Perceptions of Preparedness in Plastic Surgery Residency Training

Abstract

Background: Graduating competent surgical residents requires progressive independence during training. Recent studies in other surgical subspecialties have demonstrated overall fewer opportunities for resident independence due to changes in residency regulations, medical–legal concerns, and financial incentives. A survey study was conducted to assess perceived autonomy and preparedness during plastic surgery residency training and to assess factors affecting autonomy. Methods: Anonymous electronic surveys were sent to attending surgeons and residents of all Accreditation Council for Graduate Medical Education accredited programs during the 2017–2018 academic year. Seventy-two integrated and 42 independent plastic surgery programs were surveyed. Analysis of responses was performed using the Fisher exact and chi-square tests. Results: There were 158 attending surgeon and 129 resident responses. The resident and attending surgeon response rates were 11.7% and 16.8%, respectively. Eighty-seven percent of residents felt their operative experience within residency prepared them for practice. Residents felt least prepared in aesthetics and pediatrics/craniofacial surgery. Attending surgeons perceived that they provided residents graduated autonomy throughout residency. Residents identified the complexity of a procedure, attending surgeon supervision, and time constraints as the largest factors influencing resident autonomy. Attending surgeons noted patient safety as the largest deterrent to autonomy. Conclusions: In our study, a majority of plastic surgery residents were found to feel prepared for practice after residency; however, preparedness gaps within training still exist in aesthetic and craniomaxillofacial surgery. Plastic surgery programs must work to develop training programs that simultaneously promote resident autonomy, while prioritizing patient safety, and maintaining productivity and financial well-being.

COVID-19 Did Not Stop the Rising Tide: Trends in Case Volume Logged by Surgical Residents

“… 60 However, there are multiple studies indicating that surgical graduates feel variably prepared for independent professional practice. 61 , 62 , 63 , 64 , 65 Concerns regarding proficiency have linked to increased interest in post-residency clinical fellowships. 65 , 66 Additional operative exposure in a quality teaching environment is inherently beneficial for trainees, and the perceived disruption and impact of the coronavirus pandemic on clinical training and surgeon development, as highlighted in the aforementioned survey-based and qualitative studies of surgical residents, 31 , 33 , 34 , 35 , 37 , 38 , 40 , 41 underscores the extent to which trainees desire operative experience and hands-on training.…”

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

“…According to a 2020 survey of plastic surgery residents and faculty, only 15.1% of residents strongly agreed that they were given enough autonomy during residency to practice in pediatrics/craniofacial surgery. 11 In the same study, attendings reported that the most significant factor associated with reduced resident autonomy was concern for patient outcomes, a concern which is likely even more pronounced when operating on children. It behooves program directors to regularly evaluate the relative exposure of residents to different subspecialties to allow for the development of interest in academically focused subspecialties, and craniofacial surgeons to routinely consider the extent of resident participation in their cases.…”

“…Exposure to craniofacial surgery and pediatric plastic surgery may be more challenging to obtain during residency than other areas of plastic surgery, both due to limited rotations and operative experience during rotations. According to a 2020 survey of plastic surgery residents and faculty, only 15.1% of residents strongly agreed that they were given enough autonomy during residency to practice in pediatrics/craniofacial surgery 11. In the same study, attendings reported that the most significant factor associated with reduced resident autonomy was concern for patient outcomes, a concern which is likely even more pronounced when operating on children.…”

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

“…This is supported by studies that have shown a significant association of lower case volume, or perception thereof, with lower self-reported competence, confidence, and preparedness in those procedures. 11,12 Amidst the backdrop of an increasing movement in both the United States and Canada advocating for a transition toward competencybased standards in plastic surgery GME, there is a real need for effective tools to directly assess technical surgical skills. 13,14 Although a number of such tools exist, the utility of many is hampered by factors such as unestablished validity, reliability, and transferability to clinical practice, as well as high barriers to implementation.…”