Plastic Surgery Residency Training Research Articles

Reported Variability in General Surgery Training Across Integrated Plastic Surgery Residency Programs.

Since their development, integrated plastic and reconstructive surgery (PRS) residency training programs have established diverse methods of incorporating general surgery training into graduate medical education. Programs have questioned the necessary duration and timing of such training. The aim of this study is to assess the landscape of general surgery exposure in integrated PRS residency programs. Thirty-six integrated PRS residency programs were included based on the availability of postgraduate year (PGY)-level rotation data. Rotations were measured in units of weeks with descriptive titles maintained as advertised by the program. Individual general surgery rotations were also categorized as being either PRS-aligned, American Board of Plastic Surgery (ABPS) Required Clinical (RC) or ABPS Strongly Suggested (SS). Statistical analyses were carried out on the relative proportions of each subcategory in the 2 parent groups. All 36 programs evaluated required general surgery rotations in years PGY- 1 to -2. By PGY-3, 69% of programs required general surgery, and by PGY-6, 25%, and these were limited to 4- to 6-week rotations in burn, breast, or trauma. Looking across all 6 years, with 312 weeks of training total, the minimum number of weeks spent in general surgery rotations was 32, and the maximum number was 119, with an average of 61 weeks (±21).Programs were subcategorized into 2 groups based on whether they spent more (n = 16) or less (n = 20) than the net average number of weeks in ABPS RC + SS rotations. No significant difference was found in the relative proportion of PRS-aligned general surgery across groups. Programs with <60 weeks of general surgery had a relatively greater proportion of ABPS RC and SS rotations. These data demonstrate that there exists significant variability in overall duration of general surgery training across integrated PRS training programs. When controlling overall general surgery exposure for variables of interest like PRS-aligned exposure or compatibility with ABPS requirements, we found no discernable educational model or patterns to explain the observed range in exposure. These results warrant reexamination of an ideal general surgery track within the integrated plastic surgery training model that optimizes training for the PRS resident.

Comparing Graduating Plastic Surgery Residents' Case Logs With Accreditation Council for Graduate Medical Education Requirements, Content at National Meetings, and In-Service Examination Test Items.

The importance of adaptable and up-to-date plastic surgery graduate medical education (GME) has taken on new meaning amidst accelerating surgical innovation and increasing calls for competency-based training standards. We aimed to examine the extent to which the procedures plastic surgery residents perform, as represented in case log data, align with 2 core standardized components of plastic surgery GME: ACGME (Accreditation Council for Graduate Medical Education) minimum procedure count requirements and the PSITE (Plastic Surgery In-Service Training Examination). We also examined their alignment with procedural representation at 2 major plastic surgery meetings. Nine categories of reconstructive and aesthetic procedures were identified. Three-year averages for the number of procedures completed in each category by residents graduating in 2019-2021 were calculated from ACGME national case log data reports. The ACGME procedure count minimum requirements were also ascertained. The titles and durations of medical programming sessions scheduled for Plastic Surgery The Meeting (PSTM) 2022 and the Plastic Surgery Research Council (PSRC) Annual Meeting 2022 were retrieved from online data. Finally, test items from the 2020 to 2022 administrations of the PSITE were retrieved. Conference sessions and test items were assigned to a single procedure category when possible. Percent differences were calculated for comparison. The distribution of procedures on plastic surgery resident case logs differs from those of the major mechanisms of standardization in plastic surgery GME, in-service examination content more so than ACGME requirements. Meeting content at PSTM and PSRC had the largest percent differences with case log data, with PSTM being skewed toward aesthetics and PSRC toward reconstructive head and neck surgery. The criteria and standards by which plastic surgery residents are evaluated and content at national meetings differ from the procedures they actually complete during their training. Although largely reflecting heterogeneity of the specialty, following these comparisons will likely prove useful in the continual evaluation of plastic surgery residency training, especially in the preparation of residents for the variety of training and practice settings they pursue.

PORTE FOLIO DES COMPETENCES PRATIQUES DU RESIDENT EN CHIRURGIE PLASTIQUE AU MAROC

In Morocco, plastic surgery is a comprehensive specialty that encompasses various domains. The training is lengthy and rigorous, involving residents in a extensive curriculum with both theoretical education and practical hospital training. The study aims to assess residents skills, define mastered procedures, and collect feedback to enhance the quality of education.A secondary objective is to create a portfolio using digital support: https://sites.google.com/view/comptencespratiqueduresident/accueil. To enable residents to track their progress and make informed decisions about their career in plastic surgery. We hope this educational tool will find its rightful place in the training of plastic surgery residents.

Characteristics and academic career outcomes of Godina Fellowship recipients

The American Society for Reconstructive Microsurgery (ASRM) sponsors the Godina Fellowship to expand the careers of talented early career microsurgeons. This study characterizes the scholarly impact and academic career outcomes of Godina Fellows. The ASRM provided a list of Godina Fellows since program inception (1993 – 2020). An Internet based search obtained demographic, academic pedigree, and scholarly impact metrics. Curriculum vitae were reviewed to characterize future career outcomes including academic leadership positions. Of the 28 Godina Fellows, most were men (96%) and from the United States (61%). The average age of selection was 44 ​± ​4 years. Training pedigrees consisted primarily of plastic surgery residency training (93%) followed by orthopedic surgery (3%) and otolaryngology (3%). 32% completed reconstructive microsurgery fellowship training, 25% completed hand fellowship training, and 32% had no sub-specialty fellowship training. A minority of Fellows had a PhD (32%) and Master's Degree (14%). The average h-index was 33 ​± ​11 resulting from 160 ​± ​90 peer-reviewed manuscripts cited 3998 ​± ​2516 times. At the time of selection, Godina fellows had an average of 65 ​± ​42 peer-reviewed manuscripts. Most selected academic careers (79%), including 43% serving as chief of a sub-specialty service line (25%) or chair of a division or department (18%). Godina Fellowship recipients make important contributions to the field of reconstructive microsurgery through research impact and leadership at academic departments.

Hand Surgery Questions on the Plastic Surgery In-service Training Examination: Analysis of Content and References

Background: The Plastic Surgery In-service Training Examination (PSITE) provides residents and faculty with an objective evaluation of hand surgery knowledge during plastic surgery residency training. The purpose of this study was to understand tested hand surgery concepts and references to optimize study efforts during plastic surgery residency. Methods: We reviewed hand surgery questions on 6 consecutive PSITEs (2016-2021). Questions were classified by taxonomy and clinical subject area. Answer references were quantified by source and year of publication. Results: A total of 235 questions tested hand surgery (16% of all PSITE questions) and 60 questions had an associated image (26%). Questions required direct level I—recall (37%), level II—interpretation (28%), and level III—medical decision-making skills (35%). The most frequently tested hand surgery topics were trauma (31%), reconstruction (20%), and functional problems (17%). There were 667 references to 130 unique journals. Journal of Hand Surgery (American volume), 34% and Plastic and Reconstructive Surgery (17%) were the highest yield primary sources. The median lag from publication to PSITE was 7 years (interquartile range, 7 years) with a mode of 2 years. Green’s Operative Hand Surgery was the most referenced textbook (54% of textbook references). Conclusions: This study creates an objective benchmark for hand surgery knowledge training during plastic surgery residency. Efforts focused on the most commonly tested topics and references can enhance resident preparation in hand surgery.

Benchmarking Accomplishments of Presidents Elected to Hand Surgery Societies in the United States

ObjectiveQualifications needed to achieve national leadership positions in hand surgery are poorly defined. This study compares the academic accomplishments, demographics, and training backgrounds of presidents elected to serve the American Society for Surgery of the Hand (ASSH) and the American Association for Hand Surgery (AAHS). MethodsThe ASSH and AAHS provided names of elected Presidents (1990–2022, n = 64). Curriculum vitae and academic web sites were used to collect demographic, training, bibliometric, and National Institutes of Health (NIH) funding data of presidents. ResultsPresidents were predominately male (95%), Caucasian (90%), and orthopaedic surgery residency-trained (66%). Only 9% were racial minorities (8% Asian, 2% Hispanic, and 0% African American). The average age at appointment was 59 ± 7 years old, which was an average of 23 years from completion of hand surgery fellowship. More presidents received plastic surgery residency training in AAHS than ASSH (50 vs. 19%). The most represented hand surgery fellowships were Mayo Clinic (14%), University of Louisville (11%), and Duke University (9%). Twenty-one presidents participated in a travel fellowship (33%). Thirty presidents served as Department Chair or Division Chief at time of election (47%). The average h-index was 34 ± 18 resulting from 164 ± 160 peer-reviewed manuscripts and was similar between the two organizations. Eleven presidents had NIH grant funding (18%) and there were no differences in procurement or funding totals between the two organizations. ConclusionPresidents of American hand surgery societies obtain high levels of scholarly activity regardless of training specialty. Women and racial minorities remain underrepresented at the highest levels of leadership.

In-person, Hybrid, and Virtual Grand Rounds in Plastic Surgery: Impact and Participant Perceptions

Background: Many plastic surgery residency programs adapted to the COVID-19 pandemic by implementing virtual grand rounds. This study aimed to assess the impact of virtual grand rounds and how attendees perceived virtual grand rounds to inform future programmatic planning. Methods: This was a quality improvement initiative involving a cross-sectional survey and retrospective review of administrative records for the 2017–2018 (in-person) and 2021–2022 (virtual) academic years for two academic plastic surgery training programs in Boston, MA. Respondents were residents, fellows, and faculty within the two multisite plastic surgery residency training programs. Results: There were 39 respondents (51% faculty, 41% residents, and 8% fellows). There was no evidence of different preferences for the format of future grand rounds (P = 0.08), with most preferring hybrid, defined as in person for speakers and others who could attend. Most respondents indicated a more accessible learning environment (86.8%) and lack of in-person interaction (82.1%) as reasons for liking and not liking virtual grand rounds, respectively. Excluding outliers, attendance in 2021–2022 was on average 7.4% points greater than that in 2017–2018 (P &lt; 0.001), or six to seven more individuals at each session. There were significantly more out-of-state speakers in 2021–2022 (84%) as compared to 2017–2018 (28%) (P = 0.0008). Conclusions: Virtual grand rounds improved attendance and the geographic diversity of speakers. Attendees preferred a hybrid format for future grand rounds, citing advantages and disadvantages to both in-person and virtual formats.

A 5-Year Analysis of Saudi Arabian Applications to Plastic Surgery Residency Training in Canada

Introduction: The goal of this study is to determine factors associated with acceptance into Canadian plastic surgery (PS) residency programs by Saudi Arabian Medical Graduates. Methods: This is a cross-sectional study targeting eligible Saudi Arabian applicants to any Canadian PS residency program between 2017 and 2022. Collected data included demographics, education/licensure, electives in Canada, and letter of reference. The 2 main outcomes analyzed were “invited for an interview” and “offered a residency position.” Results: We reviewed 52 applications. Of these, 18 applicants received an invitation for an interview and 8 were offered a residency training position. Significant variables associated with receiving an invitation for an interview were completing an elective in Canada ( P = .016), having a master's degree ( P = .012), and completion of an English test ( P = .032). The variables most likely to influence receiving a residency position offer are completion of elective training in Canada ( P = .004) and receiving a letter of reference from a Canadian plastic surgeon (95% CI: 0.77 to 76.69: OR: 8.90). Conclusion: Completion of an elective rotation in Canada and obtaining Canadian letters of reference were found to be the most important factors for Saudi Arabian physician applicants to be accepted into a Canadian PS residency program. Other factors that were less critical but improved their chances of being considered include completion of an English assessment test and having a master's degree. This study offers valuable guidance for any Saudi Arabian candidates interested in PS residency in Canada and may aid Canadian programs in their assessment of potential residents.

Impact of Orthopedic Hand Surgery Fellowship Training on Hand Surgery Cases Performed by Plastic Surgeons in the United States

ObjectiveMultiple pathways exist for hand surgery training in the United States. Plastic surgeons often select Orthopedic Hand Surgery Fellowships to complement their skills and bridge perceived deficiencies in bone and joint cases. This study aims to quantify the impact of this approach on operative hand experience. Materials and methodsCase logs were analyzed for plastic surgery residents and orthopaedic hand surgery fellows (2016–2017 to 2019–2020). Reported hand surgery cases were compared between residency and fellowship using Student’s t-tests. In total, 606 plastic surgery residents and 393 orthopaedic hand surgery fellows were included in this study. One year of Orthopedic Hand Surgery Fellowship training afforded more than twice the volume of hand surgery cases than Plastic Surgery Residency training (886.1 ± 234.7 vs. 428.1 ± 147.2, p < 0.001). ResultsCase categories with the greatest positive fold difference in case volume encountered during Orthopedic Surgery Hand Fellowship were tumor (138.2 ± 63.2 vs. 22.1 ± 11.8, p < 0.001), joint reconstruction (108.7 ± 21.6 vs. 18.8 ± 11.5, p < 0.001), nerve decompression (158.4 ± 63.1 vs. 53.0 ± 32.6, p < 0.001), Dupuytren’s (18.4 ± 10.5 vs. 7.6 ± 6.4, p < 0.001), and fracture management (132.8 ± 21.7 vs. 59.6 ± 24.1, p < 0.001). ConclusionOrthopedic Hand Surgery Fellowship training doubles the operative hand case volume encountered during Plastic Surgery Residency. Significant increases are especially encountered for select case categories including bone and joint cases.

Evaluation of a Plastic and Reconstructive Surgery Resident Non-surgical Cosmetic Clinic Experience

IntroductionAn important component of plastic surgery residency training is independent cosmetic patient management. A resident cosmetic clinic was created at Oregon Health & Science University in 2007 to expand this experience. The cosmetic clinic has traditionally been most successful in offering nonsurgical facial rejuvenation with neuromodulators and soft tissue fillers. This study focuses on the demographics of the patient population and the treatments provided over a 5-year period and compares this experience to those of the same program's attending cosmetic clinics. MethodsA retrospective chart review of all patients seen at Oregon Health & Science University's Plastic and Reconstructive Surgery Resident Cosmetic Clinic between January 1, 2017, and December 31, 2021 was performed. Patient demographics, type of injectable received (neuromodulator versus soft tissue filler), location of injection, and additional cosmetic procedures were evaluated. ResultsTwo hundred patients met the study criteria, which included 114 seen in the resident clinic (RC), 31 seen in attending clinic (AC), and 55 patients seen in both. A primary analysis compared the two groups seen in the resident and attending only clinics. The average age of patients seen in the RC was younger, 45 versus 51.5 (P ≤ 0.05). There was a trend toward more patients in the RC being involved in healthcare as compared to those patients seen in the AC, but this difference was not found to be statistically significant. The median number of neuromodulator visits in the RC was 2 (1, 4) versus 1 (1, 2) in the AC (P ≤ 0.05) The most common location for neuromodulator injections in both clinics was the corrugators. ConclusionsPatients in the resident cosmetic clinic were younger females, most receiving neuromodulator injections. No statistically significant differences were identified in patient population, injections received, and location of injections between the two clinics, indicating a similar trainee skill set and patient care plan between the two clinics.

39. In-person, Hybrid, and Virtual Grand Rounds in Plastic Surgery: Impact and Participant Perceptions

Background: Many plastic surgery residency programs adapted to the COVID-19 pandemic by implementing virtual grand rounds. Little is known regarding the impact of virtual grand rounds, how attendees perceived virtual grand rounds, and how best to implement grand rounds moving forward. Methods: A cross-sectional survey was administered to residents, fellows, and faculty within two multi-site plastic surgery residency training programs as part of a quality improvement initiative. Attendance and speaker characteristics were compared between the 2017-2018 (in-person) and 2021-2022 (virtual) academic years. Hybrid grand rounds were defined as in-person for speakers and others who could attend. Results: There were 39 respondents (51% faculty, 41% residents, and 8% fellows), with a response rate of 67% among those who attended at least one grand rounds in 2021-2022. Most respondents had experience speaking at grand rounds (66.7%) and had experienced grand rounds in-person before the COVID-19 pandemic (76.9%). Between residents/fellows and attendings, there was no evidence of different preferences for the format of future grand rounds (p=0.08), with most preferring hybrid. Most respondents indicated a more accessible learning environment (86.8%) and lack of in-person interaction (82.1%) as reasons for liking and not liking virtual grand rounds, respectively. Excluding outliers, attendance in 2021-2022 was on average 7.4 percentage points greater than in 2017-2018 (p < 0.001), or 6-7 more individuals at each session. Of those present both in 2017-2018 and in 2021-2022 (n = 46), 6 individuals had lower attendance scores in 2021-2022, 7 individuals attended 0 grand rounds in both years, and 33 individuals increased their attendance in 2021-2022, including all but one trainee. There were significantly more out-of-state speakers in 2021-2022 (84%) as compared to 2017-2018 (28%) (p = 0.0008). Conclusion: Virtual grand rounds improved attendance and the geographic diversity of speakers. Attendees preferred a hybrid format for future grand rounds, citing advantages and disadvantages to both in-person and virtual formats. Plastic surgery residency programs should consider hybrid formats for future grand rounds.

Charting Outcomes in the Hand Surgery Fellowship Match

The hand surgery fellowship match attracts applicants from general, plastic, and orthopedic surgery residency training. The purpose of this study was to understand recent trends in applications and match rates in the hand surgery fellowship match. The National Resident Matching Program provided program and applicant data from the hand surgery fellowship match (2012-2020). The primary outcomes of interest were match rates and number of unfilled fellowship positions by specialty. Trends over time and comparisons of the percentage of unfilled spots by specialty were observed. The total number of applicants decreased from 199 to 188 (5.5% decrease), while the number of available positions increased from 150 to 177 (18.0% increase) during the study period. The increase in available positions was driven primarily by orthopedic fellowships, which increased from 124 to 149 (20.2% increase). The percentage of applicants that did not match to a hand surgery fellowship decreased from 24.6% in 2012 to 5.9% in 2020. United States graduates had higher match rates than non-United States graduates during each year, but this disparity narrowed over time. Most applicants matched at one of their top 3 choices (first choice, 33.3%; second choice, 12.9%; third choice, 7.9%). Applicants matching at their first choice increased from 28.1% in 2012 to 39.4% in 2020. Plastic surgery hand surgery fellowships had a higher rate of unmatched positions relative to orthopedic surgery fellowships (6.1% vs 2.2%). Match rates in the hand surgery fellowship match have increased because of an overall increase in training positions and decrease in applicants. More research is needed to understand disparities in match rates by specialty. The diverse training experiences of hand surgeons historically have been viewed as a strength for the specialty. Understanding recent trends in the hand surgery fellowship match by specialty can help future applicants and faculty anticipate likely match outcomes.

Resident Exposure and Involvement in Core Procedural Competencies within Pediatric Plastic Surgery.

Introduction: The implementation of competency-based residency training in plastic surgery is underway. Key competencies in plastic surgery have been previously identified, however, within the domain of pediatrics, data suggest limited exposure throughout training for Canadian graduates. This study aims to identify the exposure and involvement of residents in core pediatric cases. Methods: We performed a retrospective, multicenter review of plastic surgery resident case logs (T-Res, POWER, New Innovations) across 10 Canadian, English-speaking training programs between 2004 and 2014. Case logs were coded according to the 8 core pediatric competencies previously identified by a modified Delphi technique. Results: A total of 3061 of 59 405 cases (5.2%) logged by 55 graduating residents were core pediatric procedures with an average of 55.6 ± 23.0 cases logged per resident. The top 3 most commonly logged procedures were cleft lip repair, cleft palate repair, and setback otoplasty. The number of cases per program varied widely with the most at 731 and least at 85 logged cases. Roles across procedures have wide variation and residents are most commonly identified as the assistant rather than surgeon or co-surgeon. Conclusion: These findings highlight variability both within and across residency programs with a paucity of exposure and involvement in pediatric plastic surgery cases. This may present a conflict between current recommendations for residency-specific procedural competencies and true clinical exposure. Further curriculum development and simulation may be of benefit.

60. Training a Plastic Surgeon: The Cost of Residency and its Implications

Purpose: Developing and maintaining a surgical residency program entails significant financial obligations. The costs associated with plastic surgery residency training and accreditation by regulatory bodies are yet to be delineated. This study seeks to explore the costs associated with plastic surgery residency training as mandated by the American Council of Graduate Medical Education (ACGME) and the American Board of Plastic Surgery (ABPS). We aim to elucidate potential areas for improvement and innovation of funding resources to ensure the continuation and growth of proper plastic surgery training. Methods: Cost-associated mandates per the 2020 ACGME and ABPS booklet were identified. These costs were separated into labor, opportunity, and fixed costs. Calculations reflected the minimum cost of training two plastic surgery residents, which is an estimate of the average number of residents per year per program from 2017-2021, according to the National Residency Match Program Data. Salaries were based on data from the Association of American Medical Colleges. Relevant costs reflected data from our department and institution. Results: Our calculations demonstrated a minimum cost of $472,519 to train two residents per year in accordance with the ACGME and ABPS mandates, with an average cost of $236,260 per resident. This includes labor, opportunity, and fixed costs. Labor costs totaled $279,560 with resident salary being the highest contributor ($128,000). Opportunity costs were the highest cost category at $176,529, of which the cost of grand rounds ($120,238) was the highest contributor. Fixed costs were the lowest ($16,430) with the highest contributor being ABPS-required costs for board certification ($8,490). In order to reflect the financial spectrum between large and small programs, we adapted our calculations to estimate costs of one ($367,427) and five ($763,687) residents per year. Conclusion: Training future plastic surgeons is associated with significant direct and indirect financial costs. Plastic surgery represents an essential field in healthcare, and we hope that by providing cost estimates for resident education, the medical community may continue to think creatively about alternative funding sources to ensure continued quality training that meets the nation’s needs.

Impact of the COVID-19 Pandemic on the Wellness of Canadian Plastic Surgery Residents.

Background:On top of preexisting burnout, depression, and anxiety among trainees, the COVID-19 pandemic has introduced novel stressors. The objectives of this study were to determine the effects of the COVID-19 pandemic on Canadian plastic surgery residents’ practice, wellness, and overall training.Methods:Surveys for program directors and residents were created and disseminated to all English-speaking Canadian plastic surgery residency training programs. Survey results were pooled and presented as a percentage of responses for each question.Results:Response rates were 50% (n = 5/10) and 25% (n = 19/77) for program directors and residents, respectively. All program directors believed that the pandemic has a negative effect on resident wellness, 80% (n = 4/5) of which believed that their residents were coping effectively. They rated program support for resident wellness as neutral or supportive. Most programs (80%; n = 4/5) introduced strategies to support resident well-being. Most trainees (84%; n = 16/19) reported the pandemic as having a negative effect on their well-being, with approximately 50% endorsing worse emotional, social, psychological, and physical wellness, as well as feelings of burnout. Some reported difficulties coping (21%; n = 4/19). Residents felt that their wellness was supported externally by their own resilience (89%; n = 17/19), family members (74%; n = 14/19), friends (74%; n = 14/19), their partner (68%; n = 13/19), or co-residents (53%; n = 10/19). Internal support by their program was rated as neutral or negative (63%; n = 12/19).Conclusions:Our findings of negative effects of the COVID-19 pandemic on the wellness of Canadian plastic surgery trainees are concerning. Programs must implement appropriate identification and support strategies to improve resident well-being.

Routes to Residency: A National Survey Demonstrating the Pathways to Become a Plastic Surgeon.

Background:Plastic and reconstructive surgery (PRS) residency training can be completed through multiple pathways. Current residents’ experiences regarding these different routes have not been previously described. The objective of the present study was to describe the educational pathways taken by current PRS residents in the United States. We hypothesized that there would be a small cohort of current PRS residents who were initially unsuccessful in matching into an integrated residency.Methods:An online survey was sent to PRS residents across all training years from October 2020 to January 2021. The survey collected information about residents’ match history, experience after not matching, and narrative comments on their route to residency. Public match data from the past 20 years (2001–2021) were also summarized with descriptive statistics.Results:One hundred seventy-four residents responded (response rate 15%; 174/1158). Of these, 133 applied to integrated programs as senior medical students, and 15 (11%) did not match after applying as a senior medical student. Unmatched applicants took multiple different routes to PRS, including participating in the Supplemental Offer and Acceptance Program, reapplying, transferring after some general surgery training, and completing an independent PRS residency. Three-fourths (76%) of independent program residents did not originally apply to the integrated match.Conclusions:An initial unsuccessful match result does not portend that one will not be able to train for a career in PRS. Our findings illustrate the potential routes to successful completion of PRS residency training, both for unmatched applicants and residents who develop later interest in PRS.

A Systematic Review on the Implementation and Educational Value of Resident Aesthetic Clinics.

Resident aesthetic clinics (RACs) provide plastic surgery residents with hands-on aesthetic surgery training. Although RACs have demonstrated successful surgical outcomes without compromising patient care, few studies have evaluated the efficacy or educational value of RACs to increase resident confidence and competence in procedures. In addition, clinic structures vary widely among institutions, with each clinic offering a unique patient volume, caseload, and degree of resident autonomy that impacts the clinic's educational value. This systematic review identifies existing RAC practices, compares clinic structures, and proposes a curriculum framework to maximize educational value for residents. Following PRISMA guidelines, we performed a systematic review of plastic surgery residency training program RACs. We queried PubMed, Embase, and Web of Science from January 2000 to April 2020. Eligible articles were original articles that discussed RAC structure and educational value. Data abstracted included details on clinic structure (eg, volume, location, cost, clinic operations) and trainee-perceived educational value (eg, resident satisfaction, resident confidence in procedures). Of 1199 identified publications, 10 met the inclusion criteria: 6 single-site studies and 4 national survey studies. Among the single-site studies, annual volumes ranged from 22 to 68 patients/year and 35 to 81 cases/year. Resident aesthetic clinics were all staffed by full-time academic faculty (100%); one-third also were staffed by adjunct faculty and 17% also by community plastic surgeons. Resident involvement varied by hours in clinic and degree of autonomy. The survey studies found that RACs increase resident confidence and competence in performing aesthetic procedures and identified critical challenges to RAC implementation (eg, financial viability, continuity of care) that limited RAC educational value. Based on this review's findings, we propose a 6-step RAC curriculum framework for training programs seeking to establish an RAC and maximize the clinic's educational value. Resident aesthetic clinics are increasingly important for providing plastic surgery residents with aesthetic training. Patient and case volume, degree of resident autonomy, and clinic attending physicians are critical determinants of the educational value of RACs. We hope our findings can aid plastic surgery training programs in better organizing educational and sustainable RACs.

A national needs assessment to identify technical procedures in plastic surgery for simulation-based training

Medical simulation is not developed and integrated into plastic surgery unlike other surgical specialties despite the procedures being complex and require practice. First step in enhancing simulation in plastic surgery is to clarify the need among peers. The objective of the study was to identify and prioritize the technical procedures that should be included in a simulation-based curriculum for residency training in plastic surgery. A panel of participants with key roles in the Danish plastic surgery specialist training program was appointed. Participation was voluntary. A national need assessment study was performed using a three-round Delphi process to collect information from the participants. In round 1, participants reported all the procedures that a newly qualified specialist in plastic surgery should be able to perform. In round 2, participants replied to a survey exploring the frequency of the procedures, the number of surgeons performing the procedure, the risk or discomfort for patients treated by an inexperienced surgeon and the feasibility of training the procedure in simulation, resulting in a preliminary ranking of procedures. In round 3, participants eliminated and reprioritized the identified procedures according to importance. Thirty-five of 37 agreed to enter the expert panel. The response rate was 97%, 86% and 86% for rounds 1, 2 and 3, respectively. Twenty-nine of 136 procedures identified in round 1 reached the final prioritized list of procedures relevant for simulation training in plastic surgery.

Residency Training and Hand Surgery Practice Patterns: A National Surgical Quality Improvement Program Database Analysis

Introduction Fellowship-trained hand surgeons may have residency training in either orthopedic, plastic, or general surgery, generating significant variability in education background. To study the effect of different training backgrounds on practice pattern variations, we utilized the NSQIP (National Surgical Quality Improvement Database) database to assess hand surgery volumes and case variety by specialty.Materials and Methods NSQIP years 2008 to 2017 was queried with hand surgery current procedural terminology codes defined by the American Board of Orthopedic Surgery. Procedures were grouped according to type and specialty, and relative rates calculated. Hand society membership data were used to determine if procedural volume for each specialty in each category and overall contribution to the volume of hand surgery performed nationally was distributed in accordance with membership data.Results A total of 145,015 hand surgeries were performed; 13,267 (9.1%) by general surgeons, 28,402 (19.6%) by plastic surgeons, and 103,346 (71.3%) by orthopedic surgeons. Orthopedic surgeons performed significantly more bone, fracture, joint, and tendon cases. General surgeons and plastic surgeons performed higher than expected numbers of soft tissue coverage and cases overall with respective excesses of 183 and 22%.Conclusion Hand surgery is an available fellowship pathway from multiple residencies. Fellowship training does not level the field of real-world practice patterns. Residency training experiences significantly impact practice.

Frontline Reporting from the Epicenter of a Global Pandemic: A Survey of the Impact of COVID-19 on Plastic Surgery Training in New York and New Jersey.

Since the first documented case of coronavirus disease of 2019 (COVID-19), the greater New York City area quickly became the epicenter of the global pandemic, with over 500,000 cases and 50,000 deaths. This unprecedented crisis affected all aspects of health care, including plastic surgery residency training. The purpose of this study was to understand the specific impact of the COVID-19 pandemic on plastic surgery residencies. A survey of all plastic surgery residency training programs in the greater New York City area was conducted. The impact to training during the peak months of infection (March and April of 2020) was evaluated using resident education as measured by case numbers, need for redeployment, and staff wellness as primary outcome variables. A total of 11 programs were identified in the region, and seven programs completed the survey, with a response rate 63.6 percent. When comparing productivity in March and April of 2019 to March and April of 2020, a total decrease in surgical volume of 64.8 percent (range, 19.7 to 84.8 percent) and an average of 940 (range, 50 to 1287) cancelled clinic visits per month were observed. These decreases directly correlated with the local county's COVID-19 incidence rates (p = 0.70). A total of 83 percent of programs required redeployment to areas of need, and correlation between local incidence of COVID-19 and the percentage of residents redeployed to non-plastic surgical clinical environments by a given program (ρ = 0.97) was observed. As the first COVID-19 wave passes the greater New York area and spreads to the rest of the country, the authors hope their experience will shed light on the effects of the ongoing COVID-19 pandemic, and inform other programs on what to expect and how they can try and prepare for future public health crises.