American Society of Plastic Surgeons
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Applying to Plastic Surgery Integrated Residency in 2020 – A candid discussion with Amanda Gosman, MD, and Jeffrey Kozlow, MD

This year has challenged each of us to become adaptable and resilient in ways we never before considered. Our path to residency is not on the road we anticipated, but we still must make it to our destination.

The following interview was conducted through the lens of medical students applying to plastic surgery integrated residency programs in 2020 in the midst of the COVID-19 pandemic. Though the landscape of medical education continues to evolve, we hope this interview will provide an overview of the considerations for this application cycle and set appropriate expectations for medical students. Amanda Gosman, MD, and Jeff Kozlow, MD, shared this insight out of genuine interest in supporting students. It does not represent official guidelines or positions made by any societies or governing bodies.

PSR: Could you describe your current or prior involvement in medical education initiatives to help our readers understand your particular perspective?

Dr. Gosman: I'm currently the chief and program director of our plastic surgery residency program at UC San Diego. I've been the program director here since 2009. When I started, we only had an independent program, so I started our integrated program here in 2016. I also run our craniofacial Fellowship.

I've been involved in resident education because I think it's incredibly important, but also because a lot of my interest in plastic surgery is also based on global outreach. Education is the critical component of that outreach, so I founded a nonprofit organization, ConnectMed International, which is dedicated to capacity-building through education and research. I've also been involved in ACAPS for a long time. I'm currently on the board again, so I'm the chair of the Resident Selection Committee to try and help create resources and reach out to people applying this year. One of my goals in plastic surgery education has been to improve the representation and diversity in our field.

Dr. Kozlow: I've been on the faculty at the University of Michigan since 2011. During that time, I've been in charge of all of our medical student programming in plastic surgery, including career advising for students going into plastic surgery as well as running our sub-internship – both for Michigan, as well as visiting students. I also help manage our M2 Surgery Clerkship rotation which includes students on plastic surgery. I've spent time in the medical school teaching the doctoring course, which was basically physical exam and history taking, so I've had exposure to students across that whole realm. Most recently, I was asked to help lead (along with Devra Becker, MD) the ACAPS initiative to try to help students this year navigate through the turmoil.

PSR: In your experience mentoring medical students, can you share some of the concerns raised by students about applying to plastic surgery in 2020?

Dr. Kozlow: Plastic surgery has always been a competitive field, so that automatically is concerning for students. In the past, we had seen an increasing number of integrated spots and a fairly level number of applying students. Last year, we had what looked like 50 to 60 additional U.S. allopathic students with only a small increase in spots, so we watched the match numbers go down. I think that has everybody on edge to start with.

When you look at obviously what's happened with COVID, I think it has created even more concerns because, for one, there are a number of students that haven't been able to really experience plastic surgery, so in a way, you're making a career choice potentially not even having done a sub-I or having the same experience that you might have had at your home institution. The other concern is that, in the past, program knowledge of students seems to be important in terms of interviews and then, potentially down the road, matching. It has almost made the visiting sub-I rotations ultra-competitive, and that may or may not be a good thing. So, I think this is a good chance to reset.

PSR: From the perspective of residency programs, what are the concerns being raised surrounding the uncertainty in this application cycle with regards to away rotations, interviews and matching new residents?

Dr. Gosman: I would say that cancellation of away rotations is probably more a concern for the applicants than it is for the programs. We aren't thinking we're not going to get to know anybody, because we're definitely trying to make some ways to make that happen. At UCSD, we have created a virtual sub-I rotation – it's something that is an educational format to get to know people, and to expose people to the way that we train.

Dr. Kozlow: I think the programs' concerns are still that we like familiarity; that's why I think there's a high rate of students who have matched at their home program or somewhere they did the visiting rotation, because you know that person. Unlike in medicine residency where it's 30 people for three years, most of our programs are close-knit families – even the biggest programs are four residents a year, but they're with you for six or seven years. If there's a fit that doesn't work, or a match that doesn't work, that impacts the program. Not only from an education workload perspective, but it can really disrupt the culture, so that is a concern.

PSR: What is your advice for students on how to get to know programs?

Dr. Gosman: I empathize with students because I know you're stressed out about this, but I do want to empower you and say that you are all so accomplished and talented. I think trying to get the sense of "a day in the life" of what it's like for a resident is something that you want to approach with the confidence that it is just right for you. Talk to residents – and if there are ways that we can formally or informally facilitate that, we're happy to do that.

PSR: Dr. Gosman, prior to the COVID-19 pandemic, you were already leading valuable initiatives to improve the application cycle for students. Can you talk about the outcomes and lessons learned from last year's uniform interview invitation release date?

Dr. Gosman: We looked pretty closely and surveyed all of the programs and all the applicants at the beginning of the process and then after the match. I think, universally, it was positive. It's hard for people going through the process in terms of the anxiety and impact on the well-being of people who would not separate from their phone because they were waiting to hear back from programs. That was just devastating and it went on for months. The other thing is that, obviously, the cost of flying all around was enormous. From a program's standpoint, there were always late cancellations and then this whole shift happens, and it was inefficient and costly for everyone.

I think one of the things from the students, which was a little bit more of a reality check, was that they kind of knew from the beginning where they stood. A lot of the highly competitive applicants got a majority of the interviews, and then there was a trickling in exchange of things as you went into different rounds. That was sometimes a little bit harsh for people to accept initially, but I think ultimately it gave them a better idea of their standing and certainly it saved a lot of money.

PSR: What can students expect to be the same or different for this year's interview process?

Dr. Gosman: Now that uniform interview invitation release is out there, people were really appreciative of it, so we are going to do it this year. Since everything has been pushed back, the uniform invitation release date is going to be Dec. 4.

Dr. Kozlow: I think programs also may think of a more focused way to evaluate the qualities they look for in students. I can't speak for sure about our program because I'll leave that to our program director, but I wouldn't be surprised if we go in our virtual interviews, and instead of me being able to just have a conversation like I would normally, I may be tasked with evaluating an applicant specifically on communication skills. So I might then have to use a structured interview in that capacity to evaluate that quality. Someone else may be charged with evaluating an applicant's understanding of their research.

PSR: What do program directors look for in an applicant?

Dr. Gosman: I want people who are going to be very self-motivated and resourceful. I also want a diverse group of people. Everybody has a little bit of a different mentality, and so even from an applicant's perspective, if you're going to apply, don't apply some place where you're not going to live. If you're not going to move to North Dakota, don't apply there. You have to be willing to do it – you're only helping the people in your field. You're helping your fellow medical students and applicants, and you're helping the programs to make a better decision. If I only had 100 applications to review, I could probably go through it in more detail than I was speed-reading 200. There is not a top program and a bottom program; there's a right one and a wrong one for you.

PSR: Do you have any words of wisdom for students applying to integrated plastic surgery residency this cycle?

Dr. Gosman: This is an unprecedented time, and we're all in this together. We're all struggling to figure out ways to make this work on all ends. We're trying to open up the channels of communication so that we can get feedback. We also want to hear from you, but it's not going to be as comfortable as just joining a team this year. I think you have to roll the dice a little bit, put yourself out there a little bit and be willing to do that in order to get as much information as you need.

If anything, the field is more level this year because there aren't going to be people who can afford to go on all of these fancy away rotations and pay for housing; everyone has a little bit more of an equal chance. Let's figure out ways that we can do it better and change this whole process. There's always a flip side to these situations – be positive, and if there are any ways that we can make it better, let us know. Just remember that if you want to go into this field, these are people you're going to interact with forever. You might as well embrace them now and find out who you want to learn from or who you want to be your mentors.

Dr. Kozlow: Remember that everybody can become a plastic surgeon somehow. Sometimes it's not the straightforward path, and we recognize that this year there will be all kinds of bumps along the way, but if you want to be a plastic surgeon, there are lots of ways to do it. Hopefully, people don't give up on that goal. Even if it doesn't work out perfectly this year, stay focused on how you're going to get there because many of our most successful people in our specialty definitely did not have a straight path to get to where they are. There will be some bumps this year, but it will be OK.

Allyson Alfonso is an MS4 at NYU Grossman School of Medicine and Dr. Salibian is a PGY6 in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health.

The authors sincerely thank Dr. Gosman and Dr. Kozlow for their insightful contribution to this blog post. We also thank them, along with their colleagues, for their time and endless effort to support students in our endeavor to become plastic surgeons.

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