Background: Postgraduate fellowships after plastic and reconstructive surgery residency offer the opportunity to pursue advanced training and specialized mentorship. While prospective medical student applicants to integrated plastic surgery programs frequently participate in elective rotations to explore potential residency programs, the pathway for matching into fellowship is not as clearly delineated. Few plastic surgery residency programs offer senior residents protected time for elective rotations outside of the institution. At our institution, PGY-5 plastic surgery residents have several weeks of protected time for elective rotations. Our study was designed to investigate the impact of this protected elective time on postgraduate fellowship outcomes. Methods: National Resident Matching Program (NRMP) and San Francisco (SF) match data for post-graduate fellowships in aesthetic plastic surgery, craniofacial, hand, and microsurgery were collected from 2019-2025. All national hand data published by the NRMP included graduates from plastic surgery, orthopedic surgery, and general surgery residency programs. The number of applicants with plastic surgery backgrounds to hand surgery was estimated using published reports from 2019-2021. Our institution’s data was collected from a retrospective review of our PGY-5 elective time and postgraduate outcomes data from 2019-2025. Results: At our institution 93.5% of graduates pursued fellowship training from 2019-2025, compared to 78.6% nationally. In five of the six application cycles examined, a greater percentage of residents elected to pursue fellowship training at our institution compared to the national average (Table 1). Overall, 78.6% of residents at our institution matched into a fellowship program where they had completed an elective, spending an average of 2.8 weeks at each rotation. Match rates into aesthetics, craniofacial, hand, and microsurgery fellowships following elective rotations exceeded national averages over this 2019-2025 period (Table 2). At our institution 100% of hand and microsurgery applicants matched into fellowships they visited. Across all sub-specialties in the most recent two cycles, 100% of residents matched into fellowship programs where they had rotated. Conclusion: Protected time during training for electives provides residents opportunities to refine clinical and research interests, as well as obtain fellowship and job opportunities. Senior resident elective time was associated with a higher rate of application to fellowship compared to the national average. At our institution, residents were much more likely to match at program they visited on an elective rotation. In the case of hand and microsurgery, all residents matched at an elective institution. Customized rotations outside of the residency program complement the training by providing an opportunity to explore innovative approaches, network, and establish mentors for longitudinal career advancement.
Sullivan et al. (Mon,) studied this question.