A Qualitative Survey Study of United States Burn Units: Management of Burn Care and Pathways to a Career in Burn Surgery

Background: The leadership and teams involved in the different aspects of burn care vary greatly by hospital and country.^1-4 With current changes in training requirements, it is important to understand the venues in the United States for a general surgery (GS) and plastic surgery (PRS) resident interested in pursuing a burn surgery career. The aim of this study was to evaluate the current state of leadership and care in burn centers across the United States and the training requirements to secure a burn surgery position.

Methods: A cross-sectional study was conducted between August and September 2017. A 12-question survey was sent to all Burn Unit Directors in the United States. Directors were queried about their training and who manages various aspects of burn care at their respective hospitals, including immediate assessment, airway and ventilation, cardiovascular support, fluid resuscitation, antibiotics, daily critical care, surgical care, and wound care.

Results: A total of 55 responses (47% response rate) were received from Burn Unit Directors. Burn Units are lead most commonly by physicians who received general surgery training (69%), but interestingly the majority either did not undergo fellowship training (31%) or completed a burn surgery fellowship (29%). While surgical care (GS=51%, PRS=42%) and wound care (GS=51%, PRS=42%) were predominantly managed by general or plastic surgery-trained burn teams, management of every other aspect of burn care (ventilation, cardiovascular support, fluid resuscitation, antibiotic therapy, and daily critical care) varied greatly depending on the institution, demonstrating that a shift in burn care management is occurring. This is also reflected in the desired characteristics for recruitment listed by Burn Unit Directors requiring general surgery (67%) or plastic surgery residency (44%), and a burn surgery (55%), trauma surgery (15%), or critical care (44%) fellowship.

Conclusion: Our study demonstrates that while leadership in burn surgery is dominated by general surgery-trained physicians, the surgical and wound care responsibilities are shared among plastic and general surgeons. However, other aspects of burn care have also become increasingly multidisciplinary in nature and are often managed by critical care. Although one third of current Burn Unit Directors did not undergo fellowship training, our study showed that aspiring surgeons are advised to obtain a burn surgery and/or critical care fellowship.

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