ࡱ> 685` $jbjb (|c|c$ hjjjjjj, R- TTTT.hT$hTT:@\ FH \ 0R T \TEfficacy of Residency Training Pathways: The Young Plastic Surgeons National Survey C. Scott Hultman, MD; Adam Lowenstein, Rebecca Glasser, Stephanie Rowen, Garrett Wirth Purpose: Plastic surgery training currently includes three different pathways to board certification (independent, coordinated, and integrated models), but the efficacy of each model has not been completely studied. Given the changing environment of prerequisite training (the 80-hour work week, decreasing operative time, and fragmentation of general surgery) and increasing competition from other surgical and medical specialties, the current academic model of plastic surgery training is threatened and will need to evolve.1,2 Furthermore, the American Board of Surgery is actively developing a truncated, three-year core curriculum in surgery, in which post-graduate surgical education is re-organized to serve as a portal for residents who wish to pursue a subspecialty.3 The purpose of this study is to gain the perspective of young, board-certified plastic surgeons, regarding their experience in the transition from residency to practice, and to determine the efficacy of different training models, in terms of preparedness for practice. Methods: We administered a national, web-based questionnaire ( HYPERLINK "http://www.surveymonkey.com" www.surveymonkey.com) to all young (age <46 years old) members of the American Society of Plastic Surgeons (n=1060) in December 2005. 269 surgeons completed the survey, for a response rate of 25.4%. Surgeons who finished an independent pathway (n=206) were compared with surgeons who finished a coordinated or integrated pathway (n=61), using chi-square for statistical analysis, with p values <0.05 considered significant. Results: The strong majority of respondents (71%) recommended that the American Board of Plastic Surgery, in conjunction with the Residency Review Committee, develop and adopt a common pathway for residency training. Furthermore, most respondents (62%) believed that 3 years of dedicated plastic surgery training was needed to adequately prepare residents for the autonomous and competent practice of plastic surgery. The respondents (52%) also felt that 3 years of pre-requisite training, prior to plastic surgery residency, was ideal preparation for their requisite training. Most young plastic surgeons (58%) believe that coordinated or integrated programs are the most effective pathways for residency training. Regarding the demographics of this cohort, over half of the surgeons (51%) were 35-40 years old, 58% had been in practice for 5-9 years, 51% were in solo practice, and 68% practiced primarily reconstructive surgery. In terms of training, 173 surgeons completed a 2-year independent program, 33 completed a 3-year independent program, 25 completed a coordinated program, and 36 completed an integrated program. 39% were board-certified in general surgery, 57% had at least five years of prerequisite training, and 77% had at least 7 years of total training. Despite the fact that 88% of respondents were adequately prepared to enter practice, 57% of surgeons cited deficiencies in their training (cosmetic surgery 90, craniofacial surgery 18, microsurgery 15, congenital hand/wrist/replantation/brachial plexus 1). Fellowships after plastic surgery residency were pursued to gain further training (110), to increase marketability (48), and to correct deficiencies (22). A total of 46% of the respondents completed a fellowship (hand 44, aesthetic 40, microsurgery 32, craniofacial 17, body contouring 4, burn 2, critical care 1). Compared to surgeons who finished a coordinated or integrated program, surgeons who completed the independent pathway were significantly older (> than 40 years of age: 57% vs. 16%, p<0.001), had been in practice longer (>4 years of practice: 72% vs. 52%, p<0.01), were more likely to be double-boarded (56% vs. 15%, p<0.001), cited more deficiencies in training (60% vs. 45%, p<0.05), were less likely to pursue a fellowship (40% vs. 62%, p<0.01), had a longer training period (>6 years of training: 91% vs. 34%, p<0.001), were more likely to recommend the independent pathway (55% vs. 3%, p<0.001), but were equally prepared for practice (87% vs. 93%, NS). Conclusions: Most board-certified, young plastic surgeons support the concept of a single common pathway for residency training. This cohort appears to favor three years of prerequisite training, three years of plastic surgery training, and the opportunity to pursue fellowships, in part to gain further training (in hand or microsurgery) and to correct deficiencies (in cosmetic surgery). References: 1. Karamanoukian RL, Hurvitz K, Evans GRD. Short-track training in plastic surgery. Annals of Plastic Surgery 2006;56:369-372. 2. Stevenson TR. Invited discussion: Short-track training in plastic surgery. Annals of Plastic Surgery 2006;56:373. 3. Personal communication with Richard H. Bell, MD, Professor and Chair, Department of Surgery, Northwestern University, Feinberg School of Medicine; and Assistant Executive Director, American Board of Surgery. 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