From the Division of Plastic Surgery, Department of Surgery, Albany Medical Center; Department of Plastic Surgery, Vanderbilt University Medical Center; and Division of Plastic Surgery, Massachusetts General Hospital.
Plast Reconstr Surg. 2021 Apr 1;147(4):887-893. doi: 10.1097/PRS.0000000000007722.
Hand surgery is a unique subspecialty in which one can train after completion of either a plastic, orthopedic, or general surgical residency. This study compared hand surgery experience in residency among these different training pathways.
The Accreditation Council for Graduate Medical Education case logs of graduating residents in general surgery, orthopedics, and plastic surgery were evaluated for years 2009 through 2018. Cases were grouped according to the Accreditation Council for Graduate Medical Education-defined categories for hand surgery. Comparisons between specialties were made using a one-tail analysis of variance with a 95 percent confidence interval.
There were 19,159 total residents studied: 11,189 general surgery, 7290 orthopedic, and 1040 plastic surgery. General surgery performed the fewest total hand surgeries per individual resident, while plastic surgery performed the most. Plastic surgery performed more operations than orthopedics in all categories studied including tendon, nerve, amputation, soft tissue, fracture, vascular cases, with p < 0.01 for each category.
There are significant differences in the preparation of resident trainees for entry into a hand surgery fellowship, and the lack of uniform exposure to hand surgery represents an opportunity for improvement. Fellowship directors and the tripartite specialty board should embrace the differences among general surgery, orthopedic, and plastic surgery graduates early in the fellowship year and address the expected differences. Trainees' education should be optimized on an individualized basis with targeted education, additional educational courses, and encouraging trainees to seek out clinical challenges to foster their continued professional growth.
手外科是一门独特的亚专科，人们可以在完成整形、骨科或普通外科住院医师培训后进行培训。本研究比较了这三种不同培训途径在手外科住院医师培训中的经验。
评估了 2009 年至 2018 年普通外科、骨科和整形外科住院医师毕业的研究生在研究生医学教育认证委员会的病例记录。根据研究生医学教育认证委员会定义的手外科分类，将病例分为组。使用具有 95%置信区间的单尾方差分析对专业进行比较。
共研究了 19159 名住院医师：11189 名普通外科、7290 名骨科和 1040 名整形外科。普通外科每名住院医师完成的总手部手术数量最少，而整形外科完成的最多。整形外科在所有研究的类别中都比骨科进行了更多的手术，包括肌腱、神经、截肢、软组织、骨折、血管病例，每个类别都有 p < 0.01。
住院医师培训生在进入手外科奖学金培训方面存在明显差异，缺乏统一的手外科暴露机会代表着改进的机会。奖学金主任和三方专业委员会应在奖学金年早期就接受普通外科、骨科和整形外科毕业生之间的差异，并解决预期的差异。应根据个别情况优化学员的教育，提供针对性教育、额外的教育课程，并鼓励学员寻求临床挑战，以促进他们的持续专业成长。
