pursued a postgraduate year 2 preliminary surgery position subsequently obtained a categorical general surgery position. Twenty-nine nondesignated, preliminary interns joined our general surgery training program to fill open postgraduate year 2 slots. Of our nondesignated, preliminary residents (n = 300), 95% are currently practicing in the United States., Conclusion: Most nondesignated, preliminary residents at our institution secured categorical spots for continuing graduate medical education. A preliminary internship year seems a useful endeavor for most trainees and even a second prelim year produces a categorical position for most of these driven and hard-working individuals., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The letter of recommendation (LOR) is an important component of a residency application. There is great subjectivity in the interpretation of a letter writer's narrative and many residencies have moved toward standardized LORs (sLOR). We aimed to scrutinize the importance afforded to specific content and applicant attributes in an LOR in hopes of decoding this time-honored process., Design: A 35-question survey comprised of nonidentifying general questions, and participant evaluation of applicant characteristics and LOR phrases were administered (cross-sectional design). Evaluations were scored both objectively on a 10-point Likert scale and subjectively using a relative ranking., Setting: Academic, tertiary care center with a large general surgery residency program (Mayo Clinic, Rochester, MN)., Participants: Surgery attendings and general surgery residents (n = 122)., Results: Seventy-two attendings and 50 general surgery residents completed the survey. Faculty ranked strong work ethic/hard working (median rank = 1) and inquisitive/hungry learner (median rank = 3) as the top 2 attributes. "We will plan to recruit this candidate" (median rank = 1.5) and "I give my highest recommendation" (median rank = 2) were the top 2 phrases. Residents valued strong work ethic and collaborative/team player as the top 2 applicant attributes. Seventy-three percent of attendings and 82% of residents agreed that LOR allows the applicant pool to be divided into upper and lower halves. Only 17% of faculty and 18% of residents agreed that an LOR allowed candidate stratification into quartiles., Conclusions: Elaborating the most favorable applicant characteristics and highly regarded content in an LOR will help truly exceptional candidates obtain letters that make them stand out in the eyes of their evaluators. Since LORs are mostly considered to be able to stratify only upper and lower halves of the applicant pool, it is imperative to move toward LORs which portray superior applicant qualities, and can provide more objective evaluation of a candidate., (Copyright © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)