The Missing Perspective: Understanding the Plastic Surgery Applicant's Diversity Experience

Numerous leaks in the pipeline of minority entry and advancement in plastic and reconstructive surgery (PRS) exist. This study aims to (1) describe attitudes toward diversity among integrated PRS applicants, (2) characterize applicant utilization of diversity resources, and (3) assess the diversity experience of minority applicants.

We conducted a prospective cohort study of medical students applying to integrated PRS residency programs in the 2022-2023 and 2023-2024 cycles. An online survey was distributed to both minority and nonminority applicants, and a semistructured phone interview was conducted with a subgroup of minority applicants. To capture the experiences of all potentially disadvantaged groups, minority statuses included traditional underrepresented in medicine(race/ethnicity), gender (female or nonbinary), sexual orientation (gay, lesbian, or bisexual), and first-generation low-income. The survey gathered data on sociodemographic and educational characteristics and views on diversity importance, diversity resource utilization, and program evaluation. Interview transcripts underwent an integrated thematic analysis.

One hundred applicants responded to the survey and 15 minority applicants were interviewed. Applicants placed moderate importance on faculty and residency diversity, particularly regarding gender and race/ethnicity, when evaluating programs. Key facilitators of a successful application often cited by minority applicants included mentorship by individuals with similar demographic backgrounds, familiarity with the hidden curriculum, and alleviation of financial barriers related to research fellowships, away rotations, and interviews.

Efforts can be made at all levels of PRS training to connect minority applicants with minority mentors, teach hidden curriculum content, and reduce financial barriers to facilitate minority entry and advancement in PRS.