Plastic Surgery Resident Operative Volume and Milestones Performance: What Is the Correlation?

Abstract

PURPOSE: The Milestones program was introduced by the Accreditation Council for Graduate Medical Education (ACGME) in 2014 as a means of standardizing resident evaluations across plastic surgery competencies. A previous study examined the relationship between operative volume and performance in the chief year of residency and found no correlation. We sought to further explore this relationship in order to discern whether operative volume could potentially be driving competency achievements during the earlier years of training. METHODS: A retrospective review of case log numbers performed by residents at our primary training institution was conducted for 13 residents from 2014 to 2018. The cases were grouped into categories based on the Milestone competencies. The association between operative volume and levels of achievement in respective Milestones competencies was performed using Spearman’s rank correlation coefficient (P < 0.05). RESULTS: The average operative volume and average performance on Milestones both increase across all categories as residents progress through their training years. However, no significant correlation exists between overall operative volume and Patient Care Milestones or Medical Knowledge Milestones across the majority of years of training when residents are compared to their peers at a given training level. Significance was reached with positive correlations between operative volume and Medical Knowledge milestone achievement at PGY3 (r = 0.8182; P = 0.0058) and between operative volume and Patient Care Milestone achievement at PGY5 (r = 0.7858; P = 0.0480). CONCLUSION: The lack of consistently significant association between operative volume and levels of achievement in Milestones possibly supports the belief that operative exposure does not alone drive competency achievement in surgical education throughout the early years of training. Alternatively, this could suggest that the way the Milestones are being applied is not fully capturing resident competency achievement. Our small sample size is a considerable limitation, and larger scale multi-institutional studies are needed to further investigate the relationship between operative volume and milestone achievement performance.