Plastic and Reconstructive Surgery • December 2022 identified several areas for improvement to the ACAPS standardized letter of recommendation form by surveying ACAPS faculty. Most notable was the movement toward use of percentiles for the attributes section. Perhaps moving toward a percentile format for overall rank would provide more evenly distributed and comparable data.The standardized letter of recommendation is highly used in the evaluation of applicants to plastic surgery residency and analyses into its patterns are important. Caution must be used when interpreting the overall ranking as the distribution is heavily skewed and strong biases exist between home and away program letters. Understanding trends in the standardized letter of recommendation form will be vital as it gains importance in the evaluation of applicants. Further investigation on ways to improve the implementation and design of the standardized letter of recommendation form is needed.

Background The cancellation of clinical rotations (CRs) and implementation of virtual interviews (VIs) profoundly affected the residency selection process leading up to the 2021 NRMP Match. The authors investigated how these changes influenced the caliber of applicants taken by general surgery (GS) residency programs from the perspectives of program directors (PDs). Methods A 14 question, web-based electronic survey was emailed to PDs of ACGME-accredited GS residency programs. Questions sought program characteristics and PDs’ perspectives regarding potential differences in subjective characteristics and clinical skills demonstrated by their 2021 Match class relative to previous resident classes. Results A total of 75 PDs (27.2%) responded to our survey. Most respondents observed no changes in residents’ fit with their program (72.0%), communication skills (68.0%), responsiveness to clinical instruction and feedback (73.3%), work ethic (73.3%), and rotation evaluations (68.0%). Only 21.3% of PDs believed that VIs negatively impacted their ability to accurately assess applicant intangibles. Conversely, 56.0% of PDs reported that the cancellation of CRs in 2020 negatively affected residents’ clinical competency at the start of residency. At 1-year following the 2021 NRMP Match, 30.7% of PDs reported that the clinical skills exhibited by their 2021 Match class were poorer than previous resident classes. Discussion Our findings suggest that VIs limited selection committees’ ability to accurately assess applicant’s subjective characteristics to a lesser degree than previously described in the literature. Canceled CRs adversely affected the 2021 Match Class’s clinical skills at the start of residency and at 1 year following the 2021 NRMP Match.