American Council of Academic Plastic Surgeons
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Heavy Rotation: Changing Consensus in Integrated Residency Training Program Rotation Schedules
Joseph S. Puthumana, MD; Arya A. Akhavan, MD; Rafael P. Tiongco, BA; Damon S. Cooney, MD, PhD
Carisa M. Cooney, MPH (Co-PI); Scott Lifchez, MD (Co-PI).

Background: As plastic surgery training evolves, ongoing appraisal of the 6-year integrated curriculum is warranted. We performed the current study to describe inter-program variance in structured US plastic surgery curricula.
Methods: In August 2021, we obtained rotation schedules from plastic surgery training program websites. When unavailable, we requested schedules from program coordinators. Individual blocks were each recorded as one of 52 rotations and sorted as follows: led by plastics faculty ("Core Plastics"), hosted by non-plastic surgeons within the scope of plastic surgery ("Off-Service"), and rotations outside the scope of plastic surgery ("General Surgery"). Within these categories further characterization was performed using descriptive statistics.
Results: Of 84 US programs, rotation schedules were obtained for 71.4% (n=60): 50.0% (n=42) listed complete data on their websites, 3.6% (n=3) listed partial data on their websites and provided additional data upon request, 17.9% (n=15) listed no data on their websites and provided data upon request, and 28.6% (n=24) provided no data online or upon request. The most common program structure was the “2+4” model (n=29, 48.3%) followed by the “1+5” (n=16, 26.7%), the combined “3+3” (n=13, 21.7%), and the “0+6” (n=2, 3.3%) models. Overall, programs offered 51.3 (SD±5.5) months of core plastic surgery, 12.4 (SD±4.1) months of general surgery, and 7.8 (SD±2.7) months off-service (Table 1). All programs offered mixed plastic surgery [mean=28.5 (SD±14.2) months] followed by ENT and dermatology. The most common plastic surgery rotations were hand, mixed cosmetics, and craniofacial/pediatrics. Most programs offered either electives [n=31, 2.3 (SD±1.2) months] or research time [n=22, 2.0 (SD±0.9) months]. Many programs offered experience in areas beyond ACGME requirements such as neurosurgery [n=19, 1.0 (SD±0.1) months], thoracic surgery [n=14, 1.0 (SD±0.3) months], and/or urology [n=6, 1.0 (SD±0) months] (Table 1).
Conclusion: Our findings show that >75% of integrated plastic surgery training programs featured a majority (?4 years) of specialty-specific training with only 21.7% continuing the “3+3” model. While many programs provided data upon request, more than half did not include rotation schedules on their websites, potentially influencing competitive candidates’ decisions to apply. Continued transparency around plastic surgery training curricula can help program directors further refine their programs.

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