Integrated Plastic Surgery Match Trends after Step 1 Pass/Fail Implementation: Data Analysis and Literature Review

Background: Integrated plastic surgery (IPS) programs are highly competitive. The conversion of Step 1 to pass/fail has altered the landscape for how applications are evaluated. This analysis identifies trends over the most recent five match cycles and literature to identify the most valued aspects of IPS applications. Methods: A cross-sectional study of the National Residency Matching Program Charting Outcomes data from years 2020-2024 was performed. Aspects of IPS applications were compared among matched and unmatched MD seniors, DO seniors, and international medical graduates. A literature review using the PubMed Database was performed. Results: The proportion of matched White and Asian applicants closely matched the proportion who applied, however Hispanic applicants were underrepresented in the 2023 and 2025 cycles (Figure 1). There was not enough data available to analyze trends of applicants with alternative racial identities. The proportion of matched males and females to those who applied remained stable until 2025 when less females applied but the matched proportion remained stable (Figure 1). There was not enough data available to analyze trends for applicants identifying outside the gender binary. While the numbers of IPS positions available and applications submitted have increased from 2020-2024, they have done so proportionally resulting in a stable ratio 1.67 ± 0.09. Being an MD senior is associated with higher match success compared to other applicant types. The average Step 2 score of matched applicants differed only by a single point before and after the transition of Step 1 to pass/fail, suggesting no increase in significance in applicant consideration. Applicants with more publications and presentations had higher match success (Figure 2). From 2020 to 2024, the average total number of publications and presentations from a single match applicant has increased, making applicants with higher research output more likely to match. Applicants with Alpha Omega Alpha honors and graduates from a medical school designated with the highest NIH funding have higher success in the match (Figure 3). Subjective factors identified as important through the literature review included away rotations, interviews, and letters of recommendation. Conclusions: IPS remains competitive with a stable ratio of applicants outnumbering positions. Step 2 scores remain important in application evaluation, however the average score in matched individuals has not increased since the conversion of Step 1 to pass/fail. Applicants with MDs from U.S. medical schools that have a home program have a higher success rate with matching into an IPS program. High research output in the form of publications and presentations favors better in the match. Desirable applicants present well rounded applications with positive letters of recommendation, experience at away rotations, and giving a good interview.