Purpose: Increasing life expectancy of Americans, coupled with the general increase in population, suggest that we will have an expanding population of elderly patients for whom to provide health care. This study was undertaken specifically to identify educational needs for plastic surgery residents at our institution regarding the care of elderly patients.

Methods: A focus group on learning needs in caring for older adults was conducted and transcribed with a volunteer, representative sample of University of Michigan Plastic Surgery residents.  Three investigators independently reviewed the transcript, using a “concept identification” technique to form distinct “codes.”  Codes consisted of brief phrases that characterized the content of resident statements.  Each investigator independently organized the codes within the context of the six general competencies of the Accreditation Council for Graduate Medical Education (ACGME), using a best-fit method.  Inter-rater agreement was assessed by raw agreement, kappa and interclass correlation.  The codes were next analyzed to determine whether they reflected an area of educational need, demonstrated residents felt they already had adequate understanding in this area, or it was not explicit. 

Results: Eight plastic surgery residents participated in the focus group.  Each investigator independently coded between 115 and 120 concepts.  After discussion, the investigators agreed on one set of 118 codes, categorized by ACGME competency.  Raw agreement (82-90%) and kappa (0.846 and 0.878) were excellent.   Agreement between all three judges using interclass correlation was also excellent (0.855).  Educational need was explicit in 89 (75%) of the concepts coded and implied in another 13 (86% total).  The highest number of codes were noted in the areas of medical knowledge, and interpersonal and communication skills and the lowest number in professionalism.

Conclusion: The perceptions of our residents are consistent with the views of the American Geriatrics Society that a more formal education is necessary in graduate surgical education to adequately prepare for the challenges of plastic surgery in the future.  The realm of medical knowledge related to safe and effective perioperative care and patient selection was identified as the area of greatest need.  The concept coding technique is a useful tool for qualitative and quantitative analysis of focus group results, and facilitates segregation of the identified concepts within the context of the ACGME competencies.