Rodríguez-Silva Waldemar A, Lagziel Tomer, Girard Alisa, Broderick Kristen P, Yang Robin, Lifchez Scott D, Cooney Carisa M
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Plast Reconstr Aesthet Surg. 2025 Apr;103:95-101. doi: 10.1016/j.bjps.2025.02.002. Epub 2025 Feb 7.
Sub-internships are crucial for plastic and reconstructive surgery (PRS) residency matching. However, access is affected by economic and systemic barriers, particularly for international medical graduates (IMGs) and medical students without an affiliated PRS residency program, also known as "unaffiliated US medical students" (uUS-MSs). This study examines these students' access to and monetary costs associated with applying for sub-internships in PRS compared to US medical students with a PRS home program (hpUS-MSs).
We used the 2024-2025 Visiting Student Learning Opportunities platform and institutional websites to identify sub-internships in PRS for US-MSs and IMGs. We assessed availability, registration fees, and total financial commitment for an average of 4.5 rotations. Descriptive statistics and Monte Carlo simulation were used to evaluate costs, and an analysis of variance and Tukey's honestly significant difference tests were used to identify cost differences between IMGs, uUS-MSs, and hpUS-MSs.
The analysis revealed that 100 programs offer sub-internships to US-MSs, while 20 offer sub-internships to IMGs. IMGs faced average costs of $2062.05 per sub-internship, compared to $121.49 for US-MSs. Monte Carlo simulations showed that IMGs incur the highest total costs, with a median of $9114, compared to $530 for uUS-MSs and $410 for hpUS-MSs (p<0.001).
Our study identified significant financial inequities in accessing plastic surgery sub-internships between uUS-MSs and IMGs and hpUS-MSs. These economic barriers may deter qualified candidates, decreasing their matching odds and negatively impacting access to training in plastic surgery. Systemic changes, such as standardization of sub-internship costs and more grants and scholarships, are recommended to address these inequities.
实习对整形外科住院医师匹配至关重要。然而，获取实习机会受到经济和系统性障碍的影响，尤其是对于国际医学毕业生（IMGs）和没有附属整形外科住院医师项目的医学生，即所谓的“无附属关系的美国医学生”（uUS-MSs）。本研究将这些学生与有整形外科本土项目的美国医学生（hpUS-MSs）相比，考察他们获取整形外科实习机会的情况以及与之相关的金钱成本。
我们利用2024 - 2025年访问学生学习机会平台和机构网站，为美国医学生和国际医学毕业生确定整形外科的实习机会。我们评估了平均4.5次轮转的可获得性、注册费和总财务支出。使用描述性统计和蒙特卡洛模拟来评估成本，并使用方差分析和图基真实显著差异检验来确定国际医学毕业生、无附属关系的美国医学生和有本土项目的美国医学生之间的成本差异。
分析显示，100个项目为美国医学生提供实习机会，而20个项目为国际医学毕业生提供实习机会。国际医学毕业生每次实习面临的平均成本为2062.05美元，而美国医学生为121.49美元。蒙特卡洛模拟显示，国际医学毕业生的总成本最高，中位数为9114美元，相比之下，无附属关系的美国医学生为530美元，有本土项目的美国医学生为410美元（p<0.001）。
我们的研究发现，无附属关系的美国医学生、国际医学毕业生与有本土项目的美国医学生在获取整形外科实习机会方面存在重大财务不平等。这些经济障碍可能会阻碍合格候选人，降低他们的匹配几率，并对获得整形外科培训产生负面影响。建议进行系统性变革，如实习成本标准化以及增加助学金和奖学金，以解决这些不平等问题。
