Aesthetic Surgery Fellowship Selection Criteria: A National Fellowship Director Survey

Factors Affecting Selection of TraineE for Neurointervention (FASTEN)

BACKGROUND AND IMPORTANCE

Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process.

METHODS

A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs' characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate's residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)].

CONCLUSION

Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process.

Exploring Trends in Immediate Postresidency Career Paths: A Multi-year Analysis of Plastic Surgery Resident Graduates Across the United States

Background

Plastic surgery is one of the most diverse specialties in medicine. Because of the competitiveness of plastic surgery residency, applicants are entering the field with increased experience and more developed interests in specific specialties. Programs and prospective applicants may find it beneficial to know trends in the career paths of recent graduates.

Objectives

To identify trends in postresidency career paths for plastic surgery graduates.

Methods

Data from all integrated plastic surgery residency programs were analyzed from 2013 to 2022. Eighty-eight residency programs were analyzed for review. Residency websites were the primary source of data. Postresidency career paths were categorized into subspecialty fellowships, academic practice, or private practice. Secondary data included program rank, size of the program, associated fellowship program, associated independent program, and program location.

Results

Seventy-three programs met the inclusion criteria. Private practice was the most common immediate postgraduation path. Microvascular and aesthetic fellowships demonstrated maximum growth in the last 10 years, followed by hand fellowships. Programs ranked in the top 25 by Doximity reputation were significantly associated with graduates going into craniofacial (P = .05) and microvascular fellowship (P = .021), and immediate academic practice (P = .011). Lower-ranked programs were correlated with higher levels of graduates entering directly into private/community hospital practice (ρ = 0.327).

Conclusions

Life after residency is a necessary consideration for training physicians. Understanding trends in postresidency career paths could help programs and prospective applicants make more informed decisions on what programs may offer the best opportunities to pursue their desired career path.

Level of Evidence 5

Impact of the Virtual Format on Plastic Surgery Residency and Fellowship Interviews: A National Cross-Sectional Study

BACKGROUND

The 2020-2021 residency and fellowship application cycles were profoundly affected by the introduction of virtual interviews (VIs). The authors investigate the impact that the virtual format (VF) had on plastic surgery residency and fellowship interviews from the perspectives of program directors (PDs).

METHODS

Surveys were sent to PDs of integrated plastic surgery residency (RPD) and fellowship (FPD) programs to ascertain their perspectives regarding the VF's impact on residency and fellowship interviews. PDs were stratified into residency and fellowship cohorts, and comparative analysis was performed.

RESULTS

A total of 92 PDs, 28 RPDs and 64 FPDs, completed our survey (35%). When compared to in-person interviews, VIs were reported to be more economical and time efficient by RPDs (100% and 46%, respectively) and FPDs (97% and 48%, respectively). Consequentially, 36% and 47% of residency and fellowship programs were able to interview more applicants, respectively. RPDs and FPDs reported that VIs hindered their ability to assess applicants' fit with the program (75% and 63%, respectively), personality and communication skills (75% and 64%, respectively), and commitment to the field along with their ability to function as a trainee (57% and 50%, respectively). Overall, 71% of RPDs and 58% of FPDs preferred in-person interviews. The majority of residency (71%) and fellowship (56%) programs intend to conduct both in-person and VIs in future application cycles (p=0.12).

CONCLUSIONS

Despite preferring in-person interviews, PDs intend on hosting both in-person and VIs in future application cycles. It remains to be seen how VIs will be employed moving forward.

Disparities in Research during Plastic Surgery Training: How Can We Level the Playing Field?

Background:

Methods:

Results:

Conclusions:

A Systematic Review of Aesthetic Surgery Training Within Plastic Surgery Training Programs in the USA: An In-Depth Analysis and Practical Reference

BACKGROUND

The importance of aesthetic surgery exposure for plastic and reconstructive trainees has been recently validated by the expansion of case requirements for aesthetic procedures from 50 to 150, as well as resident-driven desire for increased cosmetic exposure throughout training. We aim to systematically review the literature at a national level to report on overall trends in aesthetic surgery training within PRS residencies.

METHODS

A literature search of PubMed, Embase, and Scopus identified all English articles published in the USA between 2000 and 2020, using a combination of "aesthetic surgery", "cosmetic surgery", "plastic surgery", "residency and internship", "education", and "training."

RESULTS

Our initial search resulted in 415 articles. After review of inclusion and exclusion criteria, in addition to cross-referencing, 41 studies remained, including 15 studies discussing resident and/or program director surveys, eight studies discussing teaching methods, sixteen studies discussing dedicated resident clinics, four studies discussing cosmetic/aesthetic fellowships, three studies discussing cosmetic practice patterns, and eleven studies discussing patient outcomes.

CONCLUSION

Current literature demonstrates that there are gaps in aesthetic surgery training for PRS residents in the USA, including facial and neck surgeries and non-surgical interventions. Resident clinics have clear benefits for resident education, without sacrificing patient outcomes. Residency programs should consider the development of a resident cosmetic clinic and/or dedicated cosmetic center to increase surgical exposure and increase trainee comfort in providing this subset of procedures. Published literature is limited in consistency of methods of evaluation, and further in-depth analysis of case volume and diversity at training programs within the USA and internationally is indicated.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Demonstrating Excellence in Plastic Surgery Residency

Background:

Residents can achieve distinction by discerning which areas of achievement are worth additional focus at each stage in training. Our survey examines the perspectives of faculty members affiliated with Accreditation Council for Graduation Medical Education–accredited plastic surgery residency programs regarding qualities indicative of resident excellence.

Methods:

A survey including Likert scales and rank-ordering was distributed to plastic surgery program directors and faculty with the intent to assess perspectives regarding resident excellence at each stage of training. Responses were analyzed using marginal homogeneity tests and summary tables.

Results:

In total, 90 respondents completed the survey. An estimated 94.5% believe it is possible for residents to achieve excellence at any stage of clinical training, and 87.7% report their definition of excellence differs by training level. Top three metrics indicative of resident excellence for interns and junior residents were preparation for operative cases, bedside manner, and personality. For seniors: preparation for operative cases, leadership capability, and bedside manner. For chief residents: preparation for operative cases, leadership capability, and technical operative expertise.

Conclusions:

A resident who displays excellence inspires mentorship, which can propel future career success. Faculty agree excellence can be achieved by residents of any stage, although the qualities that define this evolve by training year. Preparation for operative cases is considered a critical component of resident performance at all levels. Bedside manner and personality are ways intern and junior level residents excel, whereas leadership ability and technical expertise in the operating room become significant in senior and chief trainees.

"A Sign of Things to Come: Training Research Output Long-Term Scholarship in Academic Plastic Surgery."

BACKGROUNDS

Academic plastic surgery has utilized different methods to promote early involvement of trainees in research. Further analysis is needed to characterize the effects of this early emphasis and their impact on long-term academic contributions to the field.

METHODS

In October 2020, a cross-sectional study of 949 faculty from US academic plastic surgery programs was conducted using publicly available websites. Training research output for each surgeon was compared to post-training research output and other metrics measuring sustained career scholarship.

RESULTS

Increased training publications (P< 0.0001) and citations (P< 0.0001) were associated with fewer years in practice. 727 surgeons (80.0%) had ≥ 1 research article, and this group proceeded to attain significantly higher mean post-training publications per year (3.04 ± 0.14 vs. 1.45 ± 0.13, P< 0.0001) and citations per year (72.12 ± 5.04 vs. 28.39 ± 3.49, P< 0.0001) compared to the 182 (20.0%) surgeons with no training publications. For individuals, total training publications were positively correlated with post-training publications per year (P< 0.0001), a relationship also observed for citations (P< 0.0001). When controlling for years in practice, increased training publications and/or citations were significantly associated with attaining academic professor track (versus clinical professor track) position, endowed professor status, journal board position, and NIH funding (P< 0.05 for all).

CONCLUSIONS

There is a trend of increasing research productivity during plastic surgery training, and increased training output is predictive of attaining multiple measures of career academic achievement. Academic plastic surgery should continue to underscore research participation as a valuable part of the training process.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Prevalence of Workforce Diversity Research Among Surgical Specialties in the United States: How Does Plastic Surgery Compare?

BACKGROUND

Plastic surgeons are not as diverse as expected in relation to the increasingly diverse patient and medical student population. The authors assess the state of diversity in 8 primary surgical specialties in the United States and evaluate trends in research interest in diversity over the past 30 years.

METHODS

Articles regarding diversity in surgery from 1990 to 2020 were systematically reviewed. The Association of American Medical Colleges Physician Specialty Data Reports and the Accreditation Council for Graduate Medical Education Data Resource Books provided resident/fellow and faculty data from 2011 to 2016. Trends were analyzed over time per specialty.

RESULTS

From 1990 to 2020, a total of 199 publications related to diversity were identified among the various surgical specialties. Orthopedic surgery had significantly more publications per year compared with other specialties (P < 0.05). Every specialty demonstrated a significant increase in publications about diversity over time (P < 0.05). A majority of publications were related to sex rather than underrepresented in medicine topics. The proportion of female surgeons was significantly higher for plastic surgery than for orthopedic surgery and neurosurgery (P < 0.001). Plastic surgery exhibited the highest growth rate in female residents (+1.6% per year, P < 0.001). The proportion of underrepresented minorities composing surgical trainees has not significantly increased in any surgical specialty between 2011 and 2016 (P > 0.05).

CONCLUSIONS

Although diversity representation in surgery has somewhat improved, the rate is too slow to match the growing diversity of the US population. Outcomes have been disparate between specialties and demonstrate greater increases in sex equality relative to ethnic/racial equality. Evidence-based interventions need to be developed and implemented.

The Impact of Fellowship Training in Academic Plastic Surgery

BACKGROUND

The competitive nature of an academic plastic surgery career has contributed to an increase in sub-specialization. The aim of this study is to assess the benefits of subspecialty fellowship training to pursue a career in academic plastic surgery.

METHODS

A cross-sectional study was conducted of all current academic plastic surgeons (APSs) participating in Accreditation Council for Graduate Medical Education-certified residency programs. Online faculty website listings were used to collect their demographics, training and practice characteristics, academic rank and leadership positions, and research productivity.

RESULTS

A total of 927 APSs met the inclusion criteria, of which 70.2% had undergone fellowship training, with an overall significant increase in fellowship-trained surgeons within the last 10 years (odds ratio [OR], 1.66; P = 0.0005). Hand training was the most common fellowship (35.6%), followed by craniofacial (32.0%) and microsurgery (28.1%). Fellowship training was more prevalent among younger (48.7 vs 53.5 years, P < 0.0001), White (67.8%), and non-White (77.4%, P = 0.0058) APSs who had received either integrated (67.1%) or independent (81.8%, P < 0.0001) plastic surgery training and are currently working in a department (OR, 1.44; P = 0.028). Fellowship training was shown to influence academic rank (associate professor: OR, 1.68 [P = 0.0073]; full professor: OR, 0.58 [P = 0.0008]), leadership position (fellowship director OR, 10.09; P < 0.0001) and research productivity (publications: 26 vs 16.5; P = 0.0009). In addition, fellowship attainment did not correlate with the size of the employing academic program, population of the city of practice, or being a residency director or chair.

CONCLUSION

The majority of APSs have undergone fellowship training, and there is very strong evidence supporting its impact in current entry and advancement in academic plastic surgery.

How Comprehensive Are Canadian Plastic Surgery Fellowship Websites?

Background

Online fellowship program websites are more commonly becoming the primary information resource used by prospective applicants. This study aimed to analyze the online content of Canadian plastic surgery fellowship program websites. 

Methods

The content of all accredited Canadian Plastic Surgery fellowship program websites was evaluated using a 75-point criterion in the following ten domains: recruitment, faculty, residents/fellows, research and education, surgical program, clinical work, benefits, and career planning, wellness, environment and gender of faculty leadership. 

Results

On average, fellowship program websites obtained a score of 29.9 (SD=12.6). No correlation was detected between program websites and location (P > 0.05) nor by ranking (P > 0.05). 

Conclusions

Most Canadian plastic surgery fellowship program websites lacked content relevant to prospective applicants. More comprehensive fellowship program websites may be of benefit to prospective applicants and the programs. 

How Comprehensive Are Aesthetic Surgery Fellowship Websites?

BACKGROUND

Fellowship programs heavily utilize websites in the recruitment of senior residents. Studies in subspecialty areas have demonstrated deficiencies in website content; however, no study has evaluated the websites of esthetic surgery fellowships. The recent establishment of the aesthetic fellowship match in 2018 highlights the need for accessible program information.

OBJECTIVE

To assess the success in accessibility of educational and recruitment content of aesthetic surgery fellowship websites for prospective applicants.

METHODS

Websites of aesthetic surgery fellowships were eligible for study inclusion. Aesthetic fellowship websites (AFWs) were evaluated for content regarding fellow education and fellow recruitment. Website content was analyzed using Fisher exact test and analysis of variance.

RESULTS

Twenty-eight programs were compiled from the American Society of Aesthetic Plastic Surgery website. Regarding fellowship education, 35.7% of AFWs described operative experience and research requirements, and 28.6% of AFWs included information on didactics, but less than 11% outlined rotation schedules, annual meetings, or academic conferences. None listed fellow evaluation criteria. Regarding recruitment information, 85.7% of AFWs had program descriptions, but less than 33% listed affiliated hospitals, faculty, or current fellows. Of the 67.9% of AFWs that listed eligibility criteria, none listed selection criteria. When programs were stratified by the type of aesthetic training offered, fellowships that offered whole-body aesthetic training had significantly more recruitment content (P = 0.0394) on their websites than those specializing in facial aesthetics only.

CONCLUSIONS

There is a paucity of information regarding recruitment and education on AFWs. Programs should strive to create a comprehensive website to better attract and assist residents applying for fellowship.

Academic Productivity Among Plastic Surgery Subspecialty Fellowship Applicants

INTRODUCTION

Plastic surgery subspecialty fellowships are highly competitive. Academic productivity is an objective metric that can be used to compare candidates. This study aims to evaluate intersubspecialty differences in academic profiles of plastic surgery fellows.

METHODS

We performed a cross-sectional analysis of the plastic surgery fellows in the United States from 2015 to 2019. We used the San Francisco Match website and individual program websites to obtain details of fellowship programs (microsurgery, aesthetic, hand, and craniofacial) and plastic surgery fellows. Bibliometric data at the time of fellowship application were obtained for each fellow.

RESULTS

A total of 235 fellows were included. There was a significant difference in the median number of publications (P = 0.0067) and h-index (P = 0.0229) across subspecialties. Multivariate analysis demonstrated that dedicated research time was predictive for a high publication count (odds ratio [OR], 3.59; P = 0.0007) and h-index (OR, 4.88; P < 0.0001) at the time of fellowship application. Although international residency and aesthetic fellowship application were predictive of a reduced number of publications (OR, 0.17; P < 0.0001, and OR, 0.43; P = 0.0190, respectively), H-index was increased by possession of an advanced degree (OR, 2.00; P = 0.0291) and decreased with international residency (OR, 0.26, P = 0.0021).

CONCLUSIONS

All plastic surgery fellows have highly qualified academic profiles at the time of fellowship application. Academic productivity differs between subspecialty fellowships. Those wishing to match into competitive subspecialties should consider taking dedicated time for research or attaining an advanced degree.

Virtual Interviews for the Independent Plastic Surgery Match: A Modern Convenience or a Modern Misrepresentation?

OBJECTIVE

The virtual interview for residency and fellowship applicants has previously been utilized preliminarily in their respective processes. The COVID-19 pandemic forced many programs to switch to a virtual interview process on short notice. In the independent plastic surgery process, which was underway when the pandemic started, applicants had a heterogeneous experience of in-person and virtual interviews. The purpose of this study was to assess if applicants prefer a virtual interview experience to an in-person interview as well as determine if virtual interview applicants had a different opinion of a program compared to the in-person interview applicants.

DESIGN/SETTING/PARTICIPANTS

The 2019 to 2020 applicants who interviewed at the Indiana University Independent Plastic Surgery program were administered an anonymous online survey about their interview experience at our program.

RESULTS

Our survey response was 60% (18/30). The in-person interview group (n = 10) rated their overall interview experience higher than the virtual interview group (n = 8) 8.8 vs 7.5 (p = 0.0314). The in-person interview group felt they became more acquainted with the program, the faculty, and the residents more than the virtual group (4.7 vs 3.25, p < 0.0001) (4.3 vs 3.25, p = 0.0194) (4.3 vs 2.75, p < 0.0001). The majority of applicants favored in-person interviews (16/18, 88.9%). The in-person interview group spent significantly more money on their interview at our program compared to the virtual interview group ($587 vs $0, p < 0.0001).

CONCLUSION

Our study demonstrated that the virtual interview process was an efficient process for applicants from both a financial and time perspective. However, the virtual interview process left applicants less satisfied with their interview experience. The applicants felt they did not become as acquainted with the program as their in-person counterparts. The virtual interview process may play a large role in residency and fellowship applications in the future, and programs should spend time on how to improve the process.

Factors Considered in Ranking Orthopaedic Trauma Fellowship Applicants: A Survey of Program Directors

INTRODUCTION

More than 90% of orthopaedic surgery graduates pursue fellowship training after residency. Previous investigations have examined factors considered important by orthopaedic sports medicine and hand surgery fellowship program directors (PDs). This study sought to identify which factors orthopaedic trauma fellowship PDs deem most important when evaluating applicants.

METHODS

A web-based survey was sent to all 59 orthopaedic trauma fellowship PDs. PDs were given a list of 12 factors, which they ranked in order of importance. A weighted score for each factor was calculated. PDs could also write-in additional factors they considered important when ranking applicants.

RESULTS

The overall response rate was 83% (49/59 PDs). Forty-five percent of responding PDs listed the interview as the most important factor when ranking applicants. Other factors considered most important included letters of recommendation, personal connections to the applicant and/or letter writers, and the applicant's background in trauma. Results of the weighted score calculation again identified the interview as the most important factor when ranking applicants, followed by letters of recommendation, personal connections to the applicant/letter writers, the applicant's residency program, strength of the applicant's background in trauma, and research experience.

DISCUSSION

Orthopaedic trauma fellowship PDs consider the interview, letters of recommendation, and personal connections to the applicant/letter writers to be the most important factors when ranking fellowship applicants.

A Dedicated Quarterly Research Meeting Increases Resident Research Productivity

BACKGROUND

Research is a vital component of a plastic surgery residency. Residents participating in research are better able to critically evaluate literature, allowing them to stay current throughout their careers. Programs benefit from increased research by increasing their academic reputation and attracting stronger applicants. To discuss ongoing research projects, foster collaboration, and encourage resident involvement, a quarterly research meeting was implemented within our division. We report the effectiveness of a dedicated division-wide quarterly research meeting in increasing the academic productivity of plastic surgery residents.

MATERIALS AND METHODS

Beginning in 2015, the Division of Plastic Surgery at our institution implemented a dedicated quarterly research meeting. Academic productivity was assessed by the number of publications in peer-reviewed journals, oral presentations at national meetings, and oral presentations at regional meetings. We examined the change in productivity before and after the implementation of the quarterly meeting. Unpaired t-test was used to compare temporal differences. A direct temporal comparison was made between the 3 y of data before the implementation of the quarterly meetings and the 2 y of data after implementation.

RESULTS

In the 2 y after the implementation of the research meeting, residents published significantly more often with an average of 2 peer-reviewed journal articles published per year per resident compared with 0.47 peer-reviewed publications in the 3 y before implementation (2 versus 0.47 publications per resident per year, P = 0.009). Residents were also more likely to present at national (0 versus 0.75 presentations per resident per year, P = 0.028) and regional meetings (0 versus 1 presentations per resident per year, P = 0.001).

CONCLUSIONS

Implementation of a formal quarterly research meeting significantly improves resident research productivity. Residents demonstrated more publications and oral presentations. These results suggest that a more formal quarterly discussion of division-wide research can improve resident research productivity.

Determining the Most Important Factors Involved in Ranking Orthopaedic Sports Medicine Fellowship Applicants

Background:

Orthopaedic surgery residencies and certain fellowships are becoming increasingly competitive. Several studies have identified important factors to be taken into account when selecting medical students for residency interviews. Similar information for selecting orthopaedic sports medicine fellows does not exist.

Purpose:

To determine the most important factors that orthopaedic sports medicine fellowship program directors (PDs) take into account when ranking applicants.

Study Design:

Cross-sectional study.

Methods:

A brief survey was distributed electronically to PDs of the 92 orthopaedic sports medicine fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). Each PD was asked to rank, in order, the 5 most important factors taken into account when ranking applicants based on a total list of 13 factors: the interview, the applicant’s residency program, letters of recommendation (LORs), personal connections made through the applicant, research experience, an applicant’s geographical ties to the city/town of the fellowship program, United States Medical Licensing Examination (USMLE) scores, Orthopaedic In-Training Examination (OITE) scores, history of being a competitive athlete in college, extracurricular activities/hobbies, volunteer experience, interest in a career in academics, and publications/research/posters. Factors were scored from 1 to 5, with a score of 5 representing the most important factor and 1 representing the fifth-most important factor.

Results:

Of the 92 PDs contacted, 57 (62%) responded. Thirty-four PDs (37%) listed the interview as the most important factor in ranking fellowship applicants (overall score, 233). LORs (overall score, 196), an applicant’s residency program (overall score, 133), publications/research/posters (overall score, 115), and personal connections (overall score, 90) were reported as the second- through fifth-most important factors, respectively.

Conclusion:

According to orthopaedic sports medicine fellowship PDs, the fellowship interview is the most important factor in determining how an applicant will be ranked. Other factors, including LORs, the applicant’s residency program, research production, and personal connections, were also considered to be important. This information provides orthopaedic sports medicine fellowship applicants with a better understanding of which areas to focus on when preparing for the fellowship interview and matching process.