Update on the Selection Criteria of Plastic Surgery Residents: A Survey of Program Directors and Associate Program Directors.

BACKGROUND: Plastic and reconstructive surgery (PRS) is recognized as a highly competitive specialty. Since the first assessment of resident selection criteria in 2007, PRS residency programs have adopted holistic review processes and adapted to changes such as a decline in medical schools participating in the Alpha Omega Alpha Honor Medical Society as well as the recent transition to pass/fail grading for the United States Medical Licensing Examination (USMLE) step 1 examination (Schultz et al. Plast Reconstr Surg Glob Open . 2020;8:e2892; Tadisina et al. Plast Reconstr Surg . 2017;139:330e-331e). This study was devised to evaluate current PRS residency criteria in light of these changes. METHODS: An anonymous, 12-item, electronic survey was generated and distributed using Alchemer. An email was sent to 171 program directors (PDs) and associate program directors (APDs) of PRS residency programs. Survey questions were developed to collect data regarding respondent demographics and their desired criteria when assessing residency applicants. Complete responses were collected and analyzed with summary statistics and multivariate logistic regression using RStudio (version 1.3.109). RESULTS: In total, 44 (25.7% response rate) of the 171 PDs and APDs completed the survey. Of the 16 programs (36.4%) with a USMLE cutoff score, 7 (43.8%) reported a range of 230 to 239 and 6 (37.5%) reported a range of 240 to 249. Without a score for step 1, the majority (48.8%) of respondents believe that step 2 scores will replace step 1 scores in terms of assessment criteria, and the content of recommendation letters was selected as the criterion with the greatest increase in weight (66.7%). In addition, 27.3% of programs require a step 2 score at the time of interview. The top 3 academic criteria in order of decreasing importance were the content of recommendation letters, clinical grades, and letter writers, whereas the top 3 nonacademic criteria were subinternship performance, maturity, and interview performance. CONCLUSIONS: Plastic and reconstructive surgery remains a highly competitive specialty for residency applicants. Our findings suggest that Alpha Omega Alpha membership remains diminished in importance, whereas USMLE cutoff scores have increased. With recent changes in the step 1 grading system, PDs and APDs will rely more heavily on step 2 scores and the content of recommendation letters.

Should my recommendation letter be written by artificial intelligence?

SummaryLetters of recommendation are increasingly important for the residency match. We assessed whether an artificial intelligence (AI) tool could help in writing letters of recommendation by analyzing recommendation letters written by 3 academic staff and AI duplicate versions for 13 applicants. The preferred letters were selected by 3 blinded orthopedic program directors based on a pre-determined set of criteria. The first orthopedic program director selected the AI letter for 31% of applicants, and the 2 remaining program directors selected the AI letter for 38% of applicants, with the staff-written versions selected more often by all of the program directors (p < 0.05). The first program director recognized only 15% of the AI-written letters, the second was able to identify 92%, and the third director identified 77% of AI-written letters (p < 0.05).

Factors influencing medical student choices in the integrated vascular surgery match: Implications for future post-pandemic residency matches.

OBJECTIVE: Integrated vascular surgery residency is among the most competitive specialties, but little is known about the applicant perspective. The coronavirus disease 2019 outbreak impacted the 2021 integrated vascular surgery residency match because of travel restrictions. We sought to better understand pre-pandemic applicant recruitment strategies, logistics of away rotations, and the residency interview process to identify areas for improvement in the application process. METHODS: An anonymous survey was sent to matched students in 2020, inquiring about motivations for pursuing vascular surgery (VS), logistic of away rotations and interviews, and factors influencing students' rank lists. RESULTS: Seventy of the 73 matched students completed the survey (95.9% response rate). The median age was 27 (range, 25-41); 32.9% were female, 91.4% were U.S. medical students, and 77.1% were from institutions with a VS training program. Factors most strongly influencing the decision to choose VS as a career were interest in open vascular procedures, endovascular procedures, perceived job satisfaction, emerging technologies, and influence of a mentor. The prospect of the job market, future salary, and competitiveness of the application process had the least impact. Of the matched students, 82.9% completed an away rotation (median, 2; range, 1-4), with 51.7% of students paying a total cost of more than $2500. Fifty percent of students matched either at their home institution or where they had performed an away rotation. Students reported application submissions to a median of 50 programs (range, 1-70) and interviewed at 17 (range, 1-28), with 40% of students paying a total of more than $4000 for interview costs. The most significant factors affecting students' rank lists included program culture, open aortic surgical volume, geography, and complex endovascular procedure volume. Tours of facilities, resident salary, and male/female distribution had the least importance. CONCLUSIONS: Successfully matched applicants in 2020 prioritized operative case volume and program collegiality when ranking programs. Despite their high cost, away rotations played an important role in the Match, suggesting that time spent at potential institutions allowed ideal assessment of factors for students. The high average number of away rotations and in-person interviews performed in 2019-2020 was limited for the 2021 Match due to coronavirus disease 2019 restrictions. Programs will have to continue developing creative alternatives or additions to away rotations and the application processes to assure continued success in future post-pandemic Match cycles.

Bibliometric Review of Medical Student Research Before Matching Integrated Vascular Surgery.

BACKGROUND: Research output is one element of a multifactorial process that residency programs consider when evaluating applicants. However, there are minimal data assessing research productivity on admittance into research-oriented integrated vascular surgery residency (RO-IVSR) programs. The purpose of this study was to evaluate the association of peer-reviewed research and the RO-IVSR match process. MATERIAL AND METHODS: Vascular surgery residents who matched into an RO-IVSR in 2015-2017 were divided into those matching an RO-IVSR top 10 program versus other. Total publications, first authorships, and type of research were compared between groups. Mann-Whitney U-tests were then performed between discrete levels of research productivity (0-1 versus ≥2 publications) to detect differences in ability to match a top 10 program. RESULTS: One hundred and fifty-eight residents published a total of 214 original research articles (83%), 26 case reports (10%), and 19 systematic reviews (7%). There were 66 first authorships (25%). Median total publications at RO-IVSR top 10 versus other programs were 2 versus 1 (P < 0.01). Top 10 IVSR had a significant difference in median publications for all other research categories. The ability to match into a top 10 program by discrete levels of research productivity at 0-1 versus 2+ showed significance (P < 0.05) in all research categories, including total publications, first authorships, and H-index. CONCLUSIONS: There was significantly higher research productivity among medical students who matriculate to top 10 IVSR programs. Furthermore, having 2 or more publications significantly increased the likelihood of attending a top 10 program. Thus, top programs likely use an applicants' research productivity as a distinct qualification category and a marker of future success.

Pearls and Pitfalls of the Virtual Interview: Perspectives From Both Sides of the Camera.

As the SARS-COV-2 pandemic created the need for social distancing and the implementation of nonessential travel bans, residency and fellowship programs have moved toward a web-based virtual process for applicant interviews. As part of the Society of Asian Academic Surgeons 5th Annual Meeting, an expert panel was convened to provide guidance for prospective applicants who are new to the process. This article provides perspectives from applicants who have successfully navigated the surgical subspecialty fellowship process, as well as program leadership who have held virtual interviews.

Interview Data Highlight Importance of "Same-State" on Anesthesiology Residency Match.

BACKGROUND: The US residency application, interview, and match processes are costly and time-intensive. We sought to quantify the importance of an applicant being from the same-state as a residency program in terms of how this impacted the number of interviews needed to match. METHODS: We examined data from interview scheduling software used by 32 programs located in 31 US states and 1300 applicants for the US anesthesiology recruitment cycles from 2015 to 2018. Interviewee data (distance from program, region, numbers of interviews, and program at which interview occurred) were analyzed to quantify the effect of the interviewee being from the same state as the residency program on the odds of matching to that program. Other variables of interest (medical school, current address, US Medical Licensing Exam [USMLE] Step 1 and 2 clinical knowledge [CK] scores, Alpha Omega Alpha [AOA] status, medical school ranking) were also examined as controls. Confidence intervals (CI) were calculated for the ratios of odds ratios. RESULTS: An interviewee living in the same state as the interviewing program could have 5.42 fewer total interviews (97.5% CI, 3.02-7.81) while having the same odds of matching. The same state effect had an equivalent value as an approximately 4.14 USMLE points-difference from the program's mean (97.5% CI was 2.34-5.94 USMLE points). Addition of whether the interviewee belonged to an affiliated medical school did not significantly improve the model; same-state remained significant (P < .0001) while affiliated medical school was not (P = .40). CONCLUSIONS: Our analysis of anesthesiology residency recruitment using previously unstudied interview data shows that same-state locality is a viable predictor of residency matching and should be strongly considered when evaluating whether to interview an applicant.

Characterization of the 2019 Micrographic Surgery and Dermatologic Oncology Standardized Letter of Recommendation.

BACKGROUND: Traditional letters of recommendation used for postgraduate medical training applications have multiple limitations, including a lack of clarity, inflated and overly flattering assessments, and low reliability between interpreting faculty. A micrographic surgery and dermatologic oncology (MSDO) standardized letter of recommendation (SLOR) was created to improve the efficiency, validity, and stratification of applicants to dermatology fellowship training programs. OBJECTIVE: To analyze the MSDO SLOR for trends in grading based on letter-writer and applicant characteristics and to evaluate its ability to demonstrate differences between applicants. METHODS: Standardized letter of recommendations received by 4 fellowship programs from the 2019 San Francisco Match application cycle were reviewed retrospectively. RESULTS: Two hundred forty-nine SLORs were analyzed from 140 applicants. Grade inflation and limited variability in scores were evident. Higher scores correlated with the length of the relationships between letter-writers and applicants and with female letter-writer gender. There was no applicant gender or ethnicity bias detected. CONCLUSION: Despite score inflation, the MSDO SLOR allows for differentiation between fellowship applicants. Future studies are needed to further evaluate the reliability of the SLOR and find ways to improve its content.

More Than One-third of Orthopaedic Applicants Are in the Top 10%: The Standardized Letter of Recommendation and Evaluation of Orthopaedic Resident Applicants.

BACKGROUND: The American Orthopaedic Association (AOA) released the standardized letter of recommendation (SLOR) form to provide standardized information to evaluators of orthopaedic residency applicants. The SLOR associates numerical data to an applicant's letter of recommendation. However, it remains unclear whether the new letter form effectively distinguishes among orthopaedic applicants, for whom letters are perceived to suffer from "grade inflation." In addition, it is unknown whether letters from more experienced faculty members differ in important ways from those written by less experienced faculty. QUESTIONS/PURPOSES: (1) What proportion of SLOR recipients were rated in the top 10th percentile and top one-third of the applicant pool? (2) Did letters from program leaders (program directors and department chairs) demonstrate lower aggregate SLOR scores compared with letters written by other faculty members? (3) Did letters from away rotation program leaders demonstrate lower aggregate SLOR scores compared with letters written by faculty at the applicant's home institution? METHODS: This was a retrospective, single institution study examining 559 applications from the 2018 orthopaedic match. Inclusion criteria were all applications submitted to this residency. Exclusion criteria included all letters without an associated SLOR. In all, 1852 letters were received; of these, 26% (476) were excluded, and 74% (1376) were analyzed for SLOR data. We excluded 12% (169 of 1376) of letters that did not include a final summative score. Program leaders were defined as orthopaedic chairs and program directors. Away rotation letters were defined as letters written by faculty during an applicant's away rotation. Our study questions were answered accounting for each subcategory on the SLOR (scale 1-10) and the final ranking (scale 1-5) to form an aggregated score from the SLOR form for each letter. All SLOR questions were included in the creation of these scores. Correlations between program leaders and other faculty letter writers were assessed using a chi-square test. We considered a 1-point difference on 5-point scales to be a clinically important difference and a 2-point difference on 10-point scales to be clinically important. RESULTS: We found that 36% (437 of 1207) of the letters we reviewed indicated the candidate was in the top 10th percentile of all applicants evaluated, and 51% (619 of 1207) of the letters we reviewed indicated the candidate was in the top one-third of all applicants evaluated. We found no clinically important difference between program leaders and other faculty members in terms of summative scores on the SLOR (1.9 ± 0.7 versus 1.7 ± 0.7, mean difference -0.2 [95% CI -0.3 to 0.1]; p < 0.001). We also found no clinically important difference between home program letter writers and away program letter writers in terms of the mean summative scores (1.9 ± 0.7 versus 1.7 ± 0.7, mean difference 0.2; p < 0.001). CONCLUSION: In light of these discoveries, programs should examine the data obtained from SLOR forms carefully. SLOR scores skew very positively, which may benefit weaker applicants and harm stronger applicants. Program leaders give summative scores that do not differ substantially from junior faculty, suggesting there is no important difference in grade inflation between these faculty types, and as such, there is no strong need to adjust scores by faculty level. Likewise, away rotation letter writers' summative scores were not substantially different from those of home institution letters writers, indicating that there is no need to adjust scores between these groups either. Based on these findings, we should interpret letters with the understanding that overall there is substantial grade inflation. However, while weight used to be given to letters written by senior faculty members and those obtained on away rotations, we should now examine them equally, rather than trying to adjust them for overly high or low scores. LEVEL OF EVIDENCE: Level III, therapeutic study.

Impact of COVID-19 on Away Rotations in Surgical Fields.

The COVID-19 pandemic has presented a variety of challenges in the medical education curriculum, one of which is the possible loss of summer and fall away rotations for fourth year students applying into surgical subspecialties. Subsequently, a lack of in-person evaluations may have a major impact on an applicant's perception of the residency and the program's ability to assess the individual applicant. This is especially crucial for applicants without a home program in their specialty of interest, as away rotations are an important opportunity to confirm interest in pursuit of a subspecialty, obtain letters of recommendation, and make positive impressions at programs of interest. The objective of this article is to assess the current COVID-19 pandemic situation in light of away rotations and to provide recommendations for surgical subspecialty programs and applicants to have the best outcome during this upcoming application cycle. In particular, we emphasize the importance of implementing universal processes within each individual subspecialty. This will provide equitable opportunities for all applicants, minimizing potential biases or disadvantages based on geographic location or availability of a program at an applicant's home institution.

Evaluating Urology Residency Applications: What Matters Most and What Comes Next?

PURPOSE OF REVIEW: In light of the announcement that the United States Medical Licensing Examination Step 1 exam will transition to pass/fail reporting, we reviewed recent literature on evaluating residency applicants with a focus on identifying objective measurements of applicant potential. RECENT FINDINGS: References from attending urologists, Step 1 scores, overall academic performance, and research publications are among the most important criteria used to assess applicants. There has been a substantial increase in the average number of applications submitted per applicant, with both applicants and residency directors indicating support for a cap on the number of applications that may be submitted. Additionally, there are increasing efforts to promote diversity with the goal of improving care and representation in urology. Despite progress in standardizing interview protocols, inappropriate questioning remains an issue. Opportunities to improve residency application include promoting diversity, enforcing prohibitions of illegal practices, limiting application numbers, and finding more transparent and equitable screening measures to replace Step 1.

Health professional mobility in the WHO European Region and the WHO Global Code of Practice: data from the joint OECD/EUROSTAT/WHO-Europe questionnaire.

WHO Member States adopted the Global Code of Practice on the International Recruitment of Health Personnel 10 years ago. This study assesses adherence with the Code's principles and its continuing relevance in the WHO Europe region with regards to international recruitment of health workers. Data from the joint OECD/EUROSTAT/WHO-Europe questionnaire from 2010 to 2018 are analyzed to determine trends in intra- and inter-regional mobility of foreign-trained doctors and nurses working in case study destination countries in Europe. In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code's principles on ethical recruitment. To support ethical recruitment practices and sustainable workforce development in the region, data collection and monitoring on health worker mobility should be improved.

Identifiable Factors Associated With Acceptance Into Sports Medicine Fellowship Programs: A Brief Report.

OBJECTIVE: To identify factors associated with entry into primary care sports medicine (PCSM) fellowship programs. DESIGN: Primary care sports medicine fellowship directors (FDs) and fellowship faculty were surveyed regarding preferences for accepting applicants into their programs. SETTING: Survey study. PARTICIPANTS: Primary care sports medicine FDs and fellowship faculty. ASSESSMENT OF RISK FACTORS: Questions were designed to delineate factors [clinical experience, letters of recommendation (LOR), scholarship, service commitment, interview performance, etc] perceived to be associated with entry into PCSM fellowship (1-10 scale; 10 = highest value). Weighted mean ± SD were calculated for each question. MAIN OUTCOME MEASURES: Determination of most valued factors for entry into PCSM fellowship. RESULTS: Responses were provided by 242/2332 (10.4%) of the American Medical Society for Sports Medicine members, including 77 of 175 (44%) FDs. The top 3 factors for entry into PCSM fellowships for all respondents were as follows: interview performance (9.17 ± 1.13), LOR from SM fellowship faculty (8.20 ± 1.67), and high school game/event coverage (7.83 ± 1.70). Musculoskeletal ultrasound experience (4.50 ± 2.23) and residency training in pediatrics (4.58 ± 2.54), internal medicine (4.48 ± 2.44), emergency medicine (4.44 ± 2.59), and physical medicine and rehabilitation (4.40 ± 2.83) received the lowest scores. CONCLUSIONS: Applicants seeking entry into SM fellowships should prioritize performance during interviews, LOR from SM fellowship faculty, and team game/event coverage experiences.

Predictive Hiring to Maintain Excellence in Patient Care.

OBJECTIVE: The purpose of this research study was to design and pilot a predictive hiring model to improve the hospital's operational vacancy rate and reduce premium pay expenses. BACKGROUND: According to Purcell, the average nursing turnover rate is at 18.2%, and the new-graduate nurse turnover rate is higher at 35%. With turnover rates high for nurses, the importance of recruiting, hiring, and training the new nurse needs to be completed as soon as possible. Often, a nurse manager cannot interview and hire into a position until it is vacated. Premium pay including overtime is typically used to cover the time from the position being vacated until the next nurse is trained. METHODS: This was a pretest/posttest design with a predictive hiring model intervention. The intervention was a 3-pronged approach that consisted of a strategy for recruiting graduate nurses, hiring to operation vacancy rates, and utilizing a predictive hiring method. Operational vacancy is a calculation to determine if a department has the right amount of hired labor available to work scheduled shifts without having to routinely rely on agency nurses and/or premium pay. These are people ready to work. RESULTS: The hospital significantly decreased premium pay and eliminated the use of agency nurses by implementing a predictive hiring model tailored to the department's operational vacancy. CONCLUSIONS: A predictive model is a useful vehicle in assisting nurse managers to plan and replace positions more quickly. The model needs continued testing to support application beyond the testing site.

Interprofessional education and practice guide No. 10: Developing, supporting and sustaining a team of facilitators in online interprofessional education.

Whilst we have seen a growth in the use of information and communication technologies to deliver interprofessional education (IPE) in the last decade, little has been written about facilitating IPE in the online environment. For the last 10 years, the Faculty of Health at Deakin University has offered a fully online IPE course that has consistently employed facilitators to guide interprofessional teams in both asynchronous and synchronous (real-time) online interprofessional learning experiences. This Interprofessional Education and Practice Guide draws on the Deakin University leadership experience in supporting teams of online IPE facilitators over the last decade, underpinned by prior research and key literature. The key lessons provided in this guide aim to assist others in developing, supporting and sustaining a team of online IPE facilitators to guide asynchronous and synchronous online interprofessional learning experiences.

Value of personal statements to dermatology programs: a survey-based critical review.

The personal statement is a required component of the residency application, offering applicants the opportunity to showcase their personality as well as unique thoughts and experiences not explicitly stated elsewhere in their application. Although the applicant-generated nature of personal statements can gauge an applicant's professionalism, creativity, sound judgement, and tact, specific criteria for evaluating personal statements and comparing them to one another is lacking. Research on the value of personal statements in the application process is also lacking. The purpose of this research project is to quantify the perceived value of the personal statement to program directors and faculty members of U.S. dermatology programs involved in residency application review. Analysis of our survey responses determined that although the majority of participants consider the personal statement to be a necessary element of an application, it was rated least important compared to other components of the application. An applicant's Medical Student Performance Evaluation, clerkship grades, research projects and publications, board scores, and letters of recommendation were consistently rated as more important than the personal statement. These findings suggest the personal statement lacks the standardization needed for decision makers to confidently choose the best new dermatology residents for their program.

National criteria for academic appointment in vascular surgery.

OBJECTIVE: Advancement in academic medicine is multifactorial. Our objectives were to characterize academic appointments in vascular surgery and to investigate what factors, particularly publications, influenced academic appointment. METHODS: Academic vascular surgeons at Accreditation Council for Graduate Medical Education vascular training programs or at primary sites of U.S. allopathic medical schools were included. Those with qualified titles, such as "adjunct" or a "clinical" prefix, were excluded. Sex, education, region, board certification, and affiliation details were recorded. Web of Science was queried for publication details and h-index. The h-index is a "personal impact factor" defined as "x" number of publications cited at least "x" number of times. After surgeons' information was deidentified, univariate and multivariable analyses were completed for academic appointment and appointment as division chief. RESULTS: There were 642 vascular surgeons who met criteria: 297 (46.3%) assistant professors, 150 (23.4%) associate professors, and 195 (30.4%) professors. There were 96 (15%) division chiefs and 10 (1.6%) chairs of surgery, and 83.2% were male. Surgeons worked in the Northeast (33.5%), Southern (32.6%), Central (20.1%), and Western (13.9%) United States. The mean (±standard deviation) number of publications was 13.7 ± 15.4 for assistant professors, 33.9 ± 28.8 for associate professors, and 86.8 ± 63.6 for professors (P < .001). Mean number of first or last author publications was 5.3 ± 6.4 for assistant professors, 12.2 ± 12.7 for associate professors, and 38.7 ± 35.3 for professors (P < .001). Mean h-index was 5.9 ± 5.4 for assistant professors, 12 ± 7.7 for associate professors, and 24.9 ± 12.6 for professors (P < .001). In multivariable analysis, vascular surgery board certification (adjusted odds ratio [OR], 6.08; 95% confidence interval [CI], 1.15-32.2; P = .03), academic appointment at a public medical school (OR, 1.99; 95% CI, 1.18-3.37; P = .01), years since medical school graduation (OR, 1.13; 95% CI, 1.09-1.18; P < .001, per year), and number of publications (OR, 1.05; 95% CI, 1.03-1.06; P < .001, per publication) were independently associated with associate professor. Factors independently associated with professor were years since medical school graduation (OR, 1.18; 95% CI, 1.12-1.24; P < .001, per year) and number of first or last author publications (OR, 1.05; 95% CI, 1.02-1.09; P = .003, per publication). Appointment as division chief was independently associated with h-index (OR, 1.04; 95% CI, 1.01-1.08; P = .016, per point). CONCLUSIONS: Total number of publications was independently associated with associate professor, with number of first or last author publications particularly important for professor. The h-index was not independently associated with academic appointment, but it was for appointment as division chief. This study provides relevant data for promotional guidance in academic vascular surgery.

Development of hearing standards for Ontario's Constable Selection System.

Objective: Develop valid and defensible hearing standards for Ontario constables to ensure safe and efficient operations. Design: Research involved three steps: (1) identification of hearing critical (HC) tasks, (2) characterisation of real-world noise environments where these tasks are performed (3) and establishment of screening criteria and protocols for determining fitness for duty. Study sample: Three panels of subject matter experts (SMEs) from different Ontario police services participated in Steps 1 and 3. Result: Fifty-one HC tasks conducted in 25 different environments were identified. Acceptable levels of speech communication in noise were based on environments with the highest frequency, importance and difficulty ratings. The ability to understand soft speech was also deemed critical. These translated into a 2 dB maximum elevation in the Noise Composite speech recognition threshold (SRT) with the Hearing-In-Noise-Test and a threshold in quiet of 35 dBA or better. Conclusions: Speech communication modelling methodology greatly facilitates the task of developing fitness for duty hearing standards, but participation of SMEs is crucial for face validity.