Plastic Surgery Research Fever: Temperatures Rise Without Step 1 Scores

Integrated plastic surgery residency positions have historically been among the most competitive for medical student applicants. Traditionally, successful candidates have excelled on the United States Medical Licensing Examination Step 1 and Step 2, with these scores playing a significant role in how program directors (PDs) screen and rank applicants.1 However, in January 2022, Step 1 grading shifted to a pass/fail model, leading to speculation that other application metrics would gain prominence. A survey of plastic surgery PDs indicated that research would increase in importance, becoming the fourth most significant metric used to select applicants for interviews.2 In March 2024, the first class of integrated plastic surgery residents matched without Step 1 scores. Shortly after, the National Resident Matching Program released its biennial report detailing various factors for successfully matched plastic surgery applicants. Among these factors, the National Resident Matching Program reports “research output” (RO), a metric that quantifies an applicant’s research productivity by measuring the total number of abstracts, publications, and conference presentations. In 2020, the mean RO was 19.1.3 By 2022, this metric rose to 28.4. By 2024, this number further increased to 34.7, reflecting a 22.2% rise after the Step 1 grading shift (Fig. 1).3Fig. 1.: RO among integrated plastic surgery applicants.This increase in RO may be attributed to changes in PDs’ selection criteria, with research becoming a more significant differentiator in the absence of Step 1 scores. Alternatively, the rise could reflect a broader trend in publication efforts among all applicants. Most striking is that RO among those who did not match nearly doubled from 13.8 in 2022 to 26.3 in 2024 after remaining relatively stagnant from 2020 to 2022 (Fig. 1).3 For context, the average unsuccessful plastic surgery applicant in 2024 now has more RO than a successful applicant 4 years ago. It is important to note that the RO metric aggregates abstracts, publications, and presentations, without distinguishing between these categories. This lack of differentiation makes it difficult to assess the true nature of applicants’ productivity. If the rise in RO primarily reflects an increase in publications, it may further advantage applicants from top-tier medical schools with better access to National Institutes of Health funding. Moreover, this increased output may not reflect the quality of publications, but rather, a strategy implemented by applicants to leverage themselves against other applicants.4 Conversely, if this increase is driven more by conference presentations, there may be concerns regarding equity. Presenting research at national conferences often requires substantial financial resources, including travel and registration fees, which can present significant barriers for some students, especially those from marginalized backgrounds. If a paradigm develops where matching into plastic surgery relies more on the ability to present at conferences, success in the field may increasingly depend on an applicant’s socioeconomic status, exacerbating existing disparities.5 Further research is needed to understand the specific changes in applicants’ RO, including the type and quality of publications they are submitting. This will provide clearer insight into how the shift to pass/fail Step 1 scores has impacted selection criteria and applicant behavior. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.