Available online 5 May 2023

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Letters of recommendation play an important role in resident selection. While plastic surgery's Standardized Letter of Recommendation (SLOR) form most commonly serves as an adjunct to narrative letters, the SLOR provides objective data in the review process and could eventually replace narrative letters. The utility of the SLOR in predicting Match outcomes has not been studied.

Methods

Applicant data from 225 first-time residency applicants in 2020-21 were collected. Logistic regression modeling was used to predict Match outcomes. This model was validated using 100 randomly selected applicants from 2019-20.

Results

Rank placement (SLOR Question 6) was the most important factor when predicting Match outcomes (p<0.0001). All other SLOR questions were not predictive and subject to notable score inflation. No SLOR score differences were noted based on race; female applicants were rated higher in two of ten domains (p<0.05).

Conclusions

One question on the plastic surgery SLOR was highly predictive of an applicant matching. However, the remaining SLOR questions had little utility and were subject to gross score inflation. Further work should be done to optimize the utility of the SLOR in differentiating applicants. This has important implications in ensuring the selection of professional, competent residents according to the aims of the Accreditation Council of Graduate Medical Education.

Section snippetsINTRODUCTION

In the 2021-22 integrated plastic surgery (IPS) Match, 351 applicants applied for 194 positions: a Match rate of only 55%.1 This was a decrease from 57% in 2020-21 and 62% in 2019-20.2,3 Every year, programs choose from a pool of qualified applicants that is increasingly disproportionate to the number of IPS positions.4 Selecting the best candidates has implications for not only the success of individual programs but also the future of plastic surgery. While many factors are involved in

Data Collection

All applications to one IPS residency program during the 2020-21 application cycle were reviewed. All first-time residency applicants from United States medical schools were included. Applicants with prior postgraduate training, who had applied in a prior application cycle, or who graduated from an international medical school were excluded. These exclusion criteria were applied to ensure uniformity in letter writer contact with applicants.20 For data validation, 100 applications meeting the

RESULTS

Table 1 summarizes the demographics of applicants and letter writers included in this study. A total of 225 applications from the 2020-21 application cycle were analyzed as well as 100 randomly selected applications from 2019-20. The Match rate for the 2020-21 cohort was 70.7%, a decrease from 77% for the 2019-20 cohort. In both cycles, most applicants were female (55%), identified as Non-Hispanic White (56%), and applied from institutions with home integrated programs (70%). The writers’

DISCUSSION

LORs play a critical role in the resident selection process.5,6 Across specialties, program directors cite LOR content as highly influential when ranking applicants.6,22, 23, 24, 25 However, this is the first study to determine if responses on the plastic surgery SLOR correlate with applicant Match outcomes.

CONCLUSION

This study found that Question 6 of the ACAPS SLOR, “where would you rank this applicant…,” correlated the most strongly with Match outcomes, with Step 1 scores and number of publications also significant when predicting Match outcomes. However, the substantial score inflation of remaining SLOR questions limits their use in evaluating applicants. Now that Step 1 is pass/fail and with increasing emphasis on research output, further work should be conducted to optimize the SLOR to better

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