Preference Signals and Away Rotations Greatly Influence Application Success in the Integrated Plastic Surgery Match

Objective: Integrated plastic surgery implemented a preference signaling program (PSP) starting the 2022 to 2023 application cycle which allowed applicants to signal their top 5 preferred programs through the Plastic Surgery Central Application (PSCA). In this study, we aim to evaluate the effect on this new PSP at both the applicant and program level. Design: This cross-sectional study relies on self-reported survey data from 2019 to 2024 from the Texas Seeking Transparency in Application to Residency (STAR) database. Variables associated were analyzed using 2-sided t-tests, Chi-squared tests, variance ratio testing and receiver operating characteristic (ROC) analysis. Results: Plastic surgery applicants from 2023 to 2024 submitted more applications (85.1 vs 67.3, p < 0.001) and received fewer interview offers (12.5 vs 15.7, p = 0.003) than 2017 to 2022 applicants. 2023 to 2024 interview offers were more evenly distributed (SD: 8.25 vs 10.5, p = 0.001). Applications employing a signal were more likely to receive an interview (OR: 5.72, p < 0.001) and subsequently match (OR: 5.19, p < 0.001). Applications where students had done away rotations were significantly more likely to result in an interview offer (OR: 30.2, p < 0.001) and a match (OR: 27.4, p < 0.001). There was no significant difference in application number, Step 2 CK scores or honored clerkships between matched and unmatched 2023 to 2024 applicants. Conclusions: The implementation of preference signaling in the integrated plastic surgery residency application process appears to have corresponded to an increase in average applications per student, decreased interview offers and more evenly distributed interviews among applicants. Away rotations, preference signals and geographic connections seem to most strongly predict whether an application results in a successful match.