A Survey of Applicants to Integrated Plastic Surgery Residencies and Factors Associated With a Successful Match.

[BACKGROUND] Since USMLE Step 1 converted to pass/fail, programs increasingly use signals, away rotations, and geographic ties to gauge applicant fit. Whether these program-specific engagement tools truly outweigh traditional metrics in integrated plastic surgery selection remains unclear.

[METHODS] Texas STAR survey data from the 2017-2025 cycles were analyzed. Applicant-level analyses included 452 candidates (355 matched, 97 unmatched). Multivariable modeling comprised (1) ordinary least-squares (OLS) regression predicting the number of interview offers and (2) logistic regression predicting match success. Program-level analyses linked 284 of these applicants to 22,790 applicantprogram pairs from the 2023-2025 cycles. Four binary exposures were coded: formal signal, away rotation, self-reported geographic connection, and program location within an applicant's preferred region. Separate logistic regressions, clustered by applicant, identified independent predictors of (i) interview invitation and (ii) program-specific match.

[RESULTS] Matched applicants obtained more interview offers than unmatched peers (median 14 vs 5, P < 0.001) despite similar numeric metrics. In multivariable OLS, Step 1 score (P = 0.001), clerkship honors (P < 0.001), and peer-reviewed publications (P = 0.002) predicted interview count, yet these effects were overshadowed at the program level. Completing a visiting subinternship raised the odds of interview at that specific program by 21-fold (OR, 20.7; 95% CI, 16.1-26.6) and the odds of matching at that program by 13-fold (OR, 12.5; 95% CI, 8.95-17.5). Signaling a program and having a geographic connection also significantly increased the odds of interviewing and matching at that program.

[CONCLUSIONS] In this large, multicycle cohort, program-specific engagement, especially away rotations and formal signals, was a far stronger predictor of both interview invitations and match success than USMLE scores or publication counts. These findings offer actionable strategies for applicants navigating the pass/fail Step 1 era and underscore the responsibility of residency programs to ensure equitable access to meaningful engagement opportunities.