14. Is Plastic Surgery Resident Learning and Assessment Consistent? A Comparison of American Society of Plastic Surgery Educational Network topics, In-Service Examinations, and Residency Core Curriculums

Abstract

Background: The in-service exam is the only objective measure to compare plastic surgery (PS) residents’ knowledge. Yet, there is an ongoing debate surrounding the correlation of the test to a plastic surgeon’s success. The American Society of Plastic Surgeons (ASPS) has created an Education Network (EdNet) with an in-depth curriculum, deemed a “gold standard” on which many programs model their academic didactic sessions. However, no analysis has investigated how well the in-service examination, EdNet, and core curricula across residency programs align. This study aims to quantify differences between critical PS learning modalities to inform a more unified education plan for residents. Methods: EdNet questions, accessed through ASPS, corresponding to each course subcategory were tabulated. Next, two independent reviewers and a third arbitrator assigned each question from the 2018-2022 in-service exams to the EdNet subcategories. Finally, the curriculums for fifteen residency programs were obtained, and didactics for each curriculum were assigned to EdNet subcategories. Alignment between core curricula, in-service exam questions, and EdNet resident courses was tested with Pearson’s Chi-Square and Fisher’s Exact Tests. Results: 102 EdNet subcategories were identified, corresponding to nine major courses. 2,038 questions exist across all resident courses. 1170 in-service questions and 910 didactics were assigned to EdNet subcategories. Program core curricula taught thirty subcategories at significantly different frequencies than those presented in EdNet courses. The past five in-service examinations tested 28 subcategories at significantly different frequencies than those taught in the EdNet courses. Conclusion: This study helps answer two questions in PS resident education: do programs teach, and does the in-service exam test, the gold standard? The answer, in both cases, is “somewhat,” as nearly one-third of gold standard subcategories are taught and tested at significantly different frequencies. The gold standard may also require review. For example, while anatomy courses exist for the breast and trunk, none exist for the head and neck or extremities. Similarly, EdNet does not dedicate a category to lymphedema. Therefore, there is significant room to further align teaching and standardized testing in PS education to improve resident learning and better assess resident knowledge.