Plastic Surgery Subinternships: Current Perspectives and Future Considerations

Subinternships are an important feature of the integrated plastic and reconstructive surgery residency application process. In our experience, there exists institutional heterogeneity in how subinterns are evaluated, how they are given feedback, and how their performance is compared across institutions. In this report, we conducted standardized interviews with 9 past and present integrated plastic and reconstructive surgery residency program directors, eliciting their expert opinions on current limitations of subinternships as a method of medical student education and evaluation. There near-unanimous agreement that subinternships were an important tool for evaluating the intangible traits of subinterns, with emphasis on teamwork, work ethic, and preparation for cases. However, our respondents suggested that subinterns lack direct feedback about real-time subinternship performance, and that there is a lack of transparency to subinterns regarding the quality of letters of recommendation. In the current system of subinternship evaluation, the letter-writer's reputation possibly overshadows the subintern's actual performance, which can be unfair to the student. We encourage the academic plastic and reconstructive surgery community to work toward more consistent and equitable evaluation of subinterns to the benefit of both residency applicants and programs.