In the present article, the impact of the COVID-19 pandemic on geographical trends in the neurosurgery match in successfully matched applicants was analyzed. A cross-sectional analysis for the years from 2017 to 2021 was performed. Successful applicants' region, state, and medical school were compared with the location of their matched residency program. The number of applicants matching at a residency program within the same region or state as their home medical school or their own medical school was then evaluated. One hundred fifteen neurosurgery residency programs and 1066 successfully matched applicants were included in the analysis. When comparing 2021 with previous years, no significant change in the percentage of applicants matching at their home region (43.1% vs 49.7%, P = .09), home state (25.1% vs 26.3%, P = .69), or home program (19.9% vs 18.7%, P = .70) was found. The COVID-19 pandemic did not significantly affect geographic trends during the neurosurgery match in 2021. This is of note as the COVID-19 pandemic significantly affected the match in other competitive specialties, including plastic surgery, dermatology, and otolaryngology. Despite limited away rotations, it is possible that neurosurgery programs did not change their applicant selection criteria and implemented systems to virtually interact with applicants outside of their local region.

Geographic Trends in the Neurosurgery Match During the COVID-19 Pandemic

Analysis of Surgical Residents' Salaries and Associated Funding During Eight Residency Training Cycles: Toward Improving Future Residents' Benefits and Compensation.

The postsurgical Clavien–Dindo classification in minor surgery can improve perception and communication (Investigation on Blepharoplasty). Background: Minor surgery lacks a standardized postoperative complication classification. This leads to the presentation of inaccurate postsurgical complication rates and makes comparisons challenging, especially for patients seeking information. This study aims to evaluate a standardized five-step complication grading system (Clavien–Dindo Classification, CDC) on the example of blepharoplasty, which is the most performed minor aesthetic surgery worldwide. Methods: A retrospective observational exploratory study of patients (N = 344) who received a bilateral upper eyelid blepharoplasty under local anesthesia from the same surgical staff was performed. Data were retrieved from the electronic patient record: the CDC grading and the surgeon-reported complications (N = 128) at the first follow-up on day 7. In addition, a telephone survey with patients (N = 261) after 6 months was performed, which consisted of 7 complication-related yes/no questions. Results: Based on the CDC, 41.6% of patients were classified as having no complications, and 58.4% had one. Furthermore, 1 patient (0.3%) received a revision under general anesthesia (CDC IIIb), 18 patients (5.2%) were re-operated under local anesthesia (CDC IIIa), 23 patients (6.7%) required pharmacological intervention (CDC II), and 159 patients (46.2%) had a complication from the normal postoperative course and received supportive treatment (CDC I). Moreover, 90.5% of the mentioned complications accounted for Grade I and II; 94% of the patients subjectively experienced no complications; 51% of patients were pleased with the surgery even though a complication occurred according to the CDC; 34% of complications escaped the awareness of the surgeon. Conclusions: Grade I and II complications occurred frequently. Complications escaped the perception of the patients and surgeons. The classification identifies a wide variety of postsurgical complications and allows a standardized comparison in minor surgery objectively. Potential: The CDC in minor procedures can improve the (institutional) preoperative communication with patients regarding potential postoperative expectations. Furthermore, the classification can be a useful tool to detect complication-related costs, identify insurance-related requests, and support evidence in medicolegal disputes. The example of blepharoplasty can be translated to various other and even less invasive procedures.

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The Postsurgical Clavien–Dindo Classification in Minor Surgery Can Improve Perception and Communication (Investigation on Blepharoplasty)

Background: The purpose of this study was to assess the influence of the COVID-19 pandemic on the 2021 orthopaedic surgery residency match outcomes. Because in-person away rotations and interviews were canceled during the 2020 to 2021 application cycle, we hypothesized that applicants would match at their home program at a higher rate in 2021 than in previous years. Methods: We queried allopathic orthopaedic surgery residency websites and social media accounts for names of residents and medical school information for cohorts matching from 2017 through 2021. To assess availability of and participation in virtual away rotations, we administered a survey to Accreditation Council for Graduate Medical Education–accredited allopathic orthopaedic surgery residency programs. The primary outcome was the annual proportion of applicants matching at the program affiliated with their medical school (“home program”). Subgroup analyses were stratified by Doximity reputation ranking and availability of a virtual away rotation. Results: We identified 2,632 residents who matched between 2017 and 2020 and 698 residents who matched in 2021. Overall home program match rate and likelihood of home matching were higher in 2021 compared with 2017 to 2020 (28% vs. 20%; odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.24-1.82, p < 0.001). The increase in the home match rate at programs ranked in the top 30 (27% vs. 20%, p = 0.034) was similar to the increase at programs ranked outside the top 30 (28% vs. 20%, p < 0.001). Of the 66 (48%) programs that responded to the survey, 16 (24%) offered a virtual away rotation. Programs with a higher Doximity ranking were more likely than lower-ranked programs to offer a virtual away rotation (OR = 6.75, 95% CI 1.95-23.4, p = 0.003). Home match rates did not differ significantly between programs that offered a virtual away rotation and those that did not (26% vs. 32%, p = 0.271). Conclusions: A higher proportion of orthopaedic surgery residency applicants matched at their home program in 2021 compared with previous years. Limitations on in-person activities due to the COVID-19 pandemic may have contributed to this rise. Level of Evidence: N/A.

Assessing the Impact of COVID-19 on the 2021 Orthopaedic Surgery Match Outcomes

Background Virtual interviewing for cardiology fellowship was instituted in the 2021 fellowship application cycle because of the COVID‐19 pandemic and restricted travel. The impact on geographic patterns of fellow‐training program matching is unknown. This study sought to determine if there was a difference in geographic placement of matched fellows for cardiology fellowship match after initiation of virtual interviews compared with in‐person interviewing. Methods and Results All US‐based accredited cardiovascular disease fellowship programs that participated in the 2019 to 2021 fellowship match cycles and had publicly available data with fellowship and residency training locations and training year were included. Each fellow was categorized based on whether their fellowship and residency programs were in the same institution, same state, same US census region, or different census region. Categories were mutually exclusive. Of 236 eligible programs, 118 (50%) programs were identified, composed of 1787 matched fellows. Compared with the previrtual cohort (n=1178 matched fellows), there was no difference in the geographic placement during the 2021 virtual cycle (n=609 matched fellows) ( P =0.19), including the proportion matched at the same program (30.6% versus 31.5%), same state but different program (13% versus 13.8%), same region but different state (24.2% versus 19.7%), or different region (35% versus 33.1%). There was also no difference when stratified by program size or geographic region. Conclusions The use of virtual interviewing in the 2021 cardiology fellowship application cycle showed no significant difference in the geographic placement of matched fellows compared with in‐person interviewing. Further study is needed to evaluate the impact of virtual interviewing and optimize its use in fellowship recruitment. 

Impact of Virtual Interviewing on Geographic Placement for Cardiology Fellowship Recruitment

Introduction The AAMC transitioned to virtual interview formats for the 2020-2021 residency match. This study aims to examine the impact of the 100% virtual interview format for the 2020-2021 residency match on both application and match changes for multiple surgical specialties, including neurosurgery (NS), orthopedic surgery (OS), plastic surgery (PS), general surgery (GS), thoracic surgery (TS), and vascular surgery (VS). Methods Cross-sectional study comparing application and match changes between the in-person 2019-2020 and virtual 2020-2021 residency match cycles for different surgical specialties. Results There was an overall increase in the number of applicants for 5 of the surgery specialties but not VS, and an overall increase in the number of applications per residency program across all specialties. The average number of applications per applicant also increased, except in TS. There were no major match changes except in TS, which saw an increase in number of spots filled by MDs to nearly 100% from 84.2% in the previous cycle. Conclusion The switch to the 100% virtual 2020-2021 residency match interview format was associated with an overall increase in the number of applications per program and number of applications per applicant across multiple surgical specialties. There was a decrease in the number of applicants to VS and an increase in the number of applications per applicant. The switch to a virtual interview format in 2020-2021 was also associated with an increase in TS spots filled by MDs to almost 98%, increasing the already concerning TS match disparity for DO and IMG applicants.

Shifting the Surgical Residency Match to a 100% Virtual Interview Format During the COVID-19 Pandemic, How has It Affected Placement Into Surgical Training Programs?

•The terms major and minor surgery are commonly used in scientific literature. The lack of an established distinction between the two terms has major implications on the interpretation of research, clinical practices, and outcomes.•Researchers should be cautious when using major and minor surgery to describe procedures unless accompanied by a thorough evidence-based explanation of each category.•The terminology may be useful for setting the tone of expectations when communicating with patients and their families, but physicians must weigh this utility against the complications caused by unsuitable use in scientific literature and medical education.

Major and minor surgery: Terms used for hundreds of years that have yet to be defined.

BACKGROUND To match medical students into residency training programs, both the program and student create rank order lists (ROLs). We aim to investigate temporal trends in ROL lengths across 7 match cycles between 2014 and 2021 for both matched and unmatched residency applicants and programs. METHODS retrospective study of ROLs of 7 match cycles, 2014-2021. Residency match and ROL data were extracted from the NRMP database to assess the number of programs filled and unfilled, length of ROLs, position matched, and average ranks per position for osteopathic (DO) and allopathic (MD) medical programs. RESULTS For filled residency programs, the average ROL length consistently increased from 70.72 in 2015 to 88.73 in 2021 (P = .003), with ROL lengths consistently longer for filled vs unfilled residency programs (P < .001). The average ROL length for matched applicants increased consistently from 10.41 in 2015 to 12.35 in 2021 (P = .002), with matched applicants having consistently longer ROLs than unmatched applicants (P < .001). From 2015 to 2021, in both MD and DO applicants, progressively lower proportions of applicants matched their first and second choices. CONCLUSION Trends across the past 7 residency match cycles suggest that ROL lengths for both programs and applicants have been increasing with matched programs and applicants submitting significantly longer ROLs than unmatched applicants. Additionally, fewer applicants are matching at their preferred programs over time. Our findings support the mounting evidence that the Match has become increasingly congested and we discuss the possible factors that may be contributing to the current state of the Match as well as potential solutions.

Increasing lengths of rank order lists of applicants and programs of US medical residencies.

BACKGROUND General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors. METHODS A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs. Multivariable logistic regression was used for calculating the adjusted odds ratio (aOR) for binary outcomes. Significance was defined as P-values ≤ .05 or 95% confidence intervals (CIs) >1 or 200 overall operative case volume reported significantly higher confidence with minor cases (P = .05) and major cases (P = .02). General surgery residents that performed both minor and major surgeries reported higher confidence with minor cases at 85.7% compared to GSRs that performed mostly minor surgeries (64.7%) and mostly major surgeries (62.5%). General surgery residents who performed >50 minor surgeries during their PGY 1 and 2 were less confident with major cases than GSRs who performed <50 minor surgeries (aOR: 19.98, 95% CI: 1.26, 318). General surgery residents from community teaching hospitals reported higher confidence with major and minor cases than GSRs from university teaching hospitals and combined programs. CONCLUSION Increased case volume, predominant case type, early surgical experience during PGY 1 and 2 years, and training at community teaching hospitals were identified as the most important factors that positively influence perception of operative confidence and autonomy among GSRs. These may have important implications in the development of future surgeons.

Kevin Newsome

Papers

Shifting the Surgical Residency Match to a 100% Virtual Interview Format During the COVID-19 Pandemic, How has It Affected Placement Into Surgical Training Programs?

Major and minor surgery: Terms used for hundreds of years that have yet to be defined.

Increasing lengths of rank order lists of applicants and programs of US medical residencies.

Operative Confidence Among U.S General Surgery Residents.

HIPAA in the age of social media: Potential pitfalls and safe practices.