Subspecialty Of Plastic Surgery Research Articles

ChatGPT for improving postoperative instructions in multiple fields of plastic surgery

BackgroundClear discharge instructions are vital for patients and caregivers to manage post-op care at home. However, they often exceed the sixth-grade reading level recommended by national associations. We hypothesize that ChatGPT could help rewrite instructions to this level for increased accessibility and comprehension. We aim to assess readability, understandability, actionability, and safety of ChatGPT rewritten post-op instructions in four Plastic Surgery subspecialties: Breast, Craniofacial, Hand, and Aesthetic surgery. MethodsWe obtained post-op instructions from four index procedures in Plastic Surgery. We utilized ChatGPT to rewrite at the sixth- and fourth-grade reading levels. Readability was determined by seven readability indexes, understandability and actionability by the PEMAT-P questionnaire, and safety by the primary surgeons. ResultsOverall, average readability of the original post-op instructions ranged between seventh-eighth grade. Of the sixth-grade ChatGPT instructions, only one was lowered to the sixth-grade level. Of the fourth-grade ChatGPT instructions, all were reduced to sixth-grade or below, but none achieved fourth-grade level. Understandability scores increased as reading level decreased while actionability scores decreased for fourth-grade rewrites. Safety was not compromised in all rewrites. ConclusionsOur findings suggest that ChatGPT can adapt post-op instructions to a more readable sixth-grade level without compromising safety. We suggest prompting ChatGPT to write 1-2 grade levels lower than the desired reading level. While understandability increased for all ChatGPT rewrites, actionability decreased for fourth-grade level instructions. Sixth-grade remains as the optimal reading level for post-op instructions. This study demonstrates that ChatGPT can help improve patient care by improving readability of post-op instructions.

Discussion: Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties.

Discussion: Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties.

Article Factors Influencing Gender Disparities in Senior Authorship of Plastic Surgery Publications

Introduction Female plastic surgeons publish fewer and lower impact articles. To better understand how to address this gender gap, we explored the temporal trends in female senior authorship and evaluated predictive factors for female senior authorship. Methods A retrospective review of articles published in the 3 highest impact plastic surgery journals published from 2010 to 2020 was conducted. Trends with female senior authorship across time were analyzed with respect to study type, subspeciality, and geographical origin. Results Of the 5425 articles included, 13% (n = 720) had a female senior author, and female senior authorship increased across time (R = 0.84, P = 0.033). Over the decade, an increased proportion of cohort studies (R = 0.82, P = 0.045), systematic reviews (R = 0.96, P = 0.003), breast-related articles (R = 0.88, P = 0.022), and reconstruction-related articles (R = 0.83, P = 0.039) were published by female senior authors. Subspecialty and geography predicted female senior authorship; articles focused on aesthetic (odds ratio [OR] = 1.3, P = 0.046) and breast (OR = 1.7, P < 0.001) subspecialties or those originating from Canada (OR = 1.7 P = 0.019), Europe (OR = 1.5, P < 0.001), and Latin America (OR = 3.0, P < 0.001) were more likely to have a female senior author. Articles from East Asia were less likely to have female senior authors (OR = 0.7, P = 0.005). Conclusion Female senior authorship in plastic surgery has increased over the last decade, and the proportion of female plastic surgeons leading cohort studies and systematic reviews is increasing. Sex of the senior author is influenced by plastic surgery subspecialty and geographical origin, but article type did not impact the odds of female senior authorship.

Trends in Aesthetic Surgery Fellowship Training: An Analysis of Supply and Demand.

Aesthetic surgery fellowship applications were consolidated under the San Francisco Match in 2018. The impact of these changes on aesthetic program and applicant numbers had not yet been investigated. In this study we sought to evaluate changes in programs, positions, applications, match rates, and fill rates since aesthetic surgery joined the San Francisco Match. We also aimed to compare these trends to craniofacial surgery, microsurgery, and hand surgery fellowships over this same time period. San Francisco and National Resident Matching Program (NRMP) match data for aesthetic, craniofacial, microsurgery, and hand fellowships were obtained from 2018 to 2022, and the number of applications, positions, programs, and successful matches were evaluated. The number of aesthetic fellowship positions increased from 17 to 41 (141%) over the period studied. This resulted in increased match rates and more unfilled positions. Over the same period, fellowship positions for craniofacial, hand, and microsurgery increased by 3.4%, 6%, and 2.5% respectively. There was no increase in applications to any postgraduate subspecialty, nor was there any change in the number of residents pursuing fellowship. Similarly, there was no change in the percentage of fellowship-bound residents applying to any given discipline. The increase in aesthetic fellowship programs and positions did not generate an increase in applications. Applications to other plastic surgery subspecialties also failed to increase. Unlike aesthetic fellowships, their program numbers have remained stable. Given the limited fellowship applicant pool, our focus should be on enhancing the quality of existing aesthetic programs rather than continuing to increase the number of aesthetic positions.

Social Media Usage by United States Plastic Surgery Subspecialty Fellowship Programs.

United States plastic surgery fellowship programs in four major subspecialties (hand, microsurgery, craniomaxillofacial, and aesthetic) were identified and evaluated for social media presence on Instagram, Facebook, and Twitter. Platform-specific parameters were collected and statistically analyzed in aggregate. There were a total of 25 Instagram accounts, four Facebook accounts, and three Twitter accounts across all investigated subspecialties. Hand surgery had the greatest social media presence on Instagram (19.5%) and Twitter (3.4%). Microsurgery had the greatest presence on Facebook (4.7%). Between 2015 and 2022, Instagram was the platform with the greatest increase in adoption by fellowship programs. Geographically, microsurgery and craniomaxillofacial accounts were primarily owned by Midwest programs (66.7%, 100%), and aesthetic primarily by programs in the South (83.3%). Number of Instagram posts and followers were not significantly correlated with hospital reputation (P = 0.12, P = 0.63). Social media is underutilized by plastic surgery fellowship programs. While Instagram metrics such as posts and followers are not correlated with hospital reputation, the skewed distributions of fellowship accounts, both geographically and across platforms, represent areas of potential growth.

Comparing Trends in Medicare Reimbursement and Inflation within Plastic Surgery Subspecialties.

Over the past decade across multiple surgical specialties, Medicare reimbursement rates have remained stagnant, failing to keep pace with inflation. An internal comparison of subspecialties within plastic surgery has not yet been attempted. The goal of this study was to investigate the trends in reimbursement from 2010 to 2020 and compare across the subspecialties of plastic surgery. The Physician/Supplier Procedure Summary was used to extract the annual case volume for the top 80% most-billed CPT codes within plastic surgery. Codes were defined into the following subspecialties: microsurgery, craniofacial surgery, breast surgery, hand surgery, and general plastic surgery. The Medicare physician reimbursement was weighted by case volume. The growth rate and compound annual growth rate were calculated and compared against an inflation-adjusted reimbursement value. On average, inflation-adjusted growth in reimbursement for the procedures analyzed in this study was -13.5%. The largest decrease in growth rate was within the field of microsurgery (-19.2%), followed by craniofacial surgery (-17.6%). These subspecialties also had the lowest compound annual growth rate (-2.11% and -1.91%, respectively). For case volumes, microsurgery increased case volumes by an average of 3% per year, whereas craniofacial surgery increased case volumes by an average of 5% per year. After adjusting for inflation, all subspecialties had a decrease in growth rate. This was particularly evident in the fields of craniofacial surgery and microsurgery. Consequently, practice patterns and patient access may be negatively affected. Further advocacy and physician participation in reimbursement rate negotiation may be essential to adjust for variance and inflation.

Changes in Subspecialty Interest of Plastic Surgery Residents With Progression of Training: Impact on Academic Attrition.

Plastic surgery residency applicants often express interest in academic subspecialties, but only a small percentage of graduating residents pursue academic careers. Identifying reasons for academic attrition may help training programs address this discrepancy. A survey was sent to plastic surgery residents through the American Society of Plastic Surgeons Resident Council to assess interest in 6 plastic surgery subspecialties during junior and senior years of training. If a resident changed their subspecialty interest, the reasons for change were recorded. The importance of different career incentives over time were analyzed with paired t tests. Two hundred seventy-six plastic surgery residents of 593 potential respondents (46.5% response rate) completed the survey. Of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial and microsurgery were identified as the specialties with the highest attrition of interest, while interest in esthetic, gender-affirmation, and hand surgery increased. For residents who left craniofacial and microsurgery, the desire for higher compensation, to work in private practice, and the desire for improved job opportunities significantly increased. The desire for improved work/life balance was a prominent reason for subspecialty change among senior residents who changed to esthetic surgery. Plastic surgery subspecialties associated with academia, such as craniofacial surgery, suffer from resident attrition due to a variety of factors. Increased retention of trainees in craniofacial surgery, microsurgery, and academia could be improved through dedicated mentorship, improved job opportunities, and advocacy for fair reimbursement.

33. Microsurgical Simulation Training Enhances Medical Student Acting Internship Experience

Background: Microsurgical education typically does not begin until surgical residency, and requires significant investment of time and practice.1,2 Various models and simulations have been reported to support microsurgical training, and have mostly focused on post-graduate surgical trainees.3 It has been demonstrated that medical students are capable of learning microsurgical techniques and exposure to microsurgery may improve their interest in plastic surgery.4 There is limited literature on how exposure to microsurgery training influences senior medical students applying to plastic surgery residency. Methods: Fourth year medical students completed a four hour, individual training session with expert microsurgeon (WZ) during their acting internship. Pre-training and post-training survey responses were compared using Wilcoxon signed rank test. Results: Twelve medical students completed the training session. Eighty-three percent of students (10/12) came from institutions without a microsurgery fellowship program. Two-thirds of students had no prior hands-on microsurgery experience. Ninety-one percent of students (11/12) were either extremely or somewhat uncomfortable performing end-to-end anastomoses of synthetic vessels. After the session, 58% of students (7/12) felt extremely or somewhat comfortable, with only 17% feeling somewhat uncomfortable (p=0.003). All students rated the session as very or extremely useful, with 91% finding the level of instruction and skills practiced reasonable. When asked to rank their interest in plastic surgery subspecialties, one-third of students ranked microsurgery higher than they did prior to the training session (p=0.450). Ninety-one percent of students reported that it was important for them to be at a residency program that would prepare them to perform microsurgery independently after graduation. Conclusion: Medical students can successfully learn microsurgical skills, including vessel anastomoses, in just a single training session. Hands-on microsurgical practice opportunities enrich the acting internship experience, and may inspire greater medical student interest in the subspecialty as well as the hosting residency program. A microsurgical curriculum for medical students is in development, with plans to further optimize learning and professional growth.

Coworker Reports about Unprofessional Behavior in Plastic Surgery.

Patient reports of unprofessional conduct by surgeons have been linked to postprocedure complications and increased risk for malpractice claims. Coworkers are also positioned to observe and report unprofessional behaviors, including concerns related to delivery of competent medical care, clear and respectful communication, integrity, and responsibility. This study compared rates of coworker concerns between plastic surgeons and other physicians (other surgical specialists and nonsurgeons), and characterized whether plastic surgery subspecialties differed in their rates of complaints. Coworker concern data from January 1, 2014, to December 31, 2019, were retrieved from the Vanderbilt Center for Patient and Professional Advocacy's Coworker Observation Reporting System database. Specialty was classified as plastic surgery, non-plastic surgical, and nonsurgical. The plastic surgery cohort was further characterized by sex, medical school graduation year, predominant practice type (reconstructive only, aesthetic only, or hybrid), and postresidency training (ie, completion of a fellowship). The study cohort included 34,170 physicians (302 plastic surgeons, 7593 non-plastic surgeons, and 26,275 nonsurgeons). A greater proportion of plastic surgeons (13.6%) had one or more coworker concerns compared with nonsurgeons (10.8%) and non-plastic surgeons (6.1%) ( P < 0.001). The most prevalent concern category reported for plastic surgeons was clear and respectful communication. Among plastic surgeons who had no concerns versus those who had at least one concern, there was no significant difference when comparing sex, medical school graduation year, predominant practice type, or postresidency training. Plastic surgeons in this cohort study received more coworker reports than other surgeons and nonsurgical physicians. These data may be used by institutions to identify plastic surgeons at risk for preventable postprocedure complications and intervene with peer feedback intended to promote self-regulation.

A Systematic Review of Artificial Intelligence Applications in Plastic Surgery: Looking to the Future.

A comprehensive literature search of the Medline, EMBASE, Cochrane, and PubMed databases was conducted for AI studies with multiple search terms. Articles that progressed beyond the title and abstract screening were then subcategorized based on the plastic surgery subspecialty and AI application. The systematic search yielded a total of 1820 articles. Forty-four studies met inclusion criteria warranting further analysis. Subcategorization of articles by plastic surgery subspecialties revealed that most studies fell into aesthetic and breast surgery (27%), craniofacial surgery (23%), or microsurgery (14%). Analysis of the research study phase of included articles indicated that the current research is primarily in phase 0 (discovery and invention; 43.2%), phase 1 (technical performance and safety; 27.3%), or phase 2 (efficacy, quality improvement, and algorithm performance in a medical setting; 27.3%). Only one study demonstrated translation to clinical practice. The potential of AI to optimize clinical efficiency is being investigated in every subfield of plastic surgery, but much of the research to date remains in the preclinical status. Future implementation of AI into everyday clinical practice will require collaborative efforts.

Plastic Surgery in the Gulf Cooperation Council Countries: Role of Telemedicine.

This is a cross-sectional survey-based study that was sent online to the plastic surgeons practicing in the Gulf region. The study aimed to look into the integration of telemedicine into the practice and the surgeons' attitude and future vision about it. Participation was voluntary, and confidentiality was preserved. A total of 229 plastic surgeons enrolled in this study in mid-2020. There were 192 male participants (83.8%) and 37 female participants (16.2%). Of these, 99 (43.2%) practiced in Saudi Arabia, 85 (37.1%) in the United Arab Emirates, 24 (10.5%) in Oman, 18 (7.9%) in Kuwait, and three (1.3%) in Bahrain. In total, 85 (37.1%) used telemedicine during lockdown, and 144 (62.9%) thought that its usage will remain beneficial in the future. There was no significant difference in practicing telemedicine in different plastic surgery subspecialties, varying level of experience, and country of practice. Among those who used virtual consultations, 62 (72.9%) did not charge for consultation fees. The tendency toward telemedicine integration in plastic surgery practice is growing worldwide, especially after COVID-19. Its limitations are outweighed by its advantages and, with time, many of these will be bypassed. New innovations driven by advancement in technology will further embed telemedicine into the practice.

Differences in Applicant Perceptions of Virtual Interviews Between Integrated Plastic Surgery and Subspecialty Fellowship Applicants

We aim to survey and compare integrated plastic surgery and plastic surgery subspecialty fellowship applicants on their experiences with virtual interviews and to determine if there are differences between them. An IRB-approved survey study was conducted using the Qualtrics platform. The study was conducted at the Johns Hopkins University and the R Adams Cowley Shock Trauma Center in Baltimore Maryland. Applicants that applied to 1) the Johns Hopkins/University of Maryland or the University of California San Diego integrated plastic surgery residency programs, 2) craniofacial surgery fellowship, and 3) microsurgery, hand surgery, or burn surgery fellowship at the Johns Hopkins University were selected to participate in the survey. A total of 94 surveys were completed by residency applicants and 55 by fellowship applicants. After the interview season, 80% of fellowship applicants recommended virtual interviews compared to 61.7% of residency applicants (p = 0.03). Fellowship applicants reported significantly less issues with self-advocacy and did not view the virtual interview process as significant of a detriment when meeting program residents/staff, viewing the hospital/surrounding area, and learning about the program (p < 0.05). A higher percentage of fellowship applicants interviewed at multiple programs during a single day compared to residency applicants (56.4% vs 27.7%; p < 0.001). A higher proportion of fellowship applicants prefer virtual interviews, which associated with key differences in perceptions, expectations, and priorities. Our data supports that fellowship programs may wish to continue virtual interviews even after COVID-related restrictions are lifted, because fellows are equally able to self-advocate in a virtual format while benefiting from cost and time savings; fellowship programs would also gain the cost and time savings from this model as well.

P5. #AllHandsonDeck: A Social Media Analysis of Hand Surgery Content by Plastic Surgery Residency Programs

Background: As a core competency required by the ACGME for plastic surgery training, sufficient hand surgery exposure during residency is essential. Social media platforms, including Instagram, are widely used by residency programs and can factor into applicant decision-making. This study aims to evaluate the representation of hand surgery by integrated plastic surgery residency programs on their Instagram accounts Methods: Integrated plastic surgery residency programs were identified from the American Council of Academic Plastic Surgeons (ACAPS) website. Their Instagram accounts were identified through Instagram searches. Program variables including Doximity reputation ranking, geographic region, and accreditation date were collected. Posts uploaded through 8/21/2021 were analyzed for hand surgery-related content and hashtags. Video-only posts were excluded. Engagement scores were calculated by dividing mean likes on the 10 most recent posts by number of account followers. Student’s t and ANOVA tests were used to compare hand surgery-related content between programs (?=0.05) Results: Of 84 programs, 77 (91.7%) had active accounts, totaling 9361 posts. 788 (8.4%) posts were hand surgery-related, featuring 211 academic activity (26.9%), 147 operative case (18.7%), 143 fellowship (18.1%), 133 faculty subspecialty (16.9%), 107 research (13.6%), 77 resident interest (9.8%), 29 hand call (3.7%), 13 clinic (1.6%), 5 mission trip (0.6%), 2 news article (0.2%), 2 physical exam (0.2%), and 1 patient testimonial (0.1%) posts. The most commonly featured operative procedures included hand nerve repairs (11.6%), artery repairs (8.8%), replants (8.2%), and transplants (8.2%). 5 (6.5%) accounts had no hand-related content. 934 hand-related hashtags were used, with 75.4% used on hand-related and 24.6% on non-hand-related posts. The most frequently used hashtags were #handsurgery (567), #hand (42), and #handsurgeon (42). Program ranking, geographic region, age, affiliation with hand fellowship, and engagement score were not significantly associated with proportion of hand-related content Conclusion: Under 10% of content featured by integrated plastic surgery residency program Instagram accounts is hand-related. Hand surgery hashtag usage is relatively limited to hand-related content. Given that hand surgery represents one of multiple core competencies, future research is needed comparing proportions of content dedicated to each plastic surgery subspecialty.

P87. CHANGES IN SUBSPECIALTY INTEREST OF PLASTIC SURGERY RESIDENTS WITH PROGRESSION OF TRAINING: IMPACT ON ACADEMIC ATTRITION

PURPOSE: Plastic surgery residency applicants often express interest in academic subspecialties, but only a small percentage of graduating residents pursue academic careers. Identifying reasons for academic attrition may help training programs address this discrepancy. METHODS: A survey was sent to plastic surgery residents via the American Society of Plastic Surgeons Resident Council to assess interest in six plastic surgery subspecialties during junior and senior years of training. If a resident changed their subspecialty interest, the reasons for change were recorded. The importance of different career incentives over time were analyzed with paired t-tests. RESULTS: 276 plastic surgery residents completed the survey. Most (77%) reported initial interest in an academic career. Out of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial and microsurgery were identified as the specialties with the highest attrition of interest, while interest in aesthetic, gender affirmation, and hand surgery increased. For residents who left craniofacial and microsurgery, the desire for higher compensation, to work in private practice, and the desire for improved job opportunities significantly increased. The desire for improved work/life balance was a prominent reason for subspecialty change among senior residents who changed to aesthetic surgery. CONCLUSION: Plastic surgery subspecialties associated with academia suffer from resident attrition due to a variety of factors. Increased retention of trainees in academia, microsurgery, and craniofacial surgery could be improved through dedicated mentorship, improved job opportunities, and advocacy for fair reimbursement.

Characterizing the Effect of the COVID-19 Pandemic on the Plastic Surgery Literature.

The coronavirus disease of 2019 (COVID-19) pandemic has dramatically impacted the plastic surgery community across the globe, and it has been the center of discussion in public and private discourse throughout the year.1 Given this deep interest in the COVID-19 pandemic, we hypothesized that articles related to the COVID-19 pandemic in the plastic surgery literature would garner higher levels of attention than other articles. Using the Journal Citation Reports, 15 plastic surgery journals with the highest impact factor in 2019 were selected and all articles published in these journals in 2020 were extracted.2 For the 6815 articles identified, number of citations accrued and Altmetric score, which is a weighted calculation of the attention an article receives online, were recorded.3 COVID-19–related articles were identified by searching titles for “COVID,” “SARS,” “pandemic,” “corona,” “COVID-19,” or “SARS-CoV-2,” resulting in a total of 220 articles (3.2 percent). The Kruskal-Wallis test was used to assess Altmetric score and citations for COVID-19–related versus non–COVID-19 articles. For the COVID-19–related articles, we also assessed whether Altmetric score and citations varied by the type of article (commentary, original article, or guidelines), subspecialty of plastic surgery to which the article pertained, and the quarter of the year in which it was published. Despite the pandemic being a hot topic of discussion, the majority (n = 137, 62 percent) of COVID-19–related articles had an Almetric score of zero, meaning they were not disseminated at all on social media, news outlets, or other electronic forms of media. When compared to non–COVID-19 articles, however, COVID-19–related articles had a higher average Altmetric score (2.1 versus 1.4, p < 0.001, Fig. 1). Of the COVID-19–related articles, original articles had higher Altmetric scores as compared to editorials and guidelines (3.8 versus 1.3 and 1.5, respectively, p < 0.001). There was no association between Altmetric score and specialty (p = 0.24) or quarter of publication (p = 0.40).Fig. 1.: Altmetric score by article type. COVID-19–related articles had higher Altmetric scores than non–COVID-19 articles.COVID-19–related articles accrued a total of 247 citations, with an average of 1.1 citations per article, which is higher than the 0.2 citations non–COVID-19 articles accrued (p < 0.001) (Fig. 2). Among the COVID-19–related articles, over 65 percent of articles had zero citations and four articles alone accounted for 24 percent of all citations. Articles published earlier in the year had more citations than those published later (p < 0.001), which is expected as it takes time for articles to accrue citations. There was no association between number of citations and specialty (p = 0.16) or article type (p = 0.27).Fig. 2.: Number of citations by article type. COVID-19–related articles accrued more citations than non–COVID-19 articles.The high levels of interest in the COVID-19 pandemic were reflected in the plastic surgery literature. Altmetric score, a surrogate for interest and influence, was higher for COVID-19–related articles and highest for studies that analyzed original data.1 Impact, as measured by citations, was also higher for COVID-19–related articles, suggesting there was increased discussion among academics about the pandemic and its ramifications on plastic surgery. The impact and influence of the COVID-19 pandemic were felt by the plastic surgery community worldwide and also depicted in the literature. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Hand surgery as subspecialty of plastic surgery among Saudi medical students: is it recognized well?

Hand surgery as subspecialty of plastic surgery among Saudi medical students: is it recognized well?

Machine Learning Demonstrates High Accuracy for Disease Diagnosis and Prognosis in Plastic Surgery.

Introduction:Machine learning (ML) is a set of models and methods that can detect patterns in vast amounts of data and use this information to perform various kinds of decision-making under uncertain conditions. This review explores the current role of this technology in plastic surgery by outlining the applications in clinical practice, diagnostic and prognostic accuracies, and proposed future direction for clinical applications and research.Methods:EMBASE, MEDLINE, CENTRAL and ClinicalTrials.gov were searched from 1990 to 2020. Any clinical studies (including case reports) which present the diagnostic and prognostic accuracies of machine learning models in the clinical setting of plastic surgery were included. Data collected were clinical indication, model utilised, reported accuracies, and comparison with clinical evaluation.Results:The database identified 1181 articles, of which 51 articles were included in this review. The clinical utility of these algorithms was to assist clinicians in diagnosis prediction (n=22), outcome prediction (n=21) and pre-operative planning (n=8). The mean accuracy is 88.80%, 86.11% and 80.28% respectively. The most commonly used models were neural networks (n=31), support vector machines (n=13), decision trees/random forests (n=10) and logistic regression (n=9).Conclusions:ML has demonstrated high accuracies in diagnosis and prognostication of burn patients, congenital or acquired facial deformities, and in cosmetic surgery. There are no studies comparing ML to clinician's performance. Future research can be enhanced using larger datasets or utilising data augmentation, employing novel deep learning models, and applying these to other subspecialties of plastic surgery.

10. Attrition in Academia: Why Does Interest in Craniofacial Surgery, Microsurgery, and Academic Practice Decrease during Plastic Surgery Residency Training?

Body: Background: Many plastic surgery applicants indicate interest in academic subspecialties, such as craniofacial surgery and microsurgery. However, a much smaller percentage of graduating residents pursue academic practice. It is unclear what factors contribute to this shift. By identifying reasons for attrition, training programs may be able to provide support and mentorship opportunities that address these concerns. Methods: In May 2020, a survey was sent to plastic surgery residents nationwide via the American Society of Plastic Surgeons Resident Council. The survey assessed interest in six subspecialties of plastic surgery during their junior years (PGY 1-3) and senior years (PGY4-6), the characteristics of the specialty that contributed to their interest, and if a resident indicated changing interests, reasons for change. Specialties with decreased interest over time were identified. The perceived characteristics of the specialty were analyzed with paired t-tests, and reasons for change were analyzed with two-sample t-tests. Results: Out of 150 senior residents, 60 residents reported changing interests from their junior to senior years. Craniofacial surgery (-63%) and microsurgery (-45%) were identified as the two specialties with the highest attrition of interest. For residents who left craniofacial surgery, job opportunities, preferred practice environment, and compensation were identified as characteristics that contributed to their departure (Table 1). The same characteristics, plus two others (patient population and mentor influence), were identified as significant for those who left microsurgery. Residents who left craniofacial surgery reported finding passion in another specialty, while residents who left microsurgery cited academic responsibilities, work/life balance, and a misalignment of expectations of the specialty with its reality as reasons for change. Conclusion: Plastic surgical subspecialties associated with academia, craniofacial and microsurgery, suffer from resident attrition due to a variety of factors. It is important for program directors and educators to be aware of these trends. Increased retention of trainees in academia, microsurgery, and craniofacial surgery could be improved through dedicated mentorship and exposure to role models, as well as expansion of the role of these specialties as foundational principles to the broader practice of plastic surgery.

Academic Productivity Among Plastic Surgery Subspecialty Fellowship Applicants.

Plastic surgery subspecialty fellowships are highly competitive. Academic productivity is an objective metric that can be used to compare candidates. This study aims to evaluate intersubspecialty differences in academic profiles of plastic surgery fellows. We performed a cross-sectional analysis of the plastic surgery fellows in the United States from 2015 to 2019. We used the San Francisco Match website and individual program websites to obtain details of fellowship programs (microsurgery, aesthetic, hand, and craniofacial) and plastic surgery fellows. Bibliometric data at the time of fellowship application were obtained for each fellow. A total of 235 fellows were included. There was a significant difference in the median number of publications (P = 0.0067) and h-index (P = 0.0229) across subspecialties. Multivariate analysis demonstrated that dedicated research time was predictive for a high publication count (odds ratio [OR], 3.59; P = 0.0007) and h-index (OR, 4.88; P < 0.0001) at the time of fellowship application. Although international residency and aesthetic fellowship application were predictive of a reduced number of publications (OR, 0.17; P < 0.0001, and OR, 0.43; P = 0.0190, respectively), H-index was increased by possession of an advanced degree (OR, 2.00; P = 0.0291) and decreased with international residency (OR, 0.26, P = 0.0021). All plastic surgery fellows have highly qualified academic profiles at the time of fellowship application. Academic productivity differs between subspecialty fellowships. Those wishing to match into competitive subspecialties should consider taking dedicated time for research or attaining an advanced degree.

Certification and Accreditation in Plastic Surgery Subspecialty Training.

Summary:There are multiple subspecialties that residents can pursue after core plastic surgery training, including 5 major fellowship categories: aesthetic, burn, craniofacial, hand, and microsurgery. Hand surgery remains the only plastic surgery subspecialty to date, with a formal accreditation process following fellowship. The purpose of this study was to review the literature regarding the accreditation and match process of plastic surgery fellowship programs, the process of hand surgery certification, and future directions pertaining to certification in other plastic surgery subspecialties.