Do Plastic Surgery Residents Receive Similar Hand Surgery Training?

Purpose: Governing bodies of graduate medical education require standardized training of surgical residents. However, efforts to standardize operative hand experience for plastic surgery residents remain challenging. This study assess the variability of hand surgery cases performed by plastic surgery residents in the U.S.

Methods: National operative case logs of chief residents in plastic surgery were obtained from the Accreditation Council of Graduate Medical Education for 2014. Cumulative hand surgery cases were compared between integrated and independent residents. The number of cases performed by the 10^th and 90^th percentile of residents were compared in each category and fold differences calculated.

Results: There was no significant difference in hand surgery cases performed by integrated and independent residents (399.9 ± 192.0 vs 390.6 ± 145, p = 0.696). Hand reconstruction, tendon procedures, nerve repairs, fracture repair, Dupuytren’s release, nerve decompressions, arterial repairs, and congenital deformity repair did not vary by training pathway (p > 0.05). Independent residents performed more hand reconstructions with skin graft (19.1 ± 14.0 vs 15.3 ± 11.0, p = 0.033). Fold differences in hand surgery experience between residents in the 10^th and 90^th percentiles ranged from 2.5 – 17.5 for both integrated and independent residents and was greatest for arterial repair and arthroplasty (p < 0.05).   

Conclusions: While integrated and independent residents receive similar hand surgery training, significant variation exists within training models. This wide variability is an important issue facing trainees and the general public for creating competent hand surgeons. Ultimately, fellowship training may be a necessary option to provide adequate exposure on the full gamut of hand surgery for plastic surgery graduates.