And Then There Was One: 2021 to 2022 COVID-19 Single Away Rotation Policy's Impact on the Geography of the Integrated Plastic Surgery Match

Away rotations have been shown to play an important role in the integrated plastic surgery residency match process, with most applicants completing two or three of these electives.1 In response to coronavirus disease of 2019, the Association of American Medical Colleges (AAMC) prohibited 2020 to 2021 applicants from completing away rotations.2 During this cycle, applicants were more likely to match into their home residency program and into the same geographic region as their medical school than in previous years.3,4 Given that the AAMC updated their policy for the 2021 to 2022 cycle, which allowed up to one away rotation for students, we hypothesized that a single away rotation would allow students to overcome the geographic bias seen during the 2020 to 2021 cycle. Applicants who matched into integrated plastic surgery residency programs during the 2021 to 2022 cycle were identified using official program social media platforms (eg, Instagram, Facebook, Twitter, LinkedIn, and Doximity). Regions were assigned to an individual’s medical school and residency program according to the U.S. census map, a methodology that has been used previously.3,4 Outcomes included matching at one’s home program or at a program in the same region as one’s medical school. Home program was defined as a residency program affiliated with an applicant’s medical school. Using chi-square tests, outcomes of the 2021 to 2022 cycle (one away rotation) were compared with those of the 2020 to 2021 cycle (no away rotations) and 2015 to 2020 cycles (unlimited away rotations), which were published in this group’s previous study.4 Of the 85 programs participating in the 2021 to 2022 residency match cycle, data were obtained for 190 applicants who matched at 84 programs (98.8%). Overall, 124 (65.2%) applicants came from a medical school with a home program, at which 28 (22.6%) matched (Fig. 1). Of the 180 U.S. medical school graduates, 90 (50.0%) matched in the same region as their medical school. Applicants of the 2021 to 2022 cycle matched at their home program and in the region of their medical school at significantly lower rates than applicants of the 2020 to 2021 cycle, 22.6% versus 36.0% and 50.0% versus 61.1%, respectively (P < 0.05 for all) (Fig. 1). There was no difference in match rates between the 2021 to 2022 and 2015 to 2020 cohorts (P > 0.05 for all).Fig. 1.: Resident match outcome is influenced by away rotations. Temporal differences between the 2015 to 2020, 2020 to 2021, and 2021 to 2022 residency match cycles (2015 to 2020 and 2021 cohorts data taken from: Asadourian PA, Murphy AI, Marano AA, Rohde CH, Wu JK. Home field advantage: assessing the geographic trends of the plastic surgery residency match during the COVID-19 pandemic. J Surg Educ. 2021;78:1923–1929). Resident match rates (as a percentage) into their home program and region of their medical school are compared among groups. *P < 0.05.These findings indicate that by reinstituting a single away rotation for the 2021 to 2022 application cycle, applicants were capable of correcting the geographic biases of the match process. However, perhaps the more novel takeaway from our study is that a single away rotation may be sufficient for overcoming these geographic biases. This conclusion is further supported by Claiborne et al., who found that of applicants who completed at least one away rotation, the number of away rotations was not associated with match success.5 The AAMC may consider the implications of this finding given that applicants spend $3591 on average to complete multiple away rotations.1 The significant cost of an unrestricted away rotation policy likely favors applicants who are unconcerned with the additional financial stressors of applying to residency. Future initiatives should address this potential disparity to decrease the financial barriers to a career in plastic surgery. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.