Microsurgery Fellowship Research Articles

The Preferred Management of a Single-Digit Distal Phalanx Amputation.

Replantation of a single digit at the distal phalanx level is not routinely performed since it is technically challenging with questionable cost-effectiveness. The purpose of this study was to analyze international microsurgeons' clinical decisions when faced with this common scenario. A survey of a right-middle finger distal phalanx transverse complete amputation case was conducted via online and paper questionnaires. Microsurgeons around the world were invited to provide their treatment recommendations. In total, 383 microsurgeons replied, and their responses were stratified and analyzed by geographical areas, specialties, microsurgery fellowship training, and clinical experiences. Among 383 microsurgeons, 170 (44.3%) chose replantation as their preferred management option, 137 (35.8%) chose revision amputation, 62 (16.2%) chose local flap coverage, 8 (2.1%) chose composite graft, and 6 (1.6%) favored other choices as their reconstruction method for the case study. Microsurgeons from the Asia-Pacific, Middle East/South Asia, and Central/South America regions tend to perform replantation (70.7, 68.8, and 67.4%, respectively) whereas surgeons from North America and Europe showed a lower preference toward replantation (20.5 and 26.8%, respectively p < 0.001). Having completed a microsurgery fellowship increased the attempt rate of replantation by 15.3% (p = 0.004). Clinical experience and the surgeons' specialties did not show statistical significance in clinical decision making. From the present study, the geographic preferences and microsurgery fellowship experience influence the method of reconstruction for distal phalanx amputation. Multiple factors are taken into consideration in selecting the most suitable reconstructive method for each case scenario. In addition to the technical challenges of the proposed surgery, the cost of the procedure and the type of facility needed are important variables in the decision making process.

An Analysis of Specialty-Specific Microsurgical Head and Neck Reconstruction: A Look at a Single Institution and National Trends Over a Decade.

Head and neck free flap (HNFF) reconstructions have historically utilized a multidisciplinary approach between otolaryngology head and neck surgery (OHNS) and plastic surgery (PS). However, there seems to be a trend toward both the extirpative and reconstructive portions being performed by OHNS. We aimed to elucidate the volume trend in HNFF reconstruction over the last decade. Data were collected by 3 modalities: electronic medical record search of patients who underwent HNFF surgery at our institution (2013-2018), survey data from microsurgery fellowship programs (2007-2017), and National Surgical Quality Improvement Program (NSQIP) query of cases receiving designated HNFF Current Procedural Terminology codes (2011-2016). Data were analyzed with trends in HNFF reconstruction as our primary outcome. At our institution, HNFF reconstructions increased 4-fold (59-227). Percentage of cases by PS decreased from 18.6% to 6.0%, whereas that of OHNS increased 81.4% to 94.0% (P = 0.009). Survey data, completed by microsurgery fellowship program directors (23/81 [27.2%]), revealed the number of OHNS programs in 2007 performing 100 or more HNFF cases compared with PS was 40% (6/15) to 12.5% (1/8) (P = 0.172). By 2016, that number increased significantly for OHNS to 73.3% (11/15), whereas that of PS remained stagnant at 12.5% (1/8) (P = 0.005). According to NSQIP data, the percentage of cases performed by PS in 2011 was 52%, which was greater than OHNS's share of 43%. The other 5% was allotted to either orthopedic, oral and maxillofacial surgery, or general surgery. In 2013, those numbers reached a peak for PS at 55% and a nadir for OHNS at 36%. However, by 2016, the percentage of HNFF cases reversed. where 58% of cases were performed by OHNS and only 38% by PS. When comparing the 2011 data to the 2016 data, OHNS had a 134% increase, whereas PS had a 27% decrease (P = 0.003). Head and neck free flap reconstruction has grown dramatically over the last 10 years. Plastic surgeons are performing fewer cases, whereas otolaryngology head and neck surgeons perform more as indicated by institutional, microsurgery fellowship program director survey, and NSQIP data.

Microsurgery Fellows' Impression of Clinical and Educational Offerings during Fellowship Year.

Acquisition of microsurgical skill and clinical knowledge is the primary goal of a microsurgery fellowship. There has yet to be any comprehensive reporting in the literature of how American microsurgery fellows viewed their curricula and training at the conclusion of their fellowship year. An anonymous, electronic survey was developed and distributed to all 2016 to 2017 microsurgery fellows (n = 37) at the U.S.-based microsurgery fellowship programs (n = 23). Qualitative questions were assessed using either a Likert-type scale of 1 (not at all) to 5 (very), multiple choice, or free response. Twenty-six of 37 fellows (70%) responded to the survey. Respondents reported a mean of 14.4 lectures offered, with a range of 0 to 100. Dry laboratory simulation training was formally incorporated into 32% of microsurgery fellowships and live animal simulation training was formally incorporated into 12%. The median number of free deep inferior epigastric perforator flap cases performed was 112.5, ranging from 60 to 230. A majority felt that an organized microsurgical educational curriculum would be "beneficial," with 42% reporting that an organized microsurgery curriculum would be "very beneficial." Twenty-six of the respondents (100%) said that they would choose to do a microsurgery fellowship again if given the choice. Respondent data show that microsurgery fellows are satisfied with training, clinical experience is variable but adequate, educational experiences and opportunities vary from program to program, simulation skills training are perceived to be underutilized, and a program-organized microsurgery curriculum is believed to be advantageous to optimize development of technical and clinical skills.

Analysis of the Microsurgery Match from 2014 to 2018 Reveals Increased Competition for Microsurgery Fellowship Positions

There has been no peer-reviewed published data analyzing the microsurgery match since it was established. The aim of this study is to present and analyze match data to inform residents and programs regarding outcomes. Anonymized data were requested from the San Francisco Match, which was plotted and analyzed utilizing Pearson's Chi-square, unpaired t-test, and one-way analysis of variance (ANOVA). Match data was obtained from the years 2014 to 2018. The match rate decreased from 84.6% in 2015 to 67.3% in 2018, mean = 73.7 (8.29%), and (p = 0.01735). The position fill rate fluctuated from 82.9% in 2014 to 90.0% in 2016, mean = 86.5 (3.0%). In 2014 and 2015, 66.7% of applicants matched their first or second choice compared to 48.0% in 2018, mean = 58.7 (8.3%), (p =.04785). Matched applicants ranked mean = 6.6 (1.4%) programs versus 3.4 (1.3) for unmatched, (p < 0.0001). Filled programs ranked a greater number of applicants per position, mean = 8.5 (1.8%), compared to partially filled, mean = 4.6 (2.6%), and unfilled mean = 3.6 (3.4%), programs (p = 0.0014). In 2015, 55.0% of programs matched their first or second choice compared to 30.4% of programs in 2018, mean = 43.0 (10.1%). The application process for microsurgery has become more competitive. Matched applicants rank more programs than do unmatched. Fully filled programs rank more applicants per position than do unfilled or partially filled. Applicants and programs are increasingly less likely to match their top choices.

Abstract 2: A Disappearing Act: Trends in Head and Neck Free Flap Reconstruction over the Last Decade

BACKGROUND: Head and neck free flap (HNFF) reconstruction are complex cases often times requiring expertise in microvascular surgery. A multidisciplinary approach has historically been utilized between otolaryngologists (ENT) and plastic surgeons (PS), however, both the extirpative and reconstructive portions are now performed by ENT. We aim to elucidate the trend in volume of HNFF reconstruction over the last decade. METHODS: Data was collected from 2007 to 2017 by three modalities: electronic medical record (EMR) search of patients who underwent HNFF surgery at our institution, NSQIP query of cases receiving designated HNFF CPT codes, and survey data regarding volume from microsurgery fellowship program directors (MFPD). The data were analyzed with trends in HNFF reconstruction as our primary outcome. RESULTS: From 2013 to 2017 at our institution, the total number of HNFF microvascular reconstruction increased 4-fold (59 to 227). The percentage of cases by PS decreased from 18.6% to 6.0% while that of ENT increased 81.4% to 94.0% (p=0.009). Survey data, completed by 35 MFPD, revealed the number of ENT programs in 2007 performing ≥100 HNFF compared to PS was 40% to 12.5% (p=0.172). By 2016, that number increased significantly for ENT to 73.3% while that of PS remained stagnant at 12.5% (p=0.005). According to NSQIP data, from 2011 to 2016, HNFF volume for ENT trended up to 58% from 43% while that of PS trended down, 52% to 38% (p=0.003). CONCLUSION: HNFF reconstruction has grown dramatically over the last ten years. Plastic surgeons are performing less cases while ENT performs more as indicated by institutional, microsurgery fellowship program director survey, and NSQIP data. Understanding volume trends allows residency and fellowship directors to address shortages in training curricula mandated by the ACGME.

Microsurgery Training Resource Variation among US Integrated Plastic Surgery Residency Programs.

Given emerging focus on competency-based surgical training and work-hour limitations, surgical skills laboratories play an increasingly important role in resident education. This study was designed to investigate educational opportunities in microsurgery across integrated residency programs. Senior residents (PGY 4-6) at integrated plastic surgery programs were surveyed during the 2016 to 2017 academic year to determine each program's access to: training microscopes and anastomosis models, video-based skills assessment, pre-requisite skills exams, flap courses, or a formal microsurgical training curriculum. Programs were stratified based on large size (>18 residents) and presence of microsurgery fellows. Chi-squared analysis was performed with p < 0.05 to assess statistical significance. Survey responses were collected from 32 of 60 eligible programs (53% response rate). Sixty-nine percent provide access to one to two training microscopes, 25% provide three or more, and 6% provide none. Sixty-nine percent of programs train anastomosis with nonliving prosthetics, 66% with living biologics, and 50% with nonliving biologics. Large program size or having microsurgical fellows was not associated with increased access to training microscopes or specific anastomosis models. Programs without microsurgery fellows reported more often that a formal microsurgery curriculum would be helpful (90 vs. 58% of programs with fellows, p = 0.0003). Respondents who indicated that creating a formal curriculum would not be helpful elaborated that their program already has a formal curriculum or a high volume of microsurgery cases. This study demonstrates the current variation in microsurgery training at integrated plastic surgery residency programs. A formal microsurgical training curriculum is commonly viewed as being helpful, particularly at programs without microsurgery fellows.

Factors Correlating With Microsurgical Performance: A Clinical and Experimental Study

Microsurgery is one the most complex surgical skills to master. The factors correlating with microsurgical performance, however, are poorly understood. Understanding these factors will aid in the training and assessment of microsurgeons. A total of 29 microsurgery fellows enrolled in a dedicated 1-year microsurgery fellowship were included in the study. For the clinical evaluations, microsurgical anastomosis performance was evaluated during multiple procedures in the operating room at the start, midpoint, and end of the fellowship by all departmental faculty using a validated microsurgical assessment tool. For the laboratory evaluations, blinded video recordings of each fellow performing an arterial femoral anastomosis in a live rat model at the start and end of the fellowship were evaluated using 3 validated microsurgical global ratings scale tools. Correlations between performance and the factors assessed by the tools were evaluated. In the clinical study there were a total of 474 anastomosis evaluations; clinical performance correlated best with speed, instrument handling, and motion. In the laboratory study 58 evaluations were conducted, and performance tracked most closely with instrument handling, flow of operation, and operative steps, as well as correlating significantly inversely with time taken. The most common errors committed were unequal stitch bites, wrong grasp/damage tissue, and loose knot. Speed, both subjective and objective, instrument handling, operative flow, and motion, were relevant to performance of a microsurgical anastomosis. A prospective trial is now necessary to determine whether these factors should be considered in definitions of competency in microsurgery training pathways.

Microsurgery Fellowship at St Vincent's Hospital, Sydney, Australia: The Ultimate Hidden Gem.

Microsurgery Fellowship at St Vincent's Hospital, Sydney, Australia: The Ultimate Hidden Gem.

Microsurgery Fellowships-Development of a Clinical Curriculum.

Microsurgery fellowships have become an integral part of every plastic surgery training program. While each subspecialty differs in terms of reconstructive requirements, the basic tenets and skill sets remain the same. We explore the possibility of designing a clinical curriculum for microsurgery that can provide residents and fellows with a more foundational and structured approach to microsurgical training. Thirteen core and desired skills to accommodate an "ideal" microsurgery curriculum were listed and categorized according to the level of difficulty. The curriculum was then sent to plastic surgery trainees, fellows, and consultants within Scotland in the form of a survey. They were asked to assign a level of difficulty, basic, intermediate, or advanced, to each of the 13 skill sets. A total of 27 surgeons were surveyed; the majority of which were plastic surgery registrars. Overall a broad, generic clinical curriculum was felt to be lacking, but would be beneficial at the start of training. The curriculum should emphasize a step-wise progression, starting from achieving competency in safe, efficient anastomosis at the basic level to eventually mastering the principles of complex reconstruction at a more advanced level. A generic clinical curriculum offers a framework for tracking progress, the potential for competency-based assessment, and aid in designing a microsurgery fellowship. The curriculum should reflect the evolving nature of the specialty and provide a foundational platform for future innovations.

Interview Scores Correlate with Fellow Microsurgical Skill and Performance

The interview process for surgical trainees aims to select those individuals who will perform best during training and have the greatest potential as future surgeons. The objective of this study was to evaluate the relationship between criteria assessed at interview, technical skills, and performance, for the first time, to optimize the selection process for a Microsurgery fellowship. Twenty microsurgery fellows in three consecutive annual cohorts at a single academic center were prospectively evaluated. At interview, subjects were scored for multiple standardized domains. At the start and at end of the fellowship, microsurgical technical skill was assessed both in the laboratory and operating room (OR) using a validated assessment tool. At the end of the fellowship, there was a final evaluation of performance. At the start, microsurgical skill significantly correlated with almost all domains evaluated at interview, most closely with prior plastic surgery training experience. At the end of the fellowship, skill level improved in all trainees, with the greatest improvement made by the lowest ranked and skilled trainees. The highest ranked trainees, however, made the greatest improvement in speed. The results of this study, for the first time, validate the current interview process to correctly select the highest performing and most skilled candidates and support the effectiveness of a 1-year microsurgical fellowship in improving microsurgical skill in all trainees, irrespective of their initial ability. The importance of valuing the relative quality of prior training and experience at selection is also highlighted.

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.

Starting a microsurgery fellowship: A program's perspective

Starting a microsurgery fellowship: A program's perspective

Microsurgery Fellowship Selection Criteria: A National Program Director Survey.

Background Desirable candidate characteristics for microsurgery fellowship applicants still remain unclear, as no data are available in the literature. This study aims to provide information on the criteria that are used to select and rank applicants for the microsurgery fellowship match. Methods A 38-question survey was sent in April 2015 to all microsurgery fellowship directors (n = 36) involved in the U.S. match, using QuestionPro Software. The survey investigated various factors used for selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 influential factors from 1 ("not at all important in making my decision") to 5 ("essential in making my decision"), or for 5 controversial factors from 1 ("very negative impact in making my decision") to 5 ("very positive impact in making my decision"). Results A total of 53% (19 out of 36) of responses were received from microsurgery fellowship directors. The most important factors included letters of recommendations by microsurgeons (4.6 ± 0.5), interactions with faculty (4.6 ± 0.5), overall interview performance in the selection process (4.6 ± 0.5), and professionalism and ethics (4.4 ± 0.7). Factors that had a negative impact on the selection process included graduate from a non-U.S. plastic surgery residency program (2.1 ± 0.9), graduate needing a visa (2.3 ± 0.8), and graduate from a foreign medical school (2.4 ± 1.0). Conclusion This study provides data on the microsurgery fellowship directors' perception of the criteria important for applicant selection and shows that the most valued criteria are letters of recommendation, interactions with faculty, and interview performance.

The Chang Gung Memorial Hospital Microsurgery Fellowship: A Review of 1 Year of Experience.

Sir: The microsurgery fellowship at the Chang Gung Memorial Hospital in Taiwan was founded in 1984 by Professor Fu Chan Wei.1 The Department of Plastic and Reconstructive Surgery offers a 1-year fellowship in microsurgery. The fellowship setup, diversity and number of cases, and high success rate make it a sought target for training. In this article, I share my personal experience from a 1-year fellowship as a guide tool for those considering microsurgery training at this prestigious institution. FELLOWSHIP SETUP This fellowship is provided by the Division of Microsurgery at the Department of Plastic and Reconstructive Surgery. In total, 6 to 8 fellows are selected annually for duration of 1 year. Different areas of reconstruction are covered during the fellowship, and rotations can be customized based on the need and interest of the fellows, and these areas include head and neck reconstruction, breast reconstruction and lymphedema surgery, upper limb reconstruction, lower limb and trauma reconstruction, peripheral nerve, and facial reanimation. The fellowship is based on the principle of mentorship, and the year is composed of six 2-month rotations, where in each rotation, the team is composed of the professor, the fellow, and 1 resident. The fellow is engaged actively in the clinical and operative activity including the preoperative planning and postoperative care. There is no assigned on-call schedule for the fellow; however, he/she is expected to be in any flap takeback for the team as part of the learning experience. Table 1 summarizes the structure of the fellowship.Table 1.: Fellowship StructureEDUCATION Activities that emphasize educational value to enrich the theoretical knowledge and surgical judgment skills are as follows: Biweekly plastic surgery grand rounds: Valuable review of topics in plastic surgery, updates, and new researches are discussed. Weekly microsurgery teaching rounds: During this meeting, a review of scientific microsurgery articles, book chapters, and all cases mandates exploration during that week. Thirty-four scientific articles and 8 book chapters were reviewed this year. Operative education: Formal teaching about surgical cases is done at the day of surgery where there will be a full presentation of the cases followed by relevant literature review. SURGICAL CASES AND WORKLOAD There was an average of 3 operative days, with 2 rooms running simultaneously, and 1½ clinic days each week. The cases included microsurgical cases (free flaps, peripheral nerve surgery, and lymphatic surgery), pedicle flap, and secondary revision for all procedures. I was involved in a total of 164 cases: 101 microsurgical cases, 4 pedicled flaps, and 59 nonmicrosurgical cases. Table 2 summarizes the areas and flaps for reconstruction.Table 2.: Area of Reconstruction and Types of Free FlapRESEARCH OPPORTUNITY AND FUNDING There are ample opportunities for research in different aspects of reconstructive microsurgery. Funding is not promised for the fellow during this year. CONCLUSIONS The microsurgery fellowship at the Chang Gung Memorial Hospital provides an unparalleled opportunity to learn, understand, and practice microsurgery. I personally liked the fellowship setup, diversity and surgical loads, and the advanced techniques used here, which I think are reproducible and essential to achieve competency in microsurgery. ACKNOWLEDGMENTS The author would like to acknowledge all the professors at the Department of Plastic Surgery and the Ministry of Foreign Affairs of Taiwan (MOFA).

Abstract: Academic Productivity of Microsurgery Fellowship Faculty

INTRODUCTION: The Hirsch index (H-index) is widely recognized as a reliable measure of academic productivity. While previous studies have applied the H-index to various surgical disciplines, none have analyzed microsurgery faculty. This manuscript aims to examine the applicability of the H-index to microsurgery fellowship faculty to determine it utility as a measure of academic output for this group. MATERIALS AND METHODS: Faculty demographics and institution characteristics were obtained from the American Society of Reconstructive Microsurgery (ASRM) and official program websites. Faculty H-indices were calculated using the Scopus database (Elsevier, USA). Data was assessed using bivariate analysis and multiple linear regression models to determine the relationship between independent variables and total publications, career H-index and 5-year H-index (H5-index) of each faculty. RESULTS: A total of 139 faculty members from 22 programs were identified to meet inclusion criteria. The median faculty age was 44 (IQR 13) and 84.9% of faculty were male. Faculty size, number of years of fellowship existence, number of fellows at their program, FACS membership status, number of free flaps performed annually, and academic appointment title were significantly associated with the H index, H5-index and total publications. Multivariate analysis based on the significant independent variables demonstrated that geographical region and faculty ranks were significantly associated with the H5-index. CONCLUSIONS: Variables associated with seniority (age, years of practice after fellowship, and academic appointment were positively correlated with the H-index. Given the increased use of bibliometrics in academic medicine, these results show that H-index is a viable tool which can be used to assess research quantitative and qualitative productivity among academic microsurgeons. DISCLOSURE/FINANCIAL SUPPORT:This work was not supported by any external sources of funding. None of the authors have any financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Abstract: Trainee Selection and the Correlation between Cognitive and Technical Skill Evaluation

INTRODUCTION: The selection process for surgical trainees aims to identify those who will perform best during training and have the greatest potential as future surgeons. Better understanding the predictive relationship between interview performance, level of technical skill, and performance during training will allow optimization of the interview and evaluation process to identify the best candidates.1–3 MATERIALS AND METHODS: Three annual cohorts of Reconstructive Microsurgery fellows at the Department of Plastic Surgery at the University of Texas MD Anderson Cancer Center, comprising 20 trainees, were included in the study. At interview, subjects were rated using seven criteria, as well as given a score for overall impression. At the start and end of the fellowship, microsurgical technical skill was assessed both in the OR and laboratory using a validated tool. At the end of the fellowship there was a final evaluation of performance using criteria adapted from the six Accreditation Council for Graduate Medical Education (ACGME) core competencies. Scores at interview, technical skill assessment, and final evaluation scores were all compared in multiple ways to determine associations and predictive factors. RESULTS: Microsurgical skill assessment in the OR at the start of training correlated with all domains evaluated at interview, most closely with Plastic Surgery Training Experience. Microsurgical skill assessment in the OR at the end of training also correlated with scores on the majority of final assessment criteria based on ACGME core competencies, with the highest correlations with Patient Care and Medical Knowledge. Assessment of microsurgical skill in the laboratory at the start of the fellowship did not improve the predictive relationship between interview scores and ACGME core competency evaluations. CONCLUSION: Microsurgical technical skill in the OR tracked with all domains evaluated at interview, and also with the majority of ACGME core competency evaluations. These results validate the use of the current selection process in choosing candidates with the highest level of both cognitive and technical skill, and also support the effectiveness of the one-year microsurgical fellowship at improving microsurgical skill in all trainees. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Selber JC, Chang EI, Liu J, Suami H, Adelman DM, Garvey P, Hanasono MM, Butler CE. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg. 2012;130:550. 2. Selber JC, Tong W, Koshy J, Ibrahim A, Liu J, Butler C. Correlation between Trainee Candidate Selection Criteria and Subsequent Performance. J Am Coll Surg. 2014; 219:951–7. 3. Alrasheed T, Liu J, Hanasono MM, Butler CE, Selber JC. Robotic microsurgery: validating an assessment tool and plotting the learning curve. Plast Reconstr Surg. 2014;134:794–803.

An evaluation of accessibility and content of microsurgery fellowship websites

Background Websites for residency and fellowship programs serve as effective educational and recruitment tools. Objective To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development. Methods A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive ‘Google’ search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P&lt;0.05 was considered to be statistically significant). Results A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed ‘eligibility criteria’ (87%) and ‘general information’ (87%). ‘Evaluation criteria’ were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on ‘extremity’ versus ‘breast’ (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process. Conclusion Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.

Hand, Craniofacial, Aesthetic, and Microsurgery Fellowship Selection Criteria: A National Program Director Survey

Hand, Craniofacial, Aesthetic, and Microsurgery Fellowship Selection Criteria: A National Program Director Survey

An evaluation of accessibility and content of microsurgery fellowship websites.

Websites for residency and fellowship programs serve as effective educational and recruitment tools. To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development. A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive 'Google' search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P<0.05 was considered to be statistically significant). A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed 'eligibility criteria' (87%) and 'general information' (87%). 'Evaluation criteria' were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on 'extremity' versus 'breast' (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process. Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.

Evaluation of the content and accessibility of microsurgery fellowship program websites

Microsurgery fellowship applicants utilize Internet-based resources such as the San Francisco Match (SF Match) to manage their applications. In deciding where to apply, applicants rely on advice from mentors and online resources including microsurgery fellowship websites (MFWs). The purpose of this study was to evaluate the content and accessibility of MFWs. While microsurgery is practiced by many surgical specialties, this study focused on MFWs for programs available in the 2014 Microsurgery Fellowship Match. Program lists from the American Society for Reconstructive Microsurgery (ASRM) and the San Francisco Match (SF Match) were analyzed for the accessibility of MFW links. MFWs were evaluated for education and recruitment content, and MFW comprehensiveness was compared on the basis of program characteristics using chi square tests. Of the 25 fellowships available, only 18 had websites (72%). SF Match and ASRM listed similar programs (96% overlap) and provided website links (89%, 76%), but only a minority connected directly to the MFW (38%, 23%). A minority of programs were responsive via email inquiry (36%). MFWs maintained minimal education and recruitment content. MFW comprehensiveness was not associated with program characteristics. MFWs are often not readily accessible and contain limited information for fellowship applicants. Given the relative low-cost of website development, MFWs may be improved to facilitate fellow recruitment.