Plastic Surgery Programs Research Articles

Consensus of Leaders in Plastic Surgery: Identifying Procedural Competencies for Canadian Plastic Surgery Residency Training Using a Modified Delphi Technique.

Transitioning to competency-based surgical training will require consensus regarding the scope of plastic surgery and expectations of operative ability for graduating residents. Identifying surgical procedures experts deemed most important in preparing graduates for independent practice (i.e., "core" procedures), and those that are less important or deemed more appropriate for fellowship training (i.e., "noncore" procedures), will focus instructional and assessment efforts. Canadian plastic surgery program directors, the Canadian Society of Plastic Surgeons Executive Committee, and peer-nominated experts participated in an online, multiround, modified Delphi consensus exercise. Over three rounds, panelists were asked to sort 288 procedural competencies into five predetermined categories within core and noncore procedures, reflecting increasing expectations of ability. Eighty percent agreement was chosen to indicate consensus. Two hundred eighty-eight procedures spanning 13 domains were identified. Invitations were sent to 49 experts; 37 responded (75.5 percent), and 31 participated (83.8 percent of respondents). Procedures reaching 80 percent consensus increased from 101 (35 percent) during round 1, to 159 (55 percent) in round 2, and to 199 (69 percent) in round 3. The domain "burns" had the highest rate of agreement, whereas "lower extremity" had the lowest agreement. Final consensus categories included 154 core, essential; 23 core, nonessential; three noncore, experience; and 19 noncore, fellowship. This study provides clarity regarding which procedures plastic surgery experts deem most important for preparing graduates for independent practice. The list represents a snapshot of expert opinion regarding the current training environment. As our specialty grows and changes, this information will need to be periodically revisited.

Insta-grated Plastic Surgery Residencies: The Rise of Social Media Use by Trainees and Responsible Guidelines for Use.

Ethical guidelines for appropriate use of social media are beginning to be delineated. As social media becomes ingrained in plastic surgery culture, education of residents on appropriate use of social media is increasingly important. Recently, plastic surgery residency programs have begun to utilize social media. This study characterized the trends and content of plastic surgery residency-associated Instagram accounts. Active individual residency program Instagram accounts were identified for integrated plastic surgery programs. Metrics for each account were retrieved on September 16, 2017, including date of first post, number of posts, and followers. Individual posts were analyzed for content of post. Fourteen of 67 (21%) integrated plastic surgery programs were found to have active Instagram accounts. There has been an exponential growth of programs adopting Instagram since August 2015. A total of 806 posts were created. Thirty-two (3.97%) posts had intraoperative photos and only one (0.12%) showed a patient image. There were 4466 followers of plastic surgery residency programs. A linear correlation was found between number of posts and number of followers, while there was no correlation of number of followers and time since account start. Instagram use by plastic surgery integrated programs continues to grow exponentially, and programs are appropriately using the platform. Active use of the resident social media results in increased influence. Resident use of social media has many benefits. We propose social media guidelines for plastic surgery trainees and advocate for continued appropriate use and autoregulation by plastic surgery trainees.

Education on the Business of Plastic Surgery During Training: A Survey of Plastic Surgery Residents

Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Canadian Plastic Surgery Resident Work Hour Restrictions: Practices and Perceptions of Residents and Program Directors.

The impact of resident work hour restrictions on training and patient care remains a highly controversial topic, and to date, there lacks a formal assessment as it pertains to Canadian plastic surgery residents. To characterize the work hour profile of Canadian plastic surgery residents and assess the perspectives of residents and program directors regarding work hour restrictions related to surgical competency, resident wellness, and patient safety. An anonymous online survey developed by the authors was sent to all Canadian plastic surgery residents and program directors. Basic summary statistics were calculated. Eighty (53%) residents and 10 (77%) program directors responded. Residents reported working an average of 73 hours in hospital per week with 8 call shifts per month and sleep 4.7 hours/night while on call. Most residents (88%) reported averaging 0 post-call days off per month and 61% will work post-call without any sleep. The majority want the option of working post-call (63%) and oppose an 80-hour weekly maximum (77%). Surgical and medical errors attributed to post-call fatigue were self-reported by 26% and 49% of residents, respectively. Residents and program directors expressed concern about the ability to master surgical skills without working post-call. The majority of respondents oppose duty hour restrictions. The reason is likely multifactorial, including the desire of residents to meet perceived expectations and to master their surgical skills while supervised. If duty hour restrictions are aggressively implemented, many respondents feel that an increased duration of training may be necessary.

Undergraduate Plastic Surgery Education: A National Survey of Clerkship Directors.

The delivery of medical education has received increased attention in recent years due to ongoing time and financial constraints faced by medical educators. Given the recent calls to action by the Carnegie Foundation and Health Canada, an evaluation of the specialty education sector is warranted. To our knowledge, this is the first assessment of the Canadian plastic surgery undergraduate clerkship curriculum. An anonymous electronic survey was distributed to the plastic surgery clerkship directors of all Canadian medical schools (N = 17). The survey consisted of Likert scales and open-ended short answer questions. Themes included general clerkship information, exposure characteristics, teaching characteristics, resource characteristics, and challenges and barriers faced by clerkship directors. Survey response rate was 88%. All responding schools offered a clerkship rotation of varying length in time (1-4 weeks). Students had the most exposure to breast surgery (100%) and general plastic surgery (100%) and the least exposure to aesthetic surgery (40%). Sixty percent of schools indicated the use of modern educational methods. Resources available for teaching students varied. Rotations received excellent feedback from medical students (67%). More than half of respondents would like to see a universal, nationally formulated plastic surgery clerkship curriculum. There is significant heterogeneity in the delivery of plastic surgery clerkship in Canada. A number of areas for improvement have been identified. We hope to establish a national plastic surgery clerkship task force to address the concerns raised here and improve the delivery of undergraduate medical education. Assessment of students based on a national curriculum may help in decision-making regarding plastic surgery program admissions by introducing an element of standardization to clerkship exposure.

Academic Productivity, Knowledge, and Education in Plastic Surgery: The Benefit of the Clinical Research Fellow.

Academic research productivity is limited by strenuous resident and faculty schedules but nevertheless is imperative to the growth and success of our discipline. The authors report institutional experience with their clinical research fellowship model, providing two positions per year. A critical analysis of research productivity was performed for all trainees, faculty, and research fellows from 2000 to 2015. Academic productivity was determined by the number of peer-reviewed publications, podium presentations, and h-index. Academic fate of previous research fellows was also noted. During the 16-year timeframe, 484 articles were published in print. Notably, 92 articles were published from 2000 to 2007 and 392 articles were published from 2008 to 2015 (p = 0.0066), demonstrating linear growth after instituting the research fellowship. In addition, 33 articles were published from 2002 to 2004 before leadership change, 47 from 2005 to 2007 after leadership change but before fellowship, and 58 from 2008 to 2010 in the first few years of the fellowship (p = 0.0204). Overall, 39.9 percent of publications appeared in Plastic and Reconstructive Surgery, with a total of 77 different peer-reviewed journal inclusions. American Association of Plastic Surgeons, American Society of Plastic Surgeons, and Northeastern Society of Plastic Surgeons podium presentations totaled 143 between 2005 and 2015. Of the eight previous fellows who applied into integrated and independent programs, 100 percent have matched. Incorporation of a formalized research fellowship into a plastic surgery program can drastically increase clinical research contribution in a reproducible fashion.

Cosmetic Surgery Training in Plastic Surgery Residency Programs.

Over the past decade, plastic surgery programs have continued to evolve with the addition of 1 year of training, increase in the minimum number of required aesthetic cases, and the gradual replacement of independent positions with integrated ones. To evaluate the impact of these changes on aesthetic training, a survey was sent to residents and program directors. A 37 question survey was sent to plastic surgery residents at all Accreditation Council for Graduate Medical Education-approved plastic surgery training programs in the United States. A 13 question survey was sent to the program directors at the same institutions. Both surveys were analyzed to determine the duration of training and comfort level with cosmetic procedures. Eighty-three residents (10%) and 11 program directors (11%) completed the survey. Ninety-four percentage of residents had a dedicated cosmetic surgery rotation (an increase from 68% in 2015) in addition to a resident cosmetic clinic. Twenty percentage of senior residents felt they would need an aesthetic surgery fellowship to practice cosmetic surgery compared with 31% in 2015. Integrated chief residents were more comfortable performing cosmetic surgery cases compared with independent chief residents. Senior residents continue to have poor confidence with facial aesthetic and body contouring procedures. There is an increase in dedicated cosmetic surgery rotations and fewer residents believe they need a fellowship to practice cosmetic surgery. However, the comfort level of performing facial aesthetic and body contouring procedures remains low particularly among independent residents.

Abstract: Referrals of Plastic Surgery Patients to Integrative Medicine Centers: A Review of Resource Utility

INTRODUCTION: Integrative medicine (IM) centers are becoming increasingly more established nationwide and provide an expansive range of therapeutic services. With a high prevalence of IM usage among plastic surgery patients,1 we seek to define the rate of referrals to IM centers by plastic surgeons to define resource utility. METHODS: Institutions with plastic surgery residency programs and IM centers were identified. A survey questionnaire was sent to center directors to ascertain referral patterns. RESULTS: Out of a total of 96 institutions with plastic and reconstructive surgery programs in North America, 24(25%) have affiliated named IM centers, of which we attained a survey response from 13 (54.5%). 10 (76.9%) of these centers evaluate over 50 patients per week. Patient referrals were primarily from the Department of Medicine (73.8%) as opposed to Surgery (13.1%) (p<0.0001). An average of 0.77% of surgical referrals, or 0.077% of all referrals, arise from plastic and reconstructive surgery. CONCLUSION: IM centers surveyed are infrequently referred patients from plastic surgeons. Given the high prevalence of IM usage among our patient population, IM centers are an underutilized adjunct in the care of our patients. Further study into specific IM services that may benefit our patients would be helpful in increasing IM utilization in our field. Referral Citations: 1. Patel N, Pierson J, Lee T, et al. Utilization and Perception of Integrative Medicine Among Plastic Surgery Patients. Ann Plast Surg. Oct 17 2016.

Barriers and Attitudes to Research Among Residents in Plastic and Reconstructive Surgery: A National Multicenter Cross-Sectional Study

Research sets the foundation for developing plastic surgeons who think critically and approach clinical practice with an inquisitive mind. The objective of this study was to characterize current attitudes and perceived barriers towards conducting research during residency. A validated 36-item questionnaire was developed by a national task-force of Canadian plastic surgery trainees. The survey was distributed to all 13 plastic surgery programs in Canada. Data was collected for a period of 2 months in the form of multiple choice, Likert scales and short answers. The response rate was 64% (95/149) with representation from all 13 plastic surgery programs across Canada. The top three perceived barriers to conducting research were lack of time (83%), insufficient access to research supervisors and mentors (42%) and the research ethics process (38%). More than 70% of residents were interested in conducting research during residency and 74% of programs have a research requirement integrated into their curriculum. Despite this, less than half of residents (47%) believed that their program fosters a culture that promotes research. This was attributed to multiple factors, including a lack of internal research funding (78%), limited access to a research methods or clinical trials unit (78%), and insufficient research training (68%). University research ranking had no correlation with residents' scholarly output or their perceptions towards research barriers. Canadian Plastic Surgery residents identified several important factors considered to be barriers to research. Programs can use these findings to address barriers and improve the integration of research throughout residency training.

The Effects of Music on Microsurgical Technique and Performance: A Motion Analysis Study.

Music is commonly played in operating rooms (ORs) throughout the country. If a preferred genre of music is played, surgeons have been shown to perform surgical tasks quicker and with greater accuracy. However, there are currently no studies investigating the effects of music on microsurgical technique. Motion analysis technology has recently been validated in the objective assessment of plastic surgery trainees' performance of microanastomoses. Here, we aimed to examine the effects of music on microsurgical skills using motion analysis technology as a primary objective assessment tool. Residents and fellows in the Plastic and Reconstructive Surgery program were recruited to complete a demographic survey and participate in microsurgical tasks. Each participant completed 2 arterial microanastomoses on a chicken foot model, one with music playing, and the other without music playing. Participants were blinded to the study objectives and encouraged to perform their best. The order of music and no music was randomized. Microanastomoses were video recorded using a digitalized S-video system and deidentified. Video segments were analyzed using ProAnalyst motion analysis software for automatic noncontact markerless video tracking of the needle driver tip. Nine residents and 3 plastic surgery fellows were tested. Reported microsurgical experience ranged from 1 to 10 arterial anastomoses performed (n = 2), 11 to 100 anastomoses (n = 9), and 101 to 500 anastomoses (n = 1). Mean age was 33 years (range, 29-36 years), with 11 participants right-handed and 1 ambidextrous. Of the 12 subjects tested, 11 (92%) preferred music in the OR. Composite instrument motion analysis scores significantly improved with playing preferred music during testing versus no music (paired t test, P <0.001). Improvement with music was significant even after stratifying scores by order in which variables were tested (music first vs no music first), postgraduate year, and number of anastomoses (analysis of variance, P < 0.01). Preferred music in the OR may have a positive effect on trainees' microsurgical performance; as such, trainees should be encouraged to participate in setting the conditions of the OR to optimize their comfort and, possibly, performance. Moreover, motion analysis technology is a useful tool with a wide range of applications for surgical education and outcomes optimization.

Facial Plastic Surgery Patient Resources Exceed National Institute Recommendations.

Patient education is essential in enhancing the physician-patient therapeutic alliance, patient satisfaction, and clinical outcomes. The American Medical Association and National Institute of Health recommend that information be written at a 6th-grade reading level, but online resources often exceed patient literacy. The purpose of this study is to assess readability of online material for facial plastics procedures presented on academic plastic surgery and otolaryngology websites.An Internet search was performed of all academic institutions that had both plastic surgery and otolaryngology training programs who offered patient information on facial plastic surgery procedures. National society websites for both plastic surgery and otolaryngology were also analyzed. All procedural information was compiled and readability analyses were performed. A 2-tailed Z-test was used to compare scores, and statistical significance was set at P < 0.05.Sixty-three programs were identified; 42 had educational material. The overall average readability for all information was at a 10th-grade reading level. The national plastic surgery website had a significantly higher word count and number of syllables per word compared to the national otolaryngology website (P < 0.001, P = 0.04).The complexity of written resources represents an obstacle to online patient education and efforts to improve readability could benefit patients seeking medical information online. Current online education materials are a potential hindrance to patient education, satisfaction, and decision making. Healthcare institutions should consider writing new materials with simpler language that would be accessible to patients.

Surgeon-Reported Needs for Improved Training in Identifying and Managing Free Flap Compromise.

Background This study examined the need for improved training in the identification and management of free flap (FF) compromise and assessed a potential role for simulated scenario training. Methods Online needs assessment surveys were completed by plastic surgeons and a subsample with expertise in microsurgery education participated in focus groups. Data were analyzed using descriptive statistics and mixed qualitative methods. Results In this study, 77 surgeons completed surveys and 11 experts participated in one of two focus groups. Forty-nine (64%) participants were educators, 65 and 45% of which reported having an insufficient volume of FF cases to adequately teach the management and identification of compromise, respectively. Forty-three percent of educators felt that graduating residents are not adequately prepared to manage FF compromise independently. Exposure to normal and abnormal FF cases was felt to be critical for effective training by focus group participants. Experts identified low failure rates, communication issues, and challenging teaching conditions as current barriers to training. Most educators (74%) felt that simulated scenario training would be "very useful" or "extremely useful" to current residents. Focus groups highlighted the need for a widely accepted algorithm for re-exploration and salvage on which to base the development of a training adjunct consisting of simulated scenarios. Conclusion Trainee exposure to FF compromise is inadequate in existing plastic surgery programs. Early exposure, high case volume, and a standardized algorithmic approach to management with a focus on decision making may improve training. Simulated scenario training may be valuable in addressing current barriers.

Transgender-Related Education in Plastic Surgery and Urology Residency Programs.

With increasing public awareness of and greater coverage for gender-confirming surgery by insurers, more transgender patients are likely to seek surgical transition. The degree to which plastic surgery and urology trainees are prepared to treat transgender patients is unknown. We assessed the number of hours dedicated to transgender-oriented education in plastic surgery and urology residencies, and the impact of program director (PD) attitudes on provision of such training. PDs of all Accreditation Council for Graduate Medical Education-accredited plastic surgery (91) and urology (128) programs were invited to participate. Surveys were completed between November 2015 and March 2016; responses were collected and analyzed. In total, 154 PDs (70%) responded, and 145 (66%) completed the survey, reporting a yearly median of 1 didactic hour and 2 clinical hours of transgender content. Eighteen percent (13 of 71) of plastic surgery and 42% (31 of 74) of urology programs offered no didactic education, and 34% (24 of 71) and 30% (22 of 74) provided no clinical exposure, respectively. PDs of programs located in the southern United States were more likely to rate transgender education as unimportant or neutral (23 of 37 [62%] versus 39 of 105 [37%]; P = .017). PDs who rated transgender education as important provided more hours of didactic content (median, 1 versus 0.75 hours; P = .001) and clinical content (median, 5 versus 0 hours; P < .001). A substantial proportion of plastic surgery and urology residencies provide no education on transgender health topics, and those that do, provide variable content. PD attitudes toward transgender-specific education appear to influence provision of training.

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.

Pregnancy and the Plastic Surgery Resident.

Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.

The “Independent” Plastic Surgery Match: Analysis of Changes in Recent Years and Applicant Preferences

The number of surgical applicants to "independent" plastic surgery programs has drastically decreased. However, the competitiveness of recent applicants relative to previous years has not been assessed. The purpose of this study was to analyze the characteristics of recent "independent" applicants and to obtain their preferences regarding the match. A 25-question survey was distributed to 97 applicants of the 2012 "independent" match. The survey consisted of questions regarding demographics, academic qualifications, interview results, match results, program characteristic preferences, interview preferences, and future career plans. A total of 62 applicants responded; 71% male, 82% US medical graduates, 94% general surgery residents, and 76% in university programs. Three-quarters had ≥2 publications and 29% in plastic surgery journals. Applicants most commonly attended 11 to 13 interviews, and 31% got their top choice. Mean rank list position matched was 2.7. Out of 10 program selection criteria, overall training quality and geographic location were most important to applicants. Difficulty of on-call responsibilities and research opportunities were least important. Applicants interested in university-based practice had a significantly higher interest in research (p = 0.003). Most prefer one-on-one interviews with 5 sessions being ideal. Two-thirds would prefer regional coordination of interviews. Half were undecided about fellowship, and most were undecided about subspecialty of greatest interest. University-affiliated (39%) and university-based (33%) were the most commonly envisioned future practices. The profile of "independent" plastic surgery applicants has not changed much in recent years. When selecting a program, applicants are looking for the best overall operative training above all else with little regard for difficulty of on-call responsibilities or ability to do research. Applicants are still very moldable in their preference of future career plans with the majority possessing an early interest in academic-related practices.

How Informative are the Plastic Surgery Residency Websites to Prospective Applicants?

To evaluate the comprehensiveness of plastic surgery program websites. American Medical Association interactive database was accessed for the list of integrated plastic surgery programs, in June 2015. Since then, 67 plastic surgery program websites were accessed and searched for the presence or absence of 31 criteria, which were further grouped into 5 categories: First, program contact information; second, training and research; third, program setup; fourth, benefits and facilities; and fifth, information for applicants. Programs were categorized based on US census bureau designated regions, and number of residency positions available. One-way ANOVA test was used for comparison. Only 25% (17) program website had information available on more than two-thirds (21 or more of 31) of the criteria. The 3 least factors commonly available by program websites were: operative log (10%), contract (10%), and information on night float (25%). The 3 most commonly available factors included: coordinator information (92%), number of residents (92%), and comprehensive faculty list (88%). Less than 50% of the programs provided information regarding fellowship opportunities, active and previous research projects, and operative logs. There was no difference in amount of information on program websites when analyzed for program size or program geographic location. Programs should consider revising their websites to include aforementioned 31 criteria. This would make applicants and potential resident physicians better informed of the programs before the interview process such that they would be more likely to apply to only those programs that match their specific aspirations.

Attrition in Plastic Surgery Residencies

BACKGROUND Resident attrition is defined as the termination of a resident from his or her designated training program before completion, whether voluntarily or involuntarily. There are 2 types of plastic surgery programs: the 6-year integrated pathway and the 3-year fellowship or independent pathway. This diversity in resident backgrounds creates a complex setting for evaluation of resident attrition. Attrition in plastic surgery is poorly characterized in the literature, with previous studies estimating a 3.1% attrition rate in independent programs and indicating that independent residents may have a higher rate of voluntary attrition with integrated residents having higher rates of involuntary attrition.1,2 There has been no mention of risk factors for attrition. The aim of this study is to identify risk factors, note differences between pathways, and ultimately provide insight into resident attrition from plastic surgery residencies. METHODS An anonymous, multiple-choice and short answer, online survey was designed with Institutional Review Board approval. Surveys were sent to all plastic surgery program directors (PDs) in the United States. PDs were instructed to focus on the previous 10-year span from 2003 to 2013 and answered questions about resident attrition from their program. PDs were asked to surmise attrition rates and pathways most at risk. Outcomes measured included demographics of the program and attritional resident, timing and reasons for attrition, and possibility of preventing attrition. RESULTS Thirty-three of 95 PDs (35%) responded. PDs estimated attrition rates for plastic surgery at 6% (range 0%–17%). A majority of PDs (82%) assumed that integrated residents would be higher risk for attrition, attributing immaturity, and lack of exposure. Average attrition rates were calculated at 2.14% for independent and 0.85% for integrated programs, or 3.0% overall. Risk factors for attrition for both pathways included being single (P < 0.0001), divorced (P < 0.01), male (P < 0.05), and having no dependents (P < 0.001). One hundred percent of independent residents left by year 2 and 86% of integrated residents left by year 4. Lifestyle and loss of interest were most sited reasons for attrition. Three total residents underwent involuntary attrition (2 integrated, 1 independent). The majority of independent residents returned to their original field of training, whereas the integrated residents were more likely to transfer to another plastic surgery program. Of PDs responding, only 17% believed attrition could have been prevented. CONCLUSIONS Approximately 3.0% of plastic surgery residents underwent attrition during our study with independent residents at more risk for voluntary attrition and integrated residents for involuntary attrition. Being single, male, divorced, or having no dependents increases the risk of attrition in plastic surgery residencies. This is the first study to focus solely on plastic surgery attrition rates and demonstrate potential risk factors for plastic surgery residents undergoing attrition. Further research is warranted to help identify at-risk residents and prevent unnecessary attrition.

Abstract: Leadership Positions in Academic Plastic Surgery: Are You a Candidate?

PURPOSE: It is unclear which trainees will ultimately be successful in acquiring leadership roles in academic plastic surgery.1–3 We sought to identify factors associated with current chiefs and chairman in academic plastic surgery to encourage and shape future leaders of tomorrow. METHODS: Academic plastic surgery chiefs and chairman (n = 93) were identified through an Internet-based search of all Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs during the year of 2015. Gender, academic rank, board certification, time since certification, medical school attended, residency program attended, fellowships, advanced degrees, obtaining leadership roles at trainees institution, and h- index were analyzed. RESULTS: Of the 93 chiefs and chairman, 94% were male and 81% obtained full professor status. 98% were certified by the American Board of Plastic Surgery. The mean time since certification was 22 years (range 7–45 years). 87% graduated from medical schools within the United States. 9 plastic surgery programs were responsible for training 42% of the current chiefs/chairmen in plastic surgery. 56% had pursued fellowships beyond their primary plastic surgery training. 22% had obtained advanced degrees beyond a medical degree. 29% percent of chiefs and chairman obtained leadership roles at the institution where they had completed plastic surgery training. The mean h index was 17.6 (range 1- 63). Graduates of the 9 most represented residency programs had a mean h index of 21 vs. 15 when compared to the remaining chiefs/chairmen. (p<0.0062) CONCLUSIONS: Chiefs and Chairman in plastic surgery are more likely to be male, hold an academic rank of professor, and have completed a fellowship after residency. They are also more likely to have trained at 1 of the 9 following institutions: Harvard, Emory, NYU, UPMC, Johns Hopkins, University of Chicago, Duke, UT Southwestern and University of Michigan. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has any financial support or interest with any institutions mentioned in this paper. REFERENCES: 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. 2014 Sep;134(3):570–8. 2. DeLong MR, Hughes DB, Tandon VJ, Choi BD, Zenn MR. Factors influencing fellowship selection, career trajectory, and academic productivity among plastic surgeons. Plastic Reconstructive Surg. 2014 Mar;133(3):730–6. 3. Herrera FA, Chang EI, Suliman A, Tseng CY, Bradley JP. Recent trends in resident career choices after plastic surgery training. Ann Plast Surg. 2013 Jun;70(6):694–7.

Abstract: Readability of Online Patient Resources for Head &amp; Neck Procedures

INTRODUCTION: Patient education is essential in enhancing the therapeutic alliance, patient satisfaction, and clinical outcomes. The NIH and AMA recommend that information be written at a sixth-grade reading level; 1,2 however, online resources often exceed patient literacy. The purpose of this study is to assess readability of online material for facial procedures found on academic plastic surgery and otolaryngology websites. MATERIALS AND METHODS: An internet search was performed of all academic hospitals that had both plastic surgery and otolaryngology training programs. An average word and syllable count was performed for each procedure. Readability analyses were performed using the Flesh-Kincaid Grade Level, SMOG Index, Gunning-Fog Score, Automated Readability Index, and Coleman-Liau Index. National society websites for both plastic surgery and otolaryngology were used as controls. A two-tailed z-test was used to compare scores, and statistical significance was set at p < 0.05. RESULTS: Sixty-three programs were identified, and 42 had educational material. The national plastic surgery website had a significantly higher word count and number of syllables per word compared to the national otolaryngology website (p < 0.001, p = 0.04).The overall average readability for all information was at a 10th grade reading level, and the average Flesch-Kincaid readability score was 10.4 and 10.5 for plastic surgery and otolaryngology, respectively (p=0.45). CONCLUSION: Online resources for facial procedures are more complex than the recommended reading levels. This represents an obstacle to online patient education, and attention to this aspect of patient education could benefit patients seeking medical information online. DISCLOSURES/FINANCIAL SUPPORT:No disclosures. REFERENCES: 1. How to write easy-to-read health materials. MedlinePlus. How to write easy-to-read health materials. Available at: http://www.nlm.nih.gov/medlineplus/etr.html. Updated November 30, 2015. Accessed January 20, 2016. 2. Weiss B. Health Literacy: A Manual for Clinicians. Chicago: American Medical Association, American Medical Foundation; 2003.