Reply: Which Characteristics of Applicants and Medical Schools Produce the Most Integrated Plastic Surgery Residents? An Analysis of the 2016–2022 Cohort

Dear Editor: We greatly appreciate Winton et al1 for expanding on our recent publication, “Which Characteristics of Applicants and Medical Schools Produce the Most Integrated Plastic Surgery Residents? An Analysis of the 2016–2022 Cohort”2 and for providing actionable suggestions for improving access to the field of plastic and reconstructive surgery (PRS) for medical trainees at institutions without residency programs. We also thank Plastic and Reconstructive Surgery—Global Open for providing a forum to discuss this important topic that could increase diversity in the field. We agree with the authors that there is often little exposure to the field of PRS during preclinical medical education, and at programs without clinical elective opportunities, it can be difficult for prospective applicants to learn about PRS, become involved with the field, and craft competitive applications to PRS residency. Before the transition of United States Medical Licensing Examination Step 1 to a pass/fail system, residency programs would likely consider this score toward the strength of the applicant. Now that this metric cannot be used, we agree with the authors that there could be greater emphasis placed on research output and letters of recommendation, both of which can be easier to acquire for students at institutions with home residency programs. Dedicated research years are becoming more ubiquitous among applicants to PRS; however, these opportunities can be difficult to secure without knowledge of the field and a strong mentorship network. Additionally, numerous studies have shown that these opportunities are costly, both in terms of money and time, and may be prohibitive for certain demographics of applicants.3,4 We also echo the authors’ observation that representation in the field matters for prospective applicants, and the paucity of osteopathic and international medical graduate residents in PRS may be discouraging for talented potential applicants from each of these pools. The authors propose increasing regional connections between training institutions with and without PRS residencies to increase mentorship and research opportunities for students at institutions without home programs. They also comment that this could help connect faculty and bolster regional clinical research collaborations for the betterment of the field, beyond just training. We note with interest the virtual initiative the authors highlighted in Explore Plastic Surgery, as well as other programs, such as PREPPED (Plastic Surgery Research, Education, and Preparation Promoting Equity and Diversity), a program created to help underrepresented-in-medicine students and those without home programs explore PRS and prepare for subinternships.5 At future regional and national meetings of PRS societies, we encourage the development of interinstitutional partnerships to be discussed, with the aim of creating more programming to increase exposure to PRS for all medical trainees. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.