Patel Niyant, Dittakasem Kanlaya, Fearon Jeffrey A
Akron, Ohio; and Dallas, Texas From the Craniofacial Clinic and Plastic and Reconstructive Surgery Center at Akron Children's Hospital; the Medical City Children's Hospital; and The Craniofacial Center.
Plast Reconstr Surg. 2015 May;135(5):1454-1460. doi: 10.1097/PRS.0000000000001061.
The authors sought to evaluate current craniofacial training in the United States to achieve perspective on changes over time and to gain insights into possible process improvements.
Following a review of the San Francisco Match listings and an Internet search, an anonymous online survey invitation was sent to all fellows finishing in 2013.
Thirty-three fellows were identified in 29 listed programs and 30 responded (91 percent). All had completed plastic surgery training. A mean caseload of 380 cases (95 percent CI, 307 to 452) was reported. Case analyses permitted subclassification of fellowships into five areas of relative strengths: cleft/intracranial/midface, 35 percent; cleft/general pediatrics, 20 percent; cleft/adult plastics, 20 percent; cleft/facial trauma, 15 percent; and adult plastics/facial trauma, 10 percent of programs. Eighty-six percent were residency-type programs, whereas only 14 percent remained apprenticeships. Fellows cited confidence in any procedure following participation in more than 12 cases, but 20 percent reported not feeling adequately trained following fellowship. Over half (52 percent) thought training could be improved by establishing core areas of exposure and case category minimums.
Fellowships identified as "craniofacial" are actually fairly heterogeneous, offering diverse clinical experiences. Currently, only a minority emphasize traditional cleft, intracranial, and midfacial procedures, with the majority focused more on cleft care, general pediatric plastic surgery, and trauma. Concomitant with an increase in fellowship-trained surgeons has come a change in program structure from apprenticeships to residency-type models. Prospective fellows should consider matching their individual training goals with each program's unique clinical strengths.
作者试图评估美国目前的颅面外科培训情况，以了解其随时间的变化，并深入了解可能的流程改进。
在审查旧金山匹配列表并进行互联网搜索后，向所有2013年毕业的学员发送了匿名在线调查邀请。
在29个列出的项目中确定了33名学员，30人回复（91%）。所有人都完成了整形手术培训。报告的平均病例数为380例（95%可信区间，307至452）。病例分析允许将奖学金分为五个相对优势领域：唇腭裂/颅内/面中部，35%；唇腭裂/普通儿科，20%；唇腭裂/成人整形，20%；唇腭裂/面部创伤，15%；成人整形/面部创伤，10%的项目。86%是住院医师类型的项目，而只有14%仍然是学徒制。学员们表示，参与超过12例手术后对任何手术都有信心，但20%的人报告在奖学金培训后感觉训练不足。超过一半（52%）的人认为通过确定核心暴露领域和最低病例类别可以改进培训。
被认定为“颅面外科”的奖学金实际上相当多样化，提供了不同的临床经验。目前，只有少数项目强调传统的唇腭裂、颅内和面中部手术，大多数项目更多地关注唇腭裂护理、普通儿科整形手术和创伤。随着接受奖学金培训的外科医生数量的增加，项目结构也从学徒制转变为住院医师类型的模式。未来的学员应考虑将个人培训目标与每个项目独特的临床优势相匹配。
