Evaluating the Variability of Surgical Education in US Plastic Surgery Training Programs: Is the Current Model Sufficient or Redundant?
Anna Schoenbrunner, MD, MAS1, Adrian Diaz, MD, MPH2, Matthew Chetta, MD1 1The Ohio State University Department of Plastic and Reconstructive Surgery 2The Ohio State University Department of Surgery
Background: The Accreditation Council for Graduate Medical Education (ACGME) provides minimum case requirements to ensure that graduates acquire the skills to safely care for patients. We analyzed trends and variability in plastic surgery case volumes as programs transitioned from an independent/combined model (ICM) to an integrated model (IM). We used this information to comment on the utility of current ACGME minimum case requirements and the feasibility of transitioning to a competency based training model.
Methods: The ACGME Plastic Surgery Operative Log database was used to obtain data on graduating resident case volumes between 2008-2018. Data on total reconstructive and subcategory cases were analyzed. Trends in average case volumes and standard deviations were compared between ICM (2008-2011) and with the introduction of the IM (2011-2018). Variability was defined as the fold difference between the maximum and minimum number of cases per year.
Results: Average case volumes have remained largely consistent over the study period between ICM (1341.6 cases/year) and IM (1508.1 cases/year) (Fig. 1). The variability between graduating residents has remained large with an average of 2.9 fold difference between programs with the highest and lowest case volumes. This variability has decreased over time (ICM=3.4 fold vs IM=2.8 fold). Trends for subcategory case logs reflect this great variability: microsurgery (23.9 for ICM vs 15.2 for IM), cleft lip (44.0 for ICM vs 8.24 for IM), cleft palate (19.3 for ICM vs 11.6 for IM), hand and upper extremity (7.3 for ICM vs 5.9 for IM), and head and neck trauma (8.9 for ICM vs 7.6 for IM). Minimum requirements have remained relatively consistent despite the transition to the IM.
Conclusion: Graduating plastic surgery resident case volumes reflect great variability between programs—a trend that has remained relatively consistent despite transitioning from the ICM to the IM. These data reveal a need to reevaluate whether the required case minimums truly reflect the volume threshold to achieve competency for the average trainee, or whether the current model allows for redundancy. Plastic surgery training could be improved by identifying educational needs based on trainee competency and customizing operative experience within program specific opportunities.
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