I think plastics is just like any highly competative residency. I assume you are wanting to do a combined/integrated residency as opposed to an independant residency? The independant model is where you do general surgery first and then a plastics fellowship.
The thing to remember about plastics residencies is that plastic surgery is a very small community. Everyone knows everyone else. I am a 4th year GS residency applying for plastics fellowships. I considered doing the combined model but was and still am thinking about staying in academics and my plastics advisor thought it would be smart to be boarded in GS as well as plastics. I guess it depends on whether that is important to you or not, and certainly not everyone would hold the same opinions that he did. I had numerous friends do the combined route from different medical schools. If I were to give you advice based on watching other people go through what you are about to it would be this:
1) Forget about your numbers/qualifications/that you walk on water. Everyone who is applying does. Basically all your qualifications do is get you in the door, and if what you say is true, your foot is probably in the door.
2) Read number 1. DO NOT GET OVERCONFIDENT. DO NOT GET A SENSE OF ENTITLEMENT. Remember, everyone else has your numbers too, otherwise they wouldn't be applying for plastics spots. My medical school had a combined program and I remember hearing one of the junior attendings bragging that they turned down 1 person with a 265 and another with a 269.
3) Overconfidence and a sense of entitlement will come through in your interviews and is very unappealing. Remember, the people who are interviewing you are badasses too.
4) Apply to every program.
5) Interview at and RANK a range of programs. THe people who I saw on match day crying and gnashing their teeth were the ones who only ranked Harvard, Hopkins, Stanford, UCLA, UT SW, etc. You need to rank a few in the middle and a few less desireable ones if you want to match.
6) Get enthusiastic letters from the plastics department at your university.
7) Get your letter writers to make phone calls for you. Plastics is a very very small community.
8) Read 1 through 7 again and actually do it. Remember everyone else looks just as good as you do. Just because you are the badass in your class doesn't mean anything. There are 2 - 3 hundred other people who are the badasses in their classes applying for plastics. Only a few of you will get plastics spots.
