Abstract 1: Is Chief Resident Operative Volume Associated with Milestone Competency Achievement?

Abstract

Background: The Milestone program in Plastic Surgery was established to promote competency-based achievement in resident education. However, despite the widespread belief that clinical exposure is fundamental to competency achievement, little is known about the association between Plastic Surgery Milestone achievement and resident operative volume. The authors sought to build upon prior investigation that highlighted the absence of a significant association between chief resident cosmetic case volume and respective Milestone achievement by exploring the relationship between chief resident case volume and respective reconstructive and general Milestone competencies. Methods: A retrospective review of operations performed by eight chief residents at a single training program graduating from 2015 to 2018. Reconstructive cases were isolated and classified by type of operation, and total cosmetic and reconstructive operative volumes were calculated for each resident. The association between operative volume and levels of achievement in respective Milestone competencies was performed using Spearman’s rank correlation coefficient (p < 0.05). Results: Chief residents performed an average of 139.3 (29.0) operations at our primary training center, which was comprised of 94.6 (21.0) reconstructive operations and 44.6 (11.6) cosmetic operations. No significant association existed between chief year reconstructive case volume and patient care or medical knowledge Milestone achievements in the following areas: tissue transfer, congenital anomalies, head and neck, maxillofacial trauma, breast reconstruction, trunk and perineum, non-trauma hand, and lower extremity (p > 0.05). While upper extremity trauma patient care was also not significantly associated with relevant operative volume (r = -0.42, p = 0.31), upper extremity trauma medical knowledge had a significant negative association with relevant operative volume (r = -0.86, p = 0.01). Furthermore, there was no significant association between surgical care, wound care, or general practice competencies and total number of reconstructive and cosmetic cases (p > 0.05). Conclusion: With the exception of upper extremity trauma medical knowledge, the present study found no significant association between operative volume and Milestone achievements, suggesting that attainment of Milestone competencies relies on factors beyond operative volume alone. Further investigation is needed to evaluate the relationship between operative volume and competency achievement as residents progress through earlier years of training.