Purpose: Phase III of the ACGME Outcome Project calls for residency programs to use external measures to verify outcomes and make “data-driven improvements” to their curricula. Within plastic surgery, few such measures have been employed beyond the written and oral board examinations, which primarily assess medical knowledge and some elements of patient care. Within the remaining competencies data regarding the quality of plastic surgery education are lacking. Recent plastic surgery graduates have a keen sense of strengths and deficiencies of their preparation for independent practice, making them an excellent source of information regarding the effectiveness of plastic surgery training. The purpose of this study was to determine how well we presently teach and assess plastic surgery residents within the context of the general competencies. Our goals were to generate a needs assessment to drive curriculum change, determine which assessment tools are currently used during training, and establish a baseline for future comparison for program evaluation.

Methods: A survey was conducted by mail and online questionnaire. A new 68 item instrument was created, piloted and revised. The population of interest was plastic surgeons within six years of completion of training. A sample was drawn by contacting training programs for names of recent graduates and all names from the ASPS roster marked candidate. Within the context of the competencies, subjects were queried regarding the presence of formal curricular elements pertinent to each competency in their traiing and which assessment tools were used. Subjects were further questioned about their current practice habits, to determine whether their training was effective in preparing them for practice. Responses were via a five-point Likert scale. Composite scores were generated for each competency. Subjects were also given the opportunity to make open comments. Statistical analysis was descriptive, with Chi Square, Student's t-test and ANOVA used to evaluate differences in responses across various demographics, including gender, year of graduation, type of training, patient mix and practice type. Significance was determined at p<0.05.

Results: 742 questionnaires were disseminated via mail or online. The response rate was 19%, and 165 surveys that met inclusion criteria were analyzed. Respondents felt that all the competencies are important to plastic surgery training, although not unanimously for systems-based practice (SBP). By gestalt, graduates felt their training was strongest in patient care (PC) and weakest in SBP. Composite scores from survey items regarding their training and practice supported their opinion that SBP is an area of weakness. Contrary to opinion, however, practice-based learning and improvement (PBLI) was implicated as best taught and interpersonal and communications skills (ICS) as best practiced. The PSEF In-Service Examination and verbal feedback were the most commonly used assessment tools. Global rating scales and oral examinations were used to a lesser extent and other assessment tools only rarely. Composite scores for the competencies did not differ across any demographics. There were significant differences between integrated and independent graduates' responses to a few individual items within PBLI, SBP and professionalism (PRO). A few items within PRO, ICS and SBP generated overall negative responses about the quality of training from all respondents. Open comments suggest some confusion about the purpose and value of the competencies, and alarming conditions at a few training programs.

Conclusions: Overall, plastic surgery training is judged as excellent, but there are areas for improvement. SBP deserves the greatest curricular attention, while PBLI appears well taught and ICS well practiced. Graduates' perceptions of quality of training may not always correlate with objective evidence from their training programs or their practices. We must expand our use of assessment tools to achieve a richer measure of competency in our graduates. The value of the competencies is not universally understood or accepted in plastic surgery. In particular, there is controversy whether SBP is the duty of training programs. Further public education regarding the competencies is warranted. These results may serve as a baseline by which to measure the effectiveness of future curriculum changes.
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