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Factors Influencing Fellowship Selection, Career Trajectory, and Academic Productivity among Plastic Surgeons Sir: I read฀with฀great฀interest฀the฀article฀written฀by฀DeLong฀ et฀ al. 1 ฀ and฀ the฀ corresponding฀ Discussion฀ written฀ by฀ Greives฀and฀Losee 2 ฀that฀describes฀the฀factors฀that฀inlu- ence฀academic฀productivity฀among฀plastic฀surgeons.฀As฀ a฀budding฀plastic฀surgeon,฀their฀reports฀have฀prompted฀ me฀and฀probably฀many฀other฀students฀like฀me฀to฀con- template฀our฀future฀in฀this฀ield;฀I฀therefore฀commend฀ the฀ authors฀ for฀ this฀ and฀ for฀ their฀ well-versed฀ insights.฀ However,฀the฀commentaries฀given฀by฀the฀two฀groups฀of฀ authors฀raise฀a฀few฀questions. One฀of฀the฀conclusions฀reported฀by฀DeLong฀et฀al.฀ is฀ that฀ a฀ higher฀ number฀ of฀ publications,฀ in฀ addition฀ to฀ strong฀ mentor฀ relations,฀ correlated฀ with฀ a฀ future฀ career฀in฀academia. 1 ฀Greives฀and฀Losee฀seem฀to฀agree฀ but฀ have฀ the฀ opinion฀ that฀ those฀ who฀ pursue฀ a฀ career฀ in฀academia฀are฀“early฀differentiators.” 2 ฀By฀extension,฀ this฀suggests฀that฀the฀7-year฀integrated฀plastic฀surgery฀ programs,฀encompassing฀a฀mandatory฀year฀of฀research,฀ may฀ not฀ be฀ a฀ successful฀ means฀ of฀ fostering฀ the฀ next฀ breed฀ of฀ academic฀ “hardcores,”฀ unless฀ they฀ have฀ already฀differentiated฀before฀this.฀Would฀this฀assump- tion฀be฀correct? Moreover,฀ it฀ would฀ have฀ been฀ interesting฀ to฀ see฀ whether,฀speciically,฀irst-author฀publications฀correlated฀ with฀a฀career฀in฀academia.฀As฀Greives฀and฀Losee฀alluded฀ to,฀ many฀ medical฀ students฀ realize฀ that฀ taking฀ 1฀ year฀ out฀and฀striving฀to฀be฀included฀as฀an฀author฀in฀as฀many฀ publications฀ as฀ possible฀ is฀ their฀ “ticket฀ to฀ residency.” 2 However,฀it฀seems฀conceivable฀that฀the฀student฀who฀con- tributes฀relatively฀little฀to฀a฀number฀of฀projects฀and฀is฀a฀ named฀fourth฀or฀ifth฀author฀for฀multiple฀publications฀ may฀not฀fully฀embrace฀the฀academic฀trail฀as฀much฀as฀a฀ student฀ who฀ designed฀ and฀ drove฀ a฀ project฀ and฀ earned฀ a฀ irst-author฀ publication฀ as฀ a฀ result,฀ even฀ though฀ the฀ former฀ may฀ have฀ more฀ publications฀ overall.฀ In฀ the฀ United฀Kingdom,฀recruitment฀into฀plastic฀surgery฀train- ing฀ is฀ also฀ regarded฀ as฀ being฀ highly฀ competitive. 3 ฀ The฀ number฀of฀publications฀the฀candidate฀has฀forms฀part฀of฀ the฀ selection฀ criteria,฀ and฀ greater฀ merit฀ is฀ awarded฀ for฀ irst-author฀ publications. 3 ฀ Although฀ I฀ am฀ mindful฀ that฀ in฀ the฀ United฀ States฀ the฀ value฀ of฀ a฀ particular฀ publica- tion฀is฀determined฀on฀an฀institution-to-institution฀basis, 4 should฀ program฀ directors฀ at฀ academic-orientated฀ insti- tutions฀not฀aim฀for฀criteria฀similar฀to฀those฀in฀the฀United฀ Kingdom฀in฀vetting฀prospective฀residents? Similarly,฀ do฀ individuals฀ with฀ higher฀ degrees฀ before฀residency฀have฀an฀inclination฀toward฀academia?฀