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Evaluating the Variability of Surgical Education in US Plastic Surgery Training Programs: Is a Competency Based Training Model Feasible?
Anna Schoenbrunner, MD; Adrian Diaz, MD; Matthew Chetta, MD
The Ohio State University
2019-02-10
Presenter: Anna Schoenbrunner
Affidavit:
Anna Schoenbrunner contributed 75% of the work on this project and this project represents the original work of the resident. The remaining authors, Adrian Diaz and Matthew Chetta, equally contributed to the remainder of the project.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
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. 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. Variability was defined as the fold change between the 90th and 10th percentile of cases volumes.
Results
Average case volumes have remained consistent over the study period. The variability between graduating residents has remained large with an average of 2 fold change for total cases between highest and lowest volume graduating residents. Trends and variability for subcategory case logs likewise reflect this variability with a 3.5 fold change in total congenital head and neck cases and a 4 fold change in total free flap cases; a steady increase in volume was noted for both. Minimum requirements are consistently lower than median number of cases logged.
Conclusion
Plastic surgery resident case volumes reflect great variability-a trend that has remained consistent over time. Minimum case requirements ensure breadth of training, but not necessarily competency in training. Graduating residents have widely different operative experiences and this variability in the current training model suggests that a transition to a competency-based model is feasible.
