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Residency Match Rank List Creation: Who Waves the Wand?

Odom, Elizabeth B. M.D.; Buck, Donald W. II M.D.

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Plastic and Reconstructive Surgery: November 2016 - Volume 138 - Issue 5 - p 955e-956e
doi: 10.1097/PRS.0000000000002659
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The residency match process is nerve wracking for prospective residents and programs alike. In plastic surgery, where one in five applicants will not match, there is significant anxiety over the application process and rank list creation. Two recent studies evaluated factors applicants consider when ranking programs, and found that interaction with faculty and residents is highly influential.1,2 The American Council of Academic Plastic Surgeons has developed strict guidelines regarding postinterview contact between residency programs and prospective applicants,3 thanks in large part to the report by Nagarkar and Janis proving that applicants were likely to change their rank list order based on this contact.4 Although strict guidelines have been proposed for eliminating external influence into applicant decisions, it is unclear whether programs are following these recommendations, or what other influences may be in play.

After approval from the institutional review board, we performed a survey analyzing multiple factors and behaviors that may influence rank-list creation. Surveys were sent using a Web-based program to all applicants to our integrated residency program during the 2014 to 2015 cycle. We received 86 responses, for a 45 percent response rate. In the survey, applicants were asked to rank factors and resources most important to creating their rank list on a five-point Likert scale, and answer multiple-choice questions.

Results indicate that only 2.6 percent of respondents had received postinterview contact by program faculty. Although this suggests almost unanimous compliance with American Council of Academic Plastic Surgeons guidelines, we did discover that one in four applicants had received unsolicited postinterview contact by the residents of programs. Unfortunately, we also found that 41 percent of applicants reported hearing a faculty member speak negatively of another program during their interview. It is unclear what influence this negativity played in the applicant’s perception of said program and ultimately that program’s position on their rank list. However, one could postulate that it could have a profound influence, as our research, along with recently published data by Sinno et al.2 and Atashroo et al.,1 indicates that interaction with residents and faculty, and the interview day, are among the most important factors considered when creating a list (4.72 ± 0.58 and 4.36 ± 0.64 on the Likert scale, respectively). Therefore, it seems that the American Council of Academic Plastic Surgeons should consider developing guidelines on faculty discussion of programs at which they are not employed.

In conclusion, it appears that most programs adhere to the American Council of Academic Plastic Surgeons policies on faculty postinterview contact with applicants; however, it may be that the contact responsibility has been pushed onto the residents of the program, as one in four applicants in this research had received unsolicited contact from a resident after the interview. One concerning discovery in our research is the percentage of negative comments that faculty are making about other programs during an interview. This negativity could adversely affect an applicant’s view of a program and significantly influence his or her decision. As such, it may be necessary to address this potential problem with American Council of Academic Plastic Surgeons guidelines and/or preinterview faculty discussions on professionalism and interview etiquette.


Funding for Elizabeth Odom, M.D., was received through the National Institutes of Health grant T32 CA190194-01.


The authors have no financial interest to declare in relation to the content of this article.

Elizabeth B. Odom, M.D.
Donald W. Buck II, M.D.
Division of Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, Mo.


1. Atashroo DA, Luan A, Vyas KS, et al. What makes a plastic surgery residency program attractive? An applicant’s perspective. Plast Reconstr Surg. 2015;136:189196.
2. Sinno S, Mehta K, Squitieri L, et al. Residency characteristics that matter most to plastic surgery applicants: A multi-institutional analysis and review of the literature. Ann Plast Surg. 2015;74:713717.
3. American Council of Academic Plastic Surgeons. Uniform policy and guidelines for post interview communication. 2012. Beverly, Mass: American Council of Academic Plastic Surgeons; Available at: Accessed May 25, 2015.
4. Nagarkar PA, Janis JE. Fixing the match: A survey of resident behaviors. Plast Reconstr Surg. 2013;132:711719.


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