Academic Plastic Surgeons Research Articles

The Independent Plastic Surgery Match (2010-2018): Applicant and Program Trends, Predictors of a Successful Match, and Future Directions

Changes were made to the independent plastic surgery residency in 2009 to 2010 that included full prerequisite training and increased from 2 to 3 years of independent residency. The authors sought to determine subsequent match trends and predictors of a successful match. With American Council of Academic Plastic Surgeons approval, the San Francisco Match provided data for the independent match (2010-2018). Trends in the independent plastic surgery were reviewed. Applicant variables were analyzed to determine correlation with a successful match and a match at top-ranked programs using Doximity Residency Navigator. Total independent applicants per cycle decreased 18% while foreign medical school applicants increased from 19.4% to 27%. Available positions decreased from 97 to 66 (32%) and match rate decreased from 82% to 78%. Applicants who matched were from US medical schools, had higher USMLE Step 1 scores, were from University and top General surgery residencies, and averaged more interviews (p < 0.05). By multivariate regression, number of interviews completed (odds ratio [OR] 15.35 95% confidence interval [CI] 7.7-30.6, p < 0.001) and having completed prerequisite training at a university based program in addition to having graduated from an allopathic medical school (OR 1.78 95% CI 1.1-2.97, p = 0.027) were predictive of a successful match. Step 1 score ≥ 240 (OR 3.2, 95% CI 1.0-10.2, p = 0.046), Alpha Omega Alpha membership (OR 2.2, 95% CI 1.1-4.9, p = 0.048), and having completed prerequisite training at the same institution (7.6, 95% CI 2.2-25.7, p < 0.001) were predictive of matching at top-ranked programs. Since 2010, independent plastic surgery applicant and program participation have decreased. Greater number of interviews, university-based prerequisite training, and allopathic medical school background are variables that correlate with a successful match. Factors predictive of a match at top-ranked Doximity Residency Navigator plastic surgery programs include high Step 1 scores, Alpha Omega Alpha membership, and prerequisite training at the same institution.

Abstract 7: The Independent Plastic Surgery Match (2010 to 2018): Applicant and Program Trends, Successful Match Predictors, and Future Directions

BACKGROUND: Significant changes were made to the independent plastic surgery residency model in 2009–2010 that included full prerequisite training and increased from two to three years of independent residency. The authors sought to determine the subsequent impact on the match and predictors of a successful match at a highly regarded program METHODS: With American Council of Academic Plastic Surgeons (ACAPS) approval, the San Francisco Match provided data for the independent match (2010–2018). Applicant variables were analyzed to determine possible correlation with a successful match at a highly ranked program. RESULTS: Total independent applicants per cycle decreased 18% while foreign medical school applicants increased from 8% to 27%. Available positions decreased from 97 to 66 (32%) and match rate decreased to 78% from 82%. In 2010, 37% matched their top choice and 69% within their top 3; those numbers decreased to 32% and 62% in 2018, respectively. Matched applicants averaged more interviews (11.9 vs. 3.6, p<0.0001). By multivariate regression analysis, Step 1 scores 220–239 (OR 2.3, p=0.004), ≥ 240 (OR 3.9, p<0.0001), and Alpha Omega Alpha (AOA) membership (OR 2.2, 95% CI 1.1–4.4, p=0.03) were predictive of matching at a highly-ranked program. CONCLUSION: Since 2010, independent plastic surgery training has become less popular. Fewer applicants are matching at the top of their rank list. Factors predictive of a successful match at a highly ranked program include high Step 1 scores and AOA membership. Without changes to the independent curriculum, participation will continue to trend towards the integrated pathway.

Matching into Integrated Plastic Surgery: The Value of Research Fellowships.

Integrated plastic surgery residency applicants sometimes complete research fellowships before residency. The average productivity and the impact of these fellowships on subsequent application to residency are unknown. The purpose of this study was to provide objective data to better understand the utility and productivity of a research fellowship. A national survey was conducted in which integrated plastic surgery residency applicants from 2013 to 2016 were surveyed regarding their experiences with research fellowships. American Council of Academic Plastic Surgeons members were also surveyed to elicit their perspectives on the value of these fellowships. Six hundred twenty-one integrated plastic surgery applicants from 2013 to 2016 were included in the study. Twenty-five percent of applicants participated in a research fellowship. Applicants who completed research fellowships were more likely to match into plastic surgery compared to those who did not (97 percent versus 81 percent, respectively; p < 0.05). Fellows were highly satisfied with their fellowship experience and produced an average of five publications and presentations per fellowship year. Sixty-three percent of research fellowships were performed to strengthen applications to categorical integrated plastic surgery residency. American Council of Academic Plastic Surgeons members considered three or four publications/presentations productive. Most do not recommend research fellowships to all medical students. Research fellowships can effectively prepare for categorical plastic surgery by improving publication and presentation experience. This is the first study to show that applicants who completed research fellowships were highly satisfied with their experience, accomplished higher than expected levels of productivity, and statistically significantly matched into an integrated plastic surgery residency more often than applicants without research fellowships.

Opportunities and Advancement for the Academic Plastic Surgeon in an Independent Department Setting

Opportunities and Advancement for the Academic Plastic Surgeon in an Independent Department Setting

Do Academic Health Care Systems Really Value Education? A Survey of Academic Plastic Surgeons.

Background:Although education is critical to the mission of academic medical centers in the United States, it is often not quantified and monetized as are their research and clinical missions. We undertook this survey to assess the perceived valuation of educational endeavors of plastic surgeon faculty at the U.S. academic medical centers.Methods:A survey using Qualtrics software (Qualtrics, Provo, UT) was distributed to faculty members of the American Council of Academic Plastic Surgeons by electronic mail in February 2015. A total of 16 questions included both demographic information and Likert-item questions of perception of valuation of educational activities. For analysis, responses were grouped according to an adapted Net Promoter Score including “unsupportive” (0–6), “neutral” (7–8), and “supportive” (9–10).Results:Sixty-five surveys were completed out of a total of 406, with an overall response rate of 16%. Kruskal-Wallis statistical analysis demonstrated that region and rank were not significant in perception of hospital or departmental support for educational activities. Respondents rated their departments as more supportive than their institutions (P < 0.05), and average perceived value rating of institutions was “unsupportive.” Financial support was associated with higher ratings with respect to support of institutions and departments. Mid-career faculty displayed a trend toward lower ratings of perception of support.Conclusions:The majority of respondents perceived their institutions and departments as unsupportive of educational effort. Direct compensation to physicians for teaching efforts may improve faculty retention in academia and reduce physician burnout.

Abstract: The American Council of Academic Plastic Surgeons Plastic Surgery Boot Camp Program: Evaluation of the University of Pittsburgh’s Three Year Experience

BACKGROUND: The American Council of Academic Plastic Surgeons (ACAPS) Plastic Surgery Boot Camp program was introduced in July 2015 in Pittsburgh and was expanded to four regional sites thanks to standardized presentations, increased practical sessions, and streamlined evaluations. The aim of this study was to evaluate our ACAPS Plastic Surgery Boot Camp experience over the past three years and the impact it had on participant performance. METHODS: Over the past three years a total of 119 residents (99 Integrated / 20 Independent) attended the Boot Camp in Pittsburgh. Lecture topics and practical sessions covered the full spectrum of plastic surgery. All participants completed pre- and post- evaluation surveys with mean scores being reported as percentages and analyzed using ANOVA. RESULTS: The evaluation of Boot Camp participants increased over the past three years (2015=80%, 2016=91%, 2017=94%, p<0.001). Participants reported a statistical improvement in the Boot Camp being appropriate for the level of learning (2015=82%, 2016=90%, 2017=92%, p=0.017), and improving medical knowledge (2015=74%, 2016=88%, 2017=92%, p<0.001), technical skills (2015=74%, 2016=82%, 2017=90%, p=0.001), judgement skills (2015=74%, 2016=82%, 2017=86%, p=0.017) and confidence (2015=76%, 2016=86%, 2017=88%, p=0.008). Participants demonstrated improvement in all taught plastic surgery topics including craniofacial, hand, breast, and microsurgery. Participants reported the lowest improvement in communication skills, professionalism, and accountability. CONCLUSION: The ACAPS Plastic Surgery Boot Camp has proved successful in introducing core concepts in plastic surgery to new residents. The implementation of an improved curriculum in response to participants’ feedback has increased participant performance and evaluation over the past three years.

The ACAPS Plastic Surgery Boot Camp Program: Evaluation of the University of Pittsburgh 3-year Experience

BACKGROUND The American Council of Academic Plastic Surgeons sponsored Plastic Surgery Boot Camp program was developed in response to ongoing changes in graduate medical education. The purpose of this new program was to facilitate the transition of both Integrated and Independent residents into Plastic Surgery training, as current trainees are required to rapidly assimilate knowledge and gain clinical skills to which they have had limited and/or inconsistent exposure during their prior education. The Boot Camp program was introduced in July 2015 in Pittsburgh, PA, and has subsequently expanded to 4 regional sites across the United States due to the use of standardized presentations, increased practical sessions, and streamlined evaluations. The aim of this study was to evaluate the Pittsburgh Plastic Surgery Boot Camp experience over the past 3 years and its impact on participant performance. METHODS Over the past 3 years a total of 119 residents (99 Integrated/20 Independent) attended the Boot Camp in Pittsburgh. Lecture topics and practical sessions covered the full spectrum of plastic surgery. All participants completed pre- and postevaluation surveys with mean scores being reported as percentages and analyzed using analysis of variance. RESULTS The overall evaluation of Boot Camp participants increased significantly over the past 3 years (2015 = 80%, 2016 = 91%, 2017 = 94%, P < 0.001). Participants reported a statistically significant improvement in the Boot Camp being appropriate for the level of learning (2015 = 82%, 2016 = 90%, 2017 = 92%, P = 0.017), and significant improvements in medical knowledge (2015 = 74%, 2016 = 88%, 2017 = 92%, P < 0.001), technical skills (2015 = 74%, 2016 = 82%, 2017 = 90%, P = 0.001), judgment skills (2015 = 74%, 2016 = 82%, 2017 = 86%, P = 0.017) and confidence (2015 = 76%, 2016 = 86%, 2017 = 88%, P = 0.008). Participants demonstrated improvement in all taught plastic surgery topics including craniofacial, hand, breast, and microsurgery. Participants reported the lowest improvement in communication skills, professionalism, and accountability. CONCLUSION The American Council of Academic Plastic Surgeons Plastic Surgery Boot Camp has proved successful in introducing core concepts in plastic surgery to new residents. The implementation of an improved curriculum in response to participants’ feedback has significantly increased participant performance and evaluation over the past 3 years.

Institutional Collaboration in Plastic Surgery Research: A Solution to Resource Limitations.

Background:The current climate of health care reform and research funding restrictions presents new challenges for academic plastic surgery. Collaboration with private enterprise has been associated with greater research productivity in the general biomedical literature. This study seeks to analyze publication trends in Plastic and Reconstructive Surgery (PRS) to evaluate any changes in institutional collaboration over time.Methods:Bibliographic data were retrospectively analyzed for all original research and discussion articles published in PRS from 2012 to 2016. The institutional affiliation for each publication was characterized from its author list as solely academic, private, government, or combinations of these (defined here as “institutional collaborations”). Annual National Institutes of Health (NIH) funding data were also collected over the same period, and associations were analyzed by linear regression.Results:In total, 2,595 publications were retrieved from PRS between 2012 and 2016, of which 2,027 (78.1%) originated solely from academic institutions and 411 (15.8%) from institutional collaborations. Although the proportion of academic-only publications decreased from 82% to 74%, the proportion of institutional collaborations increased from 10% to 20% (P = 0.038). Concurrently, NIH funding declined from $33.4 billion to a low of $30.7 billion, which was associated with the decreasing proportion of academic-only publications (P = 0.025) and increasing proportion of institutional collaborations (P = 0.0053).Conclusions:Traditional sources of academic research funding have been restricted during the politically and financially tumultuous recent years. With no signs of improving access to financial resources from the NIH, academic plastic surgeons may consider diversifying their institutional partnerships to continue pioneering advances in the field.

Gender Inequality for Women in Plastic Surgery: A Systematic Scoping Review.

Previous research has highlighted the gender-based disparities present throughout the field of surgery. This study aims to evaluate the breadth of the issues facing women in plastic surgery, worldwide. A systematic scoping review was undertaken from October of 2016 to January of 2017, with no restrictions on date or language. A narrative synthesis of the literature according to themed issues was developed, together with a summary of relevant numeric data. From the 2247 articles identified, 55 articles were included in the analysis. The majority of articles were published from the United States. Eight themes were identified, as follows: (1) workforce figures; (2) gender bias and discrimination; (3) leadership and academia; (4) mentorship and role models; (5) pregnancy, parenting, and childcare; (6) relationships, work-life balance, and professional satisfaction; (7) patient/public preference; and (8) retirement and financial planning. Despite improvement in numbers over time, women plastic surgeons continue to be underrepresented in the United States, Canada, and Europe, with prevalence ranging from 14 to 25.7 percent. Academic plastic surgeons are less frequently female than male, and women academic plastic surgeons score less favorably when outcomes of academic success are evaluated. Finally, there has been a shift away from overt discrimination toward a more ingrained, implicit bias, and most published cases of bias and discrimination are in association with pregnancy. The first step toward addressing the issues facing women plastic surgeons is recognition and articulation of the issues. Further research may focus on analyzing geographic variation in the issues and developing appropriate interventions.

Scholarly activity in academic plastic surgery: the gender difference

BackgroundThe number of women in medicine has grown rapidly in recent years. Women constitute over 50% of medical school graduates and hold 38% of faculty positions at United States medical schools. Despite this, gender disparities remain prevalent in most surgical subspecialties, including plastic surgery. The purpose of this study was to analyze gender authorship trends. Materials and methodsA cross-sectional study of academic plastic surgeons was performed. Data were collected from departmental websites and online resources. National Institute of Health (NIH) funding was determined using the Research Portfolio Online Reporting Tools database. Number of published articles and h-index were obtained from Scopus (Elsevier Inc, New York, NY). Statistical analysis was performed in SPSS (SPSS Inc, Chicago, IL). ResultsA total of 814 plastic surgeons were identified in the United States. Compared to men, women had significantly fewer years in practice (P <0.001), lower academic ranks (P <0.001), and published less (P <0.001). There was no difference in the number of PhD degrees between genders; women with PhDs published less than men with PhDs (P = 0.04). 5.1% of women and 6.9% of men received NIH funding during their career (P = 0.57). There was no gender difference in scholarly output among NIH-funded surgeons. Overall, years in practice, academic rank, chief/program director title, advanced degrees, and NIH funding all positively correlated with academic productivity. ConclusionsThis study identifies significant gender disparities in scholarly productivity among plastic surgeons in academia. Future efforts should focus on improving gender equality and eliminating barriers to academic development.

Identifying Sources of Funding That Contribute to Scholastic Productivity in Academic Plastic Surgeons.

Scholastic productivity has previously been shown to be positively associated with National Institute of Health (NIH) grants and industry funding. This study examines whether society, industry, or federal funding contributes toward academic productivity as measured by scholastic output of academic plastic surgeons. Institution Web sites were used to acquire academic attributes of full-time academic plastic surgeons. The Center for Medicare and Medicaid Services Open Payment database, NIH reporter, the Plastic Surgery Foundation (PSF), and American Association of Plastic Surgeons (AAPS) Web sites were accessed for funding and endowment details. Bibliometric data of each surgeon were then collected via Scopus to ascertain strengths of association with each source. Multiple linear regression analysis was used to identify significant contributors to high scholastic output. We identified 935 academic plastic surgeons with 94 (10.1%), 24 (2.6%), 724 (77.4%), and 62 (6.6%) receiving funding from PSF, AAPS, industry, and NIH, respectively. There were positive correlations in receiving NIH, PSF, and/or AAPS funding (P < 0.001), whereas industry funding was found to negatively associate with PSF (r = -0.75, P = 0.022) grants. The NIH R award was consistently found to be the most predictive of academic output across bibliometrics, followed by the AAPS academic scholarship award. Conventional measures of academic seniority remained predictive across all measures used. Our study demonstrates for the first time interactions between industry, federal, and association funding. The NIH R award was the strongest determinant of high scholastic productivity. Recognition through AAPS academic scholarships seemed to associate with subsequent success in NIH funding.

An Evaluation of h-Index as a Measure of Research Productivity Among Canadian Academic Plastic Surgeons.

Evaluation of research productivity among plastic surgeons can be complex. The Hirsch index (h-index) was recently introduced to evaluate both the quality and quantity of one's research activity. It has been proposed to be valuable in assessing promotions and grant funding within academic medicine, including plastic surgery. Our objective is to evaluate research productivity among Canadian academic plastic surgeons using the h-index. A list of Canadian academic plastic surgeons was obtained from websites of academic training programs. The h-index was retrieved using the Scopus database. Relevant demographic and academic factors were collected and their effects on the h-index were analyzed using the t test and Wilcoxon Mann-Whitney U test. Nominal and categorical variables were analyzed using χ2 test and 1-way analysis of variance. Univariate and multivariate models were built a priori. All P values were 2 sided, and P < .05 was considered to be significant. Our study on Canadian plastic surgeons involved 175 surgeons with an average h-index of 7.6. Over 80% of the surgeons were male. Both univariable and multivariable analysis showed that graduate degree (P < .0001), academic rank (P = .03), and years in practice (P < .0001) were positively correlated with h-index. Limitations of the study include that the Scopus database and the websites of training programs were not always up-to-date. The h-index is a novel tool for evaluating research productivity in academic medicine, and this study shows that the h-index can also serve as a useful metric for measuring research productivity in the Canadian plastic surgery community. Plastic surgeons would be wise to familiarize themselves with the h-index concept and should consider using it as an adjunct to existing metrics such as total publication number.

Does industry funding mean more publications for subspecialty academic plastic surgeons?

BackgroundConflict of interest among physicians in the context of private industry funding led to the introduction of the Physician Payments Sunshine Act in 2010. This study examined whether private industry funding correlated with scholarly productivity in the respective subspecialties of plastic surgery and the wider academic plastic surgery community. Materials and methodsFull-time plastic surgeons and their academic attributes were identified via institutional websites. Fellowship-trained individuals were segregated into subspecialties of microsurgery, craniofacial surgery, hand surgery, esthetic surgery, and burn surgery. The Center for Medicare and Medicaid Services Open Payment database was used to extract industry funding information. Each individual's bibliometric data were then collected through Scopus to determine the correlation between selected surgeon characteristics, academic productivity, and industry funding. ResultsNine hundred and thirty-five academic plastic surgeons were identified, with 532 having defined subspecialty training. Academic bibliometrics among subspecialty surgeons were comparable among the five groups with esthetic and craniofacial surgeons displaying a preponderance of attaining more industry funding (P = 0.043) and career publications respectively, with the latter not attaining statistical significance (P = 0.12). Overall, research-specific funding (P = 0.014) and higher funding amounts (P < 0.0001) correlated with higher Hirsch indices in tandem with higher academic rank. A funding level of $2000 appeared to be the approximate cutoff above which scholastic productivity became apparent. ConclusionsOur study demonstrated in detail the association between industry funding and academic bibliometrics in academic plastic surgery of every subspecialty. Even at modest amounts, industry support, especially when research designated, positively influenced research and therefore, academic output.

Is Industry Funding Associated With Greater Scholastic Productivity in Academic Plastic Surgeons?

Ruan, Qing Zhao; Baek, Yoonji; Bletsis, Patrick; Celestin, Arthur R. MD, MPH; Epstein, Sherise; Bucknor, Alexandra MBBS; Flecha-Hirsch, Renata; Cohen, Justin B. MD, MHS; Lee, Bernard T. MD, MBA, MPH, FACS Author Information

Abstract: Which Funding Sources are the Greatest Contributors to Scholastic Productivity for Academic Plastic Surgeons?

INTRODUCTION: Scholastic productivity has previously been shown to be positively associated with National Institute of Health (NIH) grants and industry funding. 1–3 This study examines whether society, industry or federal funding contributes towards academic productivity as measured by scholastic output of academic plastic surgeons. METHODS: Institution websites were used to acquire academic attributes of full-time academic plastic surgeons. The Center for Medicare and Medicaid Services (CMS) Open Payment database, NIH reporter, the Plastic Surgery Foundation (PSF), and American Association of Plastic Surgeons (AAPS) websites were accessed for funding and endowment details. Bibliometric data of each surgeon were then collected via Scopus to ascertain strengths of association with each source. Multiple linear regression analysis was used to identify significant contributors to high scholastic output. RESULTS: We identified 935 academic plastic surgeons with 94 (10.1%), 24 (2.6%), 724 (77.4%), and 62 (6.6%) receiving funding from PSF, AAPS, industry, and NIH respectively. There were positive correlations in receiving NIH, PSF, and/or AAPS funding (p<0.001), while industry funding was found to negatively associate with PSF (r=-0.75, p=0.022) grants. The NIH R award was consistently found to be the most predictive of academic output across bibliometrics, followed by the AAPS academic scholarship award. Conventional measures of academic seniority remained predictive across all measures used. CONCLUSION: Our study demonstrates for the first time interactions between industry, federal and association funding. The NIH R award was the strongest determinant of high scholastic productivity. Recognition through AAPS academic scholarships appeared to associate with subsequent success in NIH funding. Reference Citations: 1. Gast KM, Kuzon WM, Jr., Adelman EE, Waljee JF. Influence of training institution on academic affiliation and productivity among plastic surgery faculty in the United States. Plast Reconstr Surg. Sep 2014;134(3):570–578. 2. Lopez J, Susarla SM, Swanson EW, Calotta N, Lifchez SD. The Association of the H-Index and Academic Rank Among Full-Time Academic Hand Surgeons Affiliated With Fellowship Programs. J Hand Surg Am. Jul 2015;40(7):1434–1441. 3. Ruan QZ, Ricci JA, Silvestre J, Ho OA, Lee BT. Academic productivity of faculty associated with microsurgery fellowships. Microsurgery. Dec 26 2016.

State of the Plastic Surgery Workforce and the Impact of Graduate Medical Education Reform on Training of Plastic Surgeons.

Although recent estimates predict a large impending shortage of plastic surgeons, graduate medical education funding through the Centers for Medicare and Medicaid Services remains capped by the 1997 Balanced Budget Act. The authors' aim was to develop a plan to stimulate legislative action. The authors reviewed responses of the American Society of Plastic Surgeons, American College of Surgeons, and American Medical Association from January of 2015 to a House Energy & Commerce Committee request for input on graduate medical education funding. In addition, all program directors in plastic surgery were surveyed through the American Council of Academic Plastic Surgeons to determine their graduate medical education funding sources. All three organizations agree that current graduate medical education funding is inadequate to meet workforce needs, and this has a significant impact on specialty selection and distribution for residency training. All agreed that funding should be tied to the resident rather than to the institution, but disagreed on whether funds should be divided between direct (allocated to residency training) and indirect (allocated to patient care) pools, as is currently practiced. Program directors' survey responses indicated that only 38 percent of graduate medical education funds comes from the Centers for Medicare and Medicaid Services. Organized medicine is at risk of losing critically needed graduate medical education funding. Specific legislation to support additional graduate medical education positions and funding (House Resolutions 1180 and 4282) has been proposed but has not been universally endorsed, in part because of a lack of collaboration in organized medicine. Collaboration among major organizations can reinvigorate these measures and implement real change in funding.

Does the Organization of Plastic Surgery Units into Independent Departments Affect Academic Productivity?

There is an increased push for plastic surgery units in the United States to become independent departments administered autonomously rather than as divisions of a multispecialty surgery department. The purpose of this research was to determine whether there are any quantifiable differences in the academic performance of departments versus divisions. Using a list of the plastic surgery units affiliated with the American Council of Academic Plastic Surgeons, unit Web sites were queried for departmental status and to obtain a list of affiliated faculty. Academic productivity was then quantified using the SCOPUS database. National Institutes of Health funding was determined through the Research Portfolio Online Reporting Tools database. Plastic surgery departments were comparable to divisions in academic productivity, evidenced by a similar number of publications per faculty (38.9 versus 38.7; p = 0.94), number of citations per faculty (692 versus 761; p = 0.64), H-indices (9.9 versus 9.9; p = 0.99), and National Institutes of Health grants (3.25 versus 2.84; p = 0.80), including RO1 grants (1.33 versus 0.84; p = 0.53). There was a trend for departments to have a more equitable male-to-female ratio (2.8 versus 4.1; p = 0.06), and departments trained a greater number of integrated plastic surgery residents (9.0 versus 5.28; p = 0.03). This study demonstrates that the academic performance of independent plastic surgery departments is generally similar to divisions, but with nuanced distinctions.

The Teaching of Ethics and Professionalism in Plastic Surgery Residency: A Cross-Sectional Survey.

The ethical practice of medicine has always been of utmost importance, and plastic surgery is no exception. The literature is devoid of information on the teaching of ethics and professionalism in plastic surgery. In light of this, a survey was sent to ascertain the status of ethics training in plastic surgery residencies. A 21-question survey was sent from the American Council of Academic Plastic Surgeons meeting to 180 plastic surgery program directors and coordinators via email. Survey questions inquired about practice environment, number of residents, presence of a formal ethics training program, among others. Binary regression was used to determine if any relationships existed between categorical variables, and Poisson linear regression was used to assess relationships between continuous variables. Statistical significance was set at a P value of 0.05. A total of 104 members responded to the survey (58% response rate). Sixty-three percent were program directors, and most (89%) practiced in academic settings. Sixty-two percent in academics reported having a formal training program, and 60% in private practice reported having one. Only 40% of programs with fewer than 10 residents had ethics training, whereas 78% of programs with more than 20 residents did. The odds of having a training program were slightly higher (odds ratio, 1.1) with more residents (P = 0.17). Despite the lack of information in the literature, formal ethics and professionalism training does exist in many plastic surgery residencies, although barriers to implementation do exist. Plastic surgery leadership should be involved in the development of standardized curricula to help overcome these barriers.

Abstract: Does the Organization of Plastic Surgery into Independent Departments Affect Academic Productivity?

INTRODUCTION: Plastic surgery has traditionally been a division of general surgery. However, there are an increasing number of plastic surgery departments. A microeconomic analysis of divisions versus departments in 2011 concluded that different surgical services under a single financial and administrative umbrella is no longer logical or optimal1. The purpose of this study was to determine whether or not departmental status (independent department vs. division) affects academic productivity in plastic surgery, as measured by publications, citations and NIH funding. MATERIALS AND METHODS: The American Council of Academic Plastic Surgeons (ACAPS) website was used to generate a list of all plastic surgery divisions/departments with residency programs. Scholarly metrics were determined for 955 faculty at the 88 ACGME plastic surgery departments and divisions with residency programs. Divisions and departments were ranked based on publications, citations and NIH funding and general characteristics were compared. RESULTS: The majority of programs continue to be divisions of general surgery (64 vs 24). The highest cited plastic surgery program in this dataset was at the Brigham and Women’s Hospital (division). Brigham and Women’s Hospital (division) also had the highest total publications, and Stanford University (division) also had the highest total numbers of NIH awards. There were no clear differences between the top five institutions by each category regarding whether they were divisions or independent departments. Departments had higher numbers of integrated residents (9 vs. 5, p = 0.03), had a more even male to female ratio (2.8 vs 4.1, p = 0.06), and a trend towards higher numbers of PhDs (0.67 vs 0.28 p = 0.1). CONCLUSIONS: No one program is the strongest in every metric of productivity, and the top five most academically productive programs using the metrics in this study represented both independent departments and divisions of general surgery. Based on this study, plastic surgery departments are at least equivalent to divisions and may be better resourced to meet their clinical obligations but also to develop their academic enterprise going forward. 1. Mar PL, Yu RA, Yu JC. Division or department: a microeconomic analysis. Plast. Reconstr. Surg. 127: 2487, 2011.

What Effect Does Self-Citation Have on Bibliometric Measures in Academic Plastic Surgery?

Research productivity plays a significant role in academic promotions. Currently, various bibliometric measures utilizing citation counts are used to judge an author's work. With increasing numbers of journals, numbers of open access publications, ease of online submission, and expedited indexing of accepted manuscripts, it is plausible that an author could influence his/her own bibliometric measures through self-citation. The purpose of this study was to determine the impact of self-citation in academic plastic surgery. A cohort of full-time academic plastic surgeons was identified from 9 U.S. plastic surgery training programs. For all included faculty, academic rank was retrieved from department/division websites, and bibliometric measures were assessed using a subscription bibliographic citation database (Scopus, Reed Elsevier, London, UK). Bibliometric measures included the Hirsch index (h-index, the number of publications h which are cited ≥ h times), total number of publications, and total number of citations. The h-index and total number of citations were collected with and without self-citations. Percent changes in the h-index and total citations were calculated after removal of self-citations and compared across academic ranks and levels of research productivity (total publications, h-index, and total citations). The study cohort consisted of 169 full-time academic plastic surgeons. The h-index and total citations experienced decreases of 2.8 ± 5.0% (P < 0.0001) and 4.5 ± 4.6% (P < 0.0001), respectively, after correction for self-citation. More than half of the cohort (n = 113, 67%) did not experience a change in the h-index after removal of self-citations. These decreases did not vary across academic rank. Surgeons who self-cited at rates greater than 5% were 9.8 times more likely (95% confidence interval, 4.5-21.9; P < 0.001) to have their h-index change as a result of self-citation (after adjusting for academic rank). There were weak correlations between percent decreases in the h-index and total citations and various biblimoteric measures (total publications, h-index, total citations; r < 0.32). Self-citation has a minor impact on common bibliometric measures in academic plastic surgery. The influence of self-citation is consistent across academic ranks and increasing levels of bibliometric measures, suggesting that authors are not manipulating the system with increasing experience.