Background: Plastic surgery training programs draw applicants directly from medical school (the "integrated path"), and they may also draw applicants who have completed other categorical training (the "independent path"). Much of the literature on applicant selection focuses on the integrated path. The authors sought to characterize the selection process of independent path programs and how they compare with the integrated path programs. Methods: An anonymous, 42-question, multiple-choice, online survey was designed for program directors of the independent training path; it was mirrored to the previously designed survey of the integrated training path. Surveys were sent to all independent path program directors in the United States. Results: Fifty of the 51 qualifying program directors (98 percent) completed the survey. Fewer exclusively independent programs (30 percent) used a United States Medical Licensing Examination step-1 cutoff for interviews than did programs using both training pathways (71 percent; p = 0.015). Letters of recommendation were deemed the most important academic criteria. The attrition rate for independent residents was 3 percent. The combined rate of the adverse outcomes of probation and attrition was statistically lower for independent programs (30 percent) than for integrated programs (43 percent; p = 0.033). Conclusions: These results may answer some questions regarding what programs are looking for. The low rates of probation, dismissal, and attrition compared with those of the integrated path would support maintaining the independent path as a viable option for those who meet selection protocols, as these candidates may have already been preselected for success through their previous training programs.
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