Research productivity has become a critical component of the plastic surgery residency application process, particularly after United States Medical Licensing Examination Step 1 score reporting was discontinued in 2022, with the most recent matched cohort reporting 5 published articles per resident. 1 Because plastic surgery is a competitive specialty with 1 in 4 candidates unmatched, many applicants pursue dedicated research years or extracurricular research projects to bolster their applications. 2 We evaluated applicant-reported research output and dedicated research time during the last 3 cycles to better understand trends in student research. Despite similar match rates (55. 3%, 62%, 58. 8%), we observed an uptrend in research output. We reviewed 135 applications from interviewees at our institution across 3 cycles (2022–2023: cycle 1; 2023–2024: cycle 2; 2024–2025: cycle 3), capturing the group most relevant to program decision-making. Data on publications, presentations, and research years were collected from application materials. Descriptive data were compiled (Table 1), and 2-tailed t tests were used for comparisons (significance P < 0. 05) (Table 2). Table 1. - Research Time and Production Characteristics of Applicants Accepting Interviews 2023–2025 Cycles Characteristic Research Year Cycle 1 Applicants No Research Year Cycle 1 Applicants 2022–2023 Cycle Applicants Research Year Cycle 2 Applicants No Research Year Cycle 2 Applicants 2023–2024 Cycle Applicants Research Year Cycle 3 Applicants No Research Year Cycle 3 Applicants 2024–2025 Cycle Applicants Sample size, n 7 39 46 12 32 44 18 27 45 Total first-author publications, mean (median) 3. 6 (4) 2. 9 (2) 3 (2) 3. 4 (3. 5) 3 (2. 5) 3. 1 (3) 5. 1 (3. 5) 4 (3) 4. 4 (3) Total publications, mean (median) 11 (8) 7. 4 (6) 8 (6) 8. 4 (8. 5) 7. 8 (6) 8 (6. 5) 15. 9 (9) 9. 4 (6) 12 (8) Total poster presentation, mean (median) 5. 7 (5) 5. 7 (4) 5. 7 (4) 8. 6 (7) 9. 6 (8. 5) 9. 3 (7. 5) 10. 8 (9. 5) 12. 7 (10) 12 (10) Total oral presentation, mean (median) 8. 4 (5) 4. 7 (3) 5. 3 (4) 14. 8 (16) 7. 4 (5. 5) 9. 4 (6) 16. 6 (14. 5) 7. 7 (6) 11 (10) Total presentations, mean (median) 14. 1 (14) 10. 4 (9) 11 (9) 23. 3 (22. 5) 17 (15) 18. 7 (16) 27. 4 (24. 5) 20. 4 (16) 23. 2 (20) Total research output, mean (median) 25. 1 (22) 17. 8 (14) 19 (15) 31. 8 (30) 24. 8 (22) 26. 7 (25) 43. 3 (32) 29. 9 (24) 35. 2 (28) Students taking research year, n (%) — — 7 (15) — — 12 (27) — — 18 (40) Table 2. - Cycle Comparisons of Research Output Metrics Between Applicant Cycles Metric Comparison Mean Difference (B Minus A) P Total first-author publications 2022–2023 versus 2023–2024 0. 16 0. 77 2022–2023 versus 2024–2025 1. 44 0. 05 2023–2024 versus 2024–2025 1. 29 0. 08 Total publications 2022–2023 versus 2023–2024 0. 04 0. 97 2022–2023 versus 2024–2025 4. 06 0. 07 2023–2024 versus 2024–2025 4. 02 0. 07 Total poster presentations 2022–2023 versus 2023–2024 3. 6* <0. 01 2022–2023 versus 2024–2025 6. 28* <0. 01 2023–2024 versus 2024–2025 2. 68 0. 07 Total oral presentation 2022–2023 versus 2023–2024 4. 13* <0. 01 2022–2023 versus 2024–2025 5. 94* <0. 01 2023–2024 versus 2024–2025 1. 81 0. 34 Total presentation 2022–2023 versus 2023–2024 7. 73* <0. 01 2022–2023 versus 2024–2025 12. 22* <0. 01 2023–2024 versus 2024–2025 4. 5 0. 11 Total research output 2022–2023 versus 2023–2024 7. 77* 0. 02 2022–2023 versus 2024–2025 16. 29* <0. 01 2023–2024 versus 2024–2025 8. 52 0. 06 *Mean difference is significant at a P value of less than 0. 05. Total research output increased by 87% across all cycles (15–28 publications/presentations), whereas the proportion of applicants taking a dedicated research year rose by 167% (15%–40% of applicants) from 2022 to 2025. An expected surge in publications and presentations occurred in the year following the Step 1 change (67% growth), although more recent gains have plateaued (12%). Growth in total output was primarily driven by presentations, with significant increases in poster and podium presentations between cycles 1–2 and cycles 1–3 (P < 0. 01 for all). Applicants who took a research year showed higher presentation counts but minimal increases in first-author publications, suggesting that research years may be more valuable for experience than measurable productivity. Despite rising research output, the predominant increase in presentations, rather than peer-reviewed publications, suggests that publishing research remains feasible for applicants not taking dedicated years. Although dedicated research time can enhance competitiveness, its expanding prevalence raises important considerations. Informal expectations may develop in which applicants must take research years to remain competitive, regardless of their interest in research-focused careers. These additional years also impose substantial financial strain, with total cost estimates ranging from 35, 000 to 74, 000, and potential socioeconomic bias favoring students with greater access to resources. 3 Additionally, the temporal commitment of a research year may not provide substantial long-term benefits, particularly for the 67%–90% of future plastic surgery residency graduates who eventually pursue private practice. 4, 5 For many of these individuals, the opportunity cost of delaying clinical training, taking out additional loans, or accruing further interest for research years may discourage highly competitive candidates from the specialty. This raises the question: do these current trends align with the long-term goals of applicants and the evolving needs of the specialty? Understanding the unintended consequences of escalating research expectations, both for future clinicians and for the specialty, is essential. Rather than continuing to prioritize easily quantified metrics, the field may benefit from a more deliberate examination of whether these trends support equitable access to the specialty, particularly for students who discover plastic surgery later in training, have limited institutional research infrastructure, or lack a home program. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.
Schwetschenau et al. (Wed,) studied this question.