I have limited exposure to the program at UMass, but I think you chose poor examples to establish your point. While SIU is a quality program with fantastic faculty, it is not a good example of a program with a large catchment area when it comes to tertiary and specialized plastic surgery services. For example, the SIU residents do a craniofacial rotation at Northwestern to get their numbers and more exposure to these specialized cases. The reality is a majority of patients being transferred or referred in that region will go to the big program in St. Louis or 1 of the 2 Chicago programs. That does not mean SIU residents have no exposure to complex cases, but it is hard to say they have the same exposure to the multitude and variety of complex cases you would see at programs that are large, tertiary referral centers. In considering a program, you have to be aware of trade-offs. At SIU, there are many advantages that potentially negate this. When evaluating UMass, make an effort to figure out what their faculty members specialize in and their volume in a variety of cases. Some people want to go to a training program that prepares them for general plastic surgery in the community, whereas others are looking for a program that exposes them to very specialized procedures. For example, if you want to be exposed to facial transplantation, the Boston program is a better option in that region. Figure out what you want to be exposed to and go from there. Talk to your mentors and other people from your university who have interviewed and get their opinions. Finally, if there is a program, like UMass, that you are interested in and no one knows a ton about, try and set up an away rotation.