MD & DO AMA Plastic Surgery Matched

[PlasticsAMA]

Hi all,

With all this home-dwelling, I've been returning back the these forums that I used to visit so frequently as a pre-med and throughout the first few years of medical school.

To be concise, I matched into an integrated plastic surgery program which is an accomplishment I had much anxiety about. Heck, I had plenty of anxiety about the question of whether this was actually what I wanted to do etc.

At this point, after doing and seeing much plastic surgery this year, I am very confident this is the path for me. I am aware however that plastic surgery is often misunderstood by the general public, and not so uncommonly, by students and non-surgical/surgical faculty.

I am very happy to answer any questions you might have about plastic surgery or the process of matching.

Be safe and best of luck to you all.

PlasticsAMA

---

Members don't see this ad.

 

[deleted903608]

Did you take a research year? Hear a lot of mixed opinions so would like to hear yours on the necessity/benefit of one.

 

[FindersFee5]

What do you think about the explosion of applicants this year? ACAPS said there were ~50 more USMDs applying this year than the previous years. Do you see this a trend that will continue? Or do you think it's foolish to try to predict anything about this next year because it will be so abnormal?

 

[Iz_FtB]

Sub I tips, things to know, things to read etc

 

[PlasticsAMA]

Did you take a research year? Hear a lot of mixed opinions so would like to hear yours on the necessity/benefit of one.

Great question - its ends up being an individual decision based on (1) your prior experience in plastic surgery through years one and three (2) your research productivity and (3) the relationships you have with plastics faculty.

Plastics is a very small field and your letters of recommendation end up being a very big part of your application. If you have had no experience with the plastic surgeons at your program, or you don't have a plastics program at your school, doing a research year with plastic surgery faculty will allow you to develop relationships with these people who can write you letters. When you do away rotations, it is commonplace to be asked "well how is so and so doing" and "so have you done any research?" When you are competing for 2-3 spots, and prior rotators have had an answer to that question, you should have something compelling to say too.

There are a few other things about the research year that i'll just rattle off in no particular order:
- There are a handful of coveted research spots at highly academic institutions. If you are coming from a less well-recognized program, having research with superstar co-authors from these places or letters from them can give your app a boost.
- The research year gives you a nice period of time to enjoy life and still be productive. Most people love theirs if they don't have to move to a place they don't like and get along with the people they work with.
- Look at your school's match history. If all or most other successful plastic surgery applicants have taken a year, you probably shouldn't take the risk and not do one.
- For the people who have some research and go straight through without a research year, I think PD's actually see them and think something the lines of "this person has a lot of confidence" - its a soft thing but thats just my personal experience.

Happy to answer any follow ups.

Again, great question.

PlasticsAMA

 

[PlasticsAMA]

What do you think about the explosion of applicants this year? ACAPS said there were ~50 more USMDs applying this year than the previous years. Do you see this a trend that will continue? Or do you think it's foolish to try to predict anything about this next year because it will be so abnormal?

This is an interesting question. I have some preliminary thoughts but if any other residents, attendings, students, want to weigh in here I'd be curious to hear your thoughts.

1) I believe if you look back at prior years, the number of applicants tend to follow and undulating pattern. Basically the theory is that one year might have a really low match rate > people are discouraged from applying > higher match rate that year > the next year people are encouraged to apply and there is a lower match rate > repeat. This years match rate was fairly lower than most other years but that could be a fluke.

2) Perhaps with fewer traditional spots being offered (i.e. traditional programs being converted to integrated), students who would otherwise have felt uncompetitive for an integrated position and taken a gen surg route are more incentivized to apply.

I have some other unbaked theories but these are probably my top 2. As I said would be curious about other people's thoughts.

PlasticsAMA

 

[PlasticsAMA]

Sub I tips, things to know, things to read etc

Sub I and things to know tips:
Generally, realize that you are being evaluated 100% of the time. On your first week, step back and try to get a sense of what is expected of you. Its different at different places (sounds obvious but its not) at some places you are expected to get supplies, at some you make the list, etc. You might feel that you are not being productive when really you are doing a good job. It can't hurt to ask either - just try not to come off super insecure or like you are doing a terrible job - be an adult about it.

other classic things that are true:
- first one is ALWAYS, last one to leave unless they say go (if they do, go).
- know how to suture COLD. Nothing leaves a better impression than a med student who knows how to sew well and fast. Simple interrupted, subcuticular, deep dermals, etc.
- There are some canonical things you must know about content wise. Off the top of my head - three stages of skin graft incorporation, definition of a flap versus a graft, know the anatomy of a micro breast reconstruction cold, know the names of common instruments, etc.
- You can't prep this but the thing people will remember most is the stuff that gets said in normal conversation.. talking about a classic rock band, a great skiing spot, sports, broadway shows, etc. - stuff people enjoy talking about.

Reading:

Your go to resources are PRS journal, Grabb and Smith, and Janis essentials of plastic surgery.

 

[frozencubes]

Did you have to think about choosing between derm and plastic? If so, what made you choose plastics?

 

[PlasticsAMA]

Did you have to think about choosing between derm and plastic? If so, what made you choose plastics?

Derm never entered the equation for me.
I went from loving big surgeries to loving the creativity of different surgeries.
The rationale that I think might bring someone interested in derm to plastics is an interest in the basic science of skin and or skin cancer, or maybe Hidranitis or some other overlapping niche disease.
Derm does a lot of medical management of inflammatory skin conditions etc. The surgeries they do are mainly mohs or sometimes minor or mild wounds of the face - could be wrong, don't think I fully appreciate the scope of derm. While plastic surgeons are interested in wound healing, certain skin conditions, complex wound management, cosmetic injectables, and facial rejuvenation with chemicals or lasers in addition to surgery, there is vastly more within the purview of plastics that makes up the bulk of practice for most surgeons.

Plastics has virtually overlapping areas with every interventional discipline - derm but also neurosurgery, thoracic surgery, transplant, vascular.. etc. That appealed greatly to the "surgeon in me". I have heard of people interested in both derm and plastics - I get it - but my feeling is that if you don't appreciate the other areas of plastics you will find the residency too challenging. Does that make sense? Apologies if that sounds critical I don't mean it to be.

 

[TLR123]

As far as research goes how much did you have and how did you know if it was enough? I’m interested in another surgical subspecialty and have had some research production but it seems like others are more productive

 

[Schwifty]

Step scores, number of pubs (field specific), number of apps, number of interviews, number of always, did you apply back ups? Thanks!

 

[FindersFee5]

Sub I and things to know tips:
Generally, realize that you are being evaluated 100% of the time. On your first week, step back and try to get a sense of what is expected of you. Its different at different places (sounds obvious but its not) at some places you are expected to get supplies, at some you make the list, etc. You might feel that you are not being productive when really you are doing a good job. It can't hurt to ask either - just try not to come off super insecure or like you are doing a terrible job - be an adult about it.

other classic things that are true:
- first one is ALWAYS, last one to leave unless they say go (if they do, go).
- know how to suture COLD. Nothing leaves a better impression than a med student who knows how to sew well and fast. Simple interrupted, subcuticular, deep dermals, etc.
- There are some canonical things you must know about content wise. Off the top of my head - three stages of skin graft incorporation, definition of a flap versus a graft, know the anatomy of a micro breast reconstruction cold, know the names of common instruments, etc.
- You can't prep this but the thing people will remember most is the stuff that gets said in normal conversation.. talking about a classic rock band, a great skiing spot, sports, broadway shows, etc. - stuff people enjoy talking about.

Reading:

Your go to resources are PRS journal, Grabb and Smith, and Janis essentials of plastic surgery.

What are your tips for working on suturing at home? I get expired sutures and gloves from friendly scrub techs and practice on pigs feet, but it's significantly tougher than actual skin (to the point of bending needles sometimes). So I end up just using scraps of cloth most of the time.

 

[longhaul3]

What are your tips for working on suturing at home? I get expired sutures and gloves from friendly scrub techs and practice on pigs feet, but it's significantly tougher than actual skin (to the point of bending needles sometimes). So I end up just using scraps of cloth most of the time.

(Not in plastics, but another surgical sub.) Pigs feet can be pretty good if you use them fresh from the butcher. Work on the most proximal parts; you may need to tack down the free edge (where it was severed from the leg) with a stitch if the skin is moving around too much since it's not anchored to anything. If the needle is bending on a fresh pig's foot, you may need to work on your technique: enter at 90 deg, more supination than pushing, don't grab the tip of the needle, make sure you're positioning the needle in properly in the needle driver to use the curve. If your technique is good and it's still bending, try a bigger needle, which will be less realistic (e.g. a big needle on a 2-0 silk for a dermal stitch) but won't bend.

All else fails, bend the needle back against the table prn.

 

[LoGo]

Did you have to think about choosing between derm and plastic? If so, what made you choose plastics?

To add to the OPs response, a lot of people think of plastics as the surgical version of derm - it’s not. Derm Is the terminal skin specialty, and does office-based surgery, procedures etc and certainly more of all of that in Mohs, where it’s not uncommon at all to do forehead flaps, cartilage grafts to nose etc as a dermatologist. Where people see derm and plastics overlap is some of the skin cancer aspects, and the cosmetics. But plastics is not strictly a specialty of the skin. The best definition of plastic surgery that I’ve come across is this, from the ASPS which IMO is critical for anyone thinking about plastics:

“Plastic surgery is a specialty which adapts surgical principles and thought processes to the unique needs of each individual patient by remolding, reshaping and manipulating bone, cartilage and all soft tissues. Not concerned with a given organ system, region of the body, or age group, it is best described as a specialty devoted to the solution of difficult wound healing and surgical problems, having as its ultimate goal the restoration or creation of the best function, form and structure of the body.”
- From Plastic Surgery Essentials for students https://plasticsurgery.ucsf.edu/media/10832679/essentials-for-students.pdf

The difference between plastics and derm here is very apparent.

 

[FindersFee5]

(Not in plastics, but another surgical sub.) Pigs feet can be pretty good if you use them fresh from the butcher. Work on the most proximal parts; you may need to tack down the free edge (where it was severed from the leg) with a stitch if the skin is moving around too much since it's not anchored to anything. If the needle is bending on a fresh pig's foot, you may need to work on your technique: enter at 90 deg, more supination than pushing, don't grab the tip of the needle, make sure you're positioning the needle in properly in the needle driver to use the curve. If your technique is good and it's still bending, try a bigger needle, which will be less realistic (e.g. a big needle on a 2-0 silk for a dermal stitch) but won't bend.

All else fails, bend the needle back against the table prn.

I've never gotten pigs feet fresh from the butcher, only previously frozen and thawed from my local grocery store. Maybe I need to visit the butcher!

 

[longhaul3]

I've never gotten pigs feet fresh from the butcher, only previously frozen and thawed from my local grocery store. Maybe I need to visit the butcher!

Aha! Gotta get them fresh. You may also be able to get them from the butcher's counter at the grocery store. They get real nasty real quick, though, so have a fresh garbage bag ready and just dump them when you're done.

I also want to highlight for others who are interested, it's key to wear gloves as you mentioned in order to simulate the OR as closely as you can; double glove and use real gloves from the OR if possible. You can reuse the inner gloves. That 5-0 caprosyn is much harder to work with when you've got two pairs of gloves on.

 

[PlasticsAMA]

Step scores, number of pubs (field specific), number of apps, number of interviews, number of always, did you apply back ups? Thanks!

charting outcomes in the match will be your best resource for this as one persons stats will only tell you so much. 250s step, around 10 pubs. Most people apply to almost all programs because it’s so competitive. 3 aways is the most common though I’ve heard of people doing four. I did 3. I applied to gen surg backup but stopped attending most gen surg interviews once I felt confident I would match in plastics (as confident as I could that is haha)

 

[PlasticsAMA]

I've never gotten pigs feet fresh from the butcher, only previously frozen and thawed from my local grocery store. Maybe I need to visit the butcher!

Fresh is the way to go. If you’re bending the needle it’s a technique issue - as was previously mentioned make sure you are supinating, the path of the needle is an arc. To be honest I haven’t found the perfect way to practice at home and have tried those suturing pads, oranges, pigs feet. The best thing is just to make sure the object you are suturing is not going to lift up when you tie down your not. Once you have that it’s all about practicing instrument ties, two handed ties (YES PRACTICE THIS!) and one handed ties. Know how to square the knot. Also know how to throw drain stitches as this is a common med student task. I know it won’t *feel* like you are suturing the real thing but it’s getting the muscle memory of tying down that’s the key thing to practice at home. Also if you are suturing something soft and your suture is cutting through the object, it’s a good way to practice how to put different levels of tension on the knot.

also IRL your needle will sometimes bend. You can usually fix it a certain degree with your forceps but not a bad thing to learn how to suture with a mucked up needle since you don’t want to be asking for a new one if that does happen in the OR.

 

[slowthai]

charting outcomes in the match will be your best resource for this as one persons stats will only tell you so much. 250s step, around 10 pubs. Most people apply to almost all programs because it’s so competitive. 3 aways is the most common though I’ve heard of people doing four. I did 3. I applied to gen surg backup but stopped attending most gen surg interviews once I felt confident I would match in plastics (as confident as I could that is haha)

When you say 3 aways, are you talking a sub-i + 2 aways? Because I heard the average for plastics is 2.1 aways. Like people rotate at home, then rotate at 2 other programs.

 

[PlasticsAMA]

When you say 3 aways, are you talking a sub-i + 2 aways? Because I heard the average for plastics is 2.1 aways. Like people rotate at home, then rotate at 2 other programs.

Ah apologies I can see how that was unclear - the average applicant nowadays does 3 aways outside of their institution in addition to one done at their home program. So 4 sub I’s in total - 3 aways.

 

[slowthai]

1. Favorite subspecialty of plastics? Least favorite?
2. Plan on doing a fellowship?

 

[PlasticsAMA]

1. Favorite subspecialty of plastics? Least favorite?

Great question. The truth is I find myself loving almost every area of plastics. Recently I've been really interested in peripheral nerve surgery including facial reanimation surgery, brachial plexus surgery, etc. Previously I was very interested in craniofacial. There are some combined microsurgery/hand fellowships that look interesting. Finally, I don't want to sell myself short and understate my interest in cosmetic surgery - those cases fascinate me too. Right now my focus in residency will be to establish a solid base on bread and butter plastic surgery and the rest I'll figure out along the way. Wish I had a more concrete answer for you but alas I do not. I would say that doing a micro fellowship just to do autologous breast reconstruction is not something that speaks to me personally.

2. Plan on doing a fellowship?

Heck yea, just gotta figure out which one..

 

[FishermanDon99]

Specific recommendations for someone without a home program on finding resources? Research, mentorship, networking, funding for gap year, etc. I had some pretty prestigious non-plastics research lined up for my MS1 summer - derm at the NIH or uro at Harvard - but they are now on hold due to COVID so I'm not sure what to do at this point.

Did you get AOA?

 

[Therealestdoc]

Specific recommendations for someone without a home program on finding resources? Research, mentorship, networking, funding for gap year, etc. I had some pretty prestigious non-plastics research lined up for my MS1 summer - derm at the NIH or uro at Harvard - but they are now on hold due to COVID so I'm not sure what to do at this point.

Did you get AOA?

Second this one - Aside from away rotations is there anything additional you recommend for students without a home program? Specifically in pre-clinical years where plastics research may be limited/non-existent.

 

[hellanutella]

Specific recommendations for someone without a home program on finding resources? Research, mentorship, networking, funding for gap year, etc. I had some pretty prestigious non-plastics research lined up for my MS1 summer - derm at the NIH or uro at Harvard - but they are now on hold due to COVID so I'm not sure what to do at this point.

Did you get AOA?

Not to hijack thread, but the plastics application spreadsheet for this year has started a tab with info on year-long fellowships. ACAPS (American Council of Academic Plastic Surgeons) and PSRC (Plastic Surgery Research Council) have been popping by to connect students with educational ventures and virtual programming.

Sorry to hear about the covid cancellations – this year will be throwing most for a loop. ):

 

[PlasticsAMA]

Specific recommendations for someone without a home program on finding resources? Research, mentorship, networking, funding for gap year, etc. I had some pretty prestigious non-plastics research lined up for my MS1 summer - derm at the NIH or uro at Harvard - but they are now on hold due to COVID so I'm not sure what to do at this point.

Did you get AOA?

Check the google spreadsheet that I linked earlier in the thread. It's a great resource for speaking with past and current applicants and I believe there is a tab with research fellowship information. DM me if you are thinking of taking a year in the north east as we may have something opening up at my institution.

No AOA for me which at the time was a bummer but it worked out all the same.

 

[Dr. Anonymouss]

How did you narrow in on plastics as opposed to another surgical specialty? I refuse to be that MS1 that guns plastics right out of the gate, but I want to leave my options open. I am fairly certain all of my interests reside on the surgical side of medicine, but I am not quite sure which field that may be in.


And NYbella93's question will be helpful as my medical school doesn't have a plastics program, only general and orthopaedic surgery.

 

[dial1010usa]

Step scores, number of pubs (field specific), number of apps, number of interviews, number of always, did you apply back ups? Thanks!

 

[PlasticsAMA]

How did you narrow in on plastics as opposed to another surgical specialty? I refuse to be that MS1 that guns plastics right out of the gate, but I want to leave my options open. I am fairly certain all of my interests reside on the surgical side of medicine, but I am not quite sure which field that may be in.


And NYbella93's question will be helpful as my medical school doesn't have a plastics program, only general and orthopaedic surgery.

it took rotating on multiple other surgical services to know plastics was for me. I loved many types of surgery. Wanted to be both a neurosurgeon and orthopedic surgeon at one point. Ultimately I took a year off to do research and decide for sure. The combination of case diversity, career diversity, Mentorship, and a myriad number of other factors pushed me in the direction of plastics. I couldn’t see myself doing anything else know interestingly enough. it’s a hard decision to make though - make sure you speak with people who are in and out of training of every field you are considering, ask them about their lives and work, spend time on every service you are interested in, both in OR and clinic. Get advice from non medical people too.

Regarding your “refusal to gun” I’m not exactly sure how to understand this. I can tell you that plastics and other competitive sub surg specialities rewards those who demonstrate early interest. I and many others at my school got involved w plastics early. When compared w those who got involved after M3, we have an enormous advantage in the app cycle.of course there were those who didn’t apply to plastics, I’m sure they didn’t regret the research they did though. Also just a note on gunning, you should always try to do your best and don’t worry how others perceive you

 

[PlasticsAMA]

Step scores, number of pubs (field specific), number of apps, number of interviews, number of always, did you apply back ups? Thanks!

I believe I answered this earlier in the thread but if I didn’t.. 250s, 7-10 some plastic all surgical, 70, ~15 interviews, 3 aways + home, applied gen surg backup but only attended a handful

 

[slowthai]

Do you have an idea of whether you want to stay in academia or go into private practice?