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. 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 (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.

Results: Regarding demographics, 51% of surgeons 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, 77% had at least 7 years of total training, and 46% completed a fellowship (hand 44, aesthetic 40, microsurgery 32, craniofacial 17, body contouring 4, burn 2, critical care 1). Fellowships were pursued “to gain further training” (110), “to increase marketability” (48), and “to correct deficiencies” (22). 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). Compared to surgeons who finished a coordinated or integrated program, surgeons who completed the independent pathway were significantly older, had been in practice longer, were more likely to be double-boarded, cited more deficiencies in training, were less likely to pursue a fellowship, had a longer training period, were more likely to recommend the independent pathway, but were equally “prepared for practice.” However, 71% of respondents recommended that the American Board of Plastic Surgery, in combination with the Residency Review Committee, should develop and adopt a common pathway for residency training. 52% of surgeons recommended 3 years of prerequisite training, and 62% recommended 3 years of plastic surgery requisite training. 42% of respondents believe that independent programs are the most effective pathway for residency training.

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).