December 2023
- thestitchprs
- Dec 19, 2023
- 8 min read
Happy Holidays!
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Best, The Stitch Editorial Board
How Have Competitive Applicants in Plastic Surgery Changed?
Opinion by Youssef Aref, California University of Science and Medicine
Matching into Plastic Surgery (PS) Integrated Residency is one of the most competitive specialties. The National Residency Matching Program (NRMP) match outcomes for 2022 show a 63.2% match rate (1). Research and USMLE Step scores have been central factors discussed among applicants in successfully matching. However, how have these factors among applicants changed over time?
Research is a necessary part of applications for PS residency. The amount of research experiences and publications has continued to increase over time. In 2018, the NRMP reported the mean number of research experiences and number of abstracts, presentations, and publications for matched PS applicants were 5.4 and 14.2, respectively. During the same year, these amounts were similar to those of unmatched applicants at 5.1 and 14.9, respectively. The main difference in matching during this year may have been due to USMLE Step 1 and Step 2 scores with the mean for each among matched applicants being 249 and 254, respectively. Unmatched applicants in 2018 had mean scores of 239 and 248 on each exam, respectively.
Comparing these values to the 2022 NRMP Match outcomes, matched applicants' mean number of research experiences and number of abstracts, presentations, and publications were 6.1 and 28.4, respectively. Unmatched applicants in 2022 showed similar research experiences but less than half the mean number of abstracts, presentations, and publications of 5.9 and 13.8, respectively. The USMLE Step 1 and Step 2 score differences also demonstrated a larger gap between matched and unmatched applicants. Matched applicants' mean Step 1 of 251 and mean Step 2 of 257 were greater than those of unmatched applicants with mean Step 1 of 240 and mean Step 2 of 247.
When comparing the match outcomes over these 5 years, we can see that PS applicants are becoming much more competitive in both Step scores and research. With the almost doubling of research experiences, prospective students should continue to get involved in research. However, where will this increase end and how will it impact the quality of research within these experiences? Students interested in PS should work to improve communication with Residency Program Directors (PDs) to understand how they can focus on becoming a strong PS candidate and better understanding how these statistics play a role in the eyes of a PD.
The competitiveness of PS applicants does not appear to be plateauing anytime soon. Medical students will continue to work toward the statistics of match outcomes to increase their likelihood of matching. However, as a community, we should work towards discovering the true importance of each factor in a residency application. Once we reach this understanding, we may have a better vision of what a truly “strong” PS applicant looks like and how we can support students on their journey toward becoming successful future plastic surgeons.
Reference: Residency Data & Reports. NRMP. Accessed December 13, 2023. https://www.nrmp.org/match-data-analytics/residency-data-reports/
A Day in the Life of a Resident:
Featuring Mikayla Borusiewicz, PGY-5 from Pennsylvania State University
Interview by Olivia Waldron, Pennsylvania State COM
Quick background
Hometown: Yardley, PA; Highlands Ranch, CO
Medical School: Penn State
Interests: Hand/Upper Extremity, Pediatric Plastic Surgery
Career path: Early on in medical school, my interests were centered around pediatrics. As I began working with the plastic surgery department on craniofacial research and observing surgeries, I gravitated toward the operating room. It became clear that plastic surgery uniquely bridged my passion for working with pediatric patient populations and the intricacies of craniofacial surgery.
At the beginning of the residency, I was interested in craniofacial. I found the surgeries to be exciting as we rebuilt the structure of the face. Additionally, I enjoyed that these surgeries incorporated all the building blocks of plastic surgery. During my fourth year, I became more interested in hand surgery and its intersectionality across a number of plastic surgery domains. I enjoyed the bony and soft tissue reconstruction, the emphasis on functionality, and the biomechanical principles used in these surgeries.
What’s your day like?
I start my morning off with La Colombe cold brew as I get ready for the day. During my drive to the hospital, I try to listen to a podcast either The Daily or Up First.
At 6 AM, I am rounding with the team or in morning conference. After conference, I meet our first patient in the pre-op area before heading to the operating room for the day.
Between cases, I’m checking on new consults or grabbing a coffee. Our team always tries to meet up for lunch in the courtyard when the weather is nice enough. I also use this time to update our Instagram with any exciting research updates from the Ravnic Lab or congratulate our residents on their hard work.
Once cases are done for the day, I track down the rest of the team and run the list for the day. If it's still light out, I try to go for a run outside or go to the gym with some of the other residents.
At 6 PM, I am usually home unless it is a call night. For my co-residents on call, I make a double or triple serving of dinner and drop it off for them. The rest of the night I spend prepping for morning conference, indications, cases, or journal club and catching up on some much-needed TV (currently watching The Bear).
What reminds you of the why behind this journey?
The collaboration with patients and my team. Plastics is an intensely collaborative specialty and requires teamwork with your team, other teams, and the patient. I am always reminded of this during free flap cases when half the team is working on micro at the recipient site and others are closing the donor site. We are working in tandem and it makes the hours spent in the operating room feel rewarding.
What keeps you motivated?
A combination of my patients, my team, and the creative challenges of the field.
As a largely reconstructive center, patients present to us with unpredictable problems after traumatic injuries. These individuals are vulnerable and fearful, often with challenging-to-treat injuries, turning to plastic surgery for solutions. It is rewarding to be able to treat these patients, support them through a challenging time, restore function, and help them return to a resemblance of normalcy.
Having a great team is necessary in residency. I love my team because we continuously bounce ideas off one another to come up with a holistic plan for each of our patients. We find humor in challenging situations and always support each other.
Lastly, I love the creative aspect of plastics. I think of this field as a craft and as a resident you are an apprentice mastering the technical and mechanical aspects of surgery. But with time, you develop finesse and cultivate creativity that makes you a skilled and elegant surgeon.
What’s one piece of advice you have for someone who wants to do what you do?
“A rising tide lifts all boats” -- This quote symbolizes the benefit of collaboration. As a medical student, working with your peers who have similar interests to start an interest group will allow you to build your resumes together and make connections in the process. I believe it is a good practice to get into as team work will only serve you, your clinical team and your patients better.
Lightning Round
Favorite Procedure? Either LRTI for basilar joint arthritis or vascular reconstruction with vein graft for hypothenar hammer syndrome.
Music in the OR? Most of our attendings will have music on. My go-to playlists are gold handle mega mix, or poolside grooves. Another solid choice is Leon Bridges
Favorite On-Call Snack? Delivery from Pho Miss Saigon
Favorite shoes to wear in the OR? Calzuros (with holes)
Liquid Rhinoplasty: A Case Series Study on the Deep Columellar Approach
Article Review by Matthew Henn, Oregon Health and Science University
We are entering a new era of nose cosmetics with liquid rhinoplasty: a non-invasive approach to reshape and sculpt your ideal nose, minus the complex surgery.
The world of facial plastics is evolving, with a recent surge in a procedure known as liquid rhinoplasty, a non-invasive approach to the most common cosmetic procedure. Liquid rhinoplasty involves soft tissue filler injections of hyaluronic acid (HA) or collagen-stimulating filler into the deep fatty layer to reshape the nose in a variety of ways.
A study of 338 patients and 511 total liquid rhinoplasty procedures was conducted utilizing a specific 4-step deep columellar approach (DCA) with 33% of the patients having undergone a liquid rhinoplasty one or more times in the past. Only 2.73% of the patients experienced adverse effects, proving the DCA to be a safe and consistent procedure due to the avoidance of arteries in the nose. The patient satisfaction rate was over 90% shortly post-operatively and remained over 90% at 6-month follow up.
Plastic surgery is constantly pushing the boundaries of surgical and non-surgical excellence, and liquid rhinoplasty is at the cutting edge of nose cosmetics. Albeit an “off-label” use, liquid rhinoplasty offers a safer, non-surgical avenue for those looking to sculpt their ideal nose, minus the complex surgery.
References
Magacho-Vieira FN, Alfertshofer MG, Cotofana S. The Deep Columellar Approach for Liquid Rhinoplasty - A Case Series of 511 Procedures over 16 years. Facial Plast Surg Clin North Am. 2022 May;30(2):193-203. PMID: 35501057.
Fostering Compassion and Expertise: The Crucial Role of Patient Understanding and Historical Context in Plastic Surgery
Opinion by Kimberley Brondeel, University of Texas Medical Branch
In the world of surgery, meticulous preparation is paramount. Before donning those sterile gloves and stepping into the operating room, there's a checklist that goes far beyond the instruments and drapes. It begins with a fundamental act of humanity – introducing oneself to the patient. Without this, we risk becoming mere technicians, our actions devoid of context and compassion.
Why is it so crucial to know who the patient is, why they're here, and what they're about to undergo? Because understanding their journey, potential outcomes, and postoperative course is not just a courtesy; it's a professional obligation. We owe it to our patients to be fully informed, to be more than "that guy" who disregards the sterile field before surgery even commences.
Preparation extends to mastering the nuances of the procedure itself. From indications to contraindications, complications to anatomy, a surgeon's knowledge must be unwavering. Textbooks and manuals are our allies in this quest for excellence.
Yet, in our pursuit of perfection, we sometimes overlook a vital aspect of our craft – the history behind it. I recently scrubbed into a paramedian forehead flap procedure, a cornerstone of nasal reconstruction. It struck me that we often forget to delve into the historical roots of our craft, to appreciate how far we've come.
The history of plastic surgery, I discovered, reaches back to 600 BC. Sushruta, an ancient surgeon, described a comprehensive approach that included using a leaf to create a wound template, a cheek flap to supply tissue, and hollowed reeds as nasal stents. This technique, born out of necessity, evolved over time.
The power of this historical perspective is profound. It connects us to a legacy stretching back millennia, reminding us that we stand on the shoulders of countless surgeons who shaped our field. Instead of rote memorization, I urge my colleagues to explore the rich history of our procedures. It's a journey that illuminates and deepens our appreciation for the art and science of surgery, offering insight into the hands that have crafted its evolution.
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