From the Division of Plastic Surgery, Stony Brook University, Stony Brook, NY.
School of Medicine, University of California Riverside SOM, Riverside, CA.
Ann Plast Surg. 2024 Apr 1;92(4):457-462. doi: 10.1097/SAP.0000000000003837.
Since their development, integrated plastic and reconstructive surgery (PRS) residency training programs have established diverse methods of incorporating general surgery training into graduate medical education. Programs have questioned the necessary duration and timing of such training. The aim of this study is to assess the landscape of general surgery exposure in integrated PRS residency programs.
Thirty-six integrated PRS residency programs were included based on the availability of postgraduate year (PGY)-level rotation data. Rotations were measured in units of weeks with descriptive titles maintained as advertised by the program. Individual general surgery rotations were also categorized as being either PRS-aligned, American Board of Plastic Surgery (ABPS) Required Clinical (RC) or ABPS Strongly Suggested (SS). Statistical analyses were carried out on the relative proportions of each subcategory in the 2 parent groups.
All 36 programs evaluated required general surgery rotations in years PGY- 1 to -2. By PGY-3, 69% of programs required general surgery, and by PGY-6, 25%, and these were limited to 4- to 6-week rotations in burn, breast, or trauma. Looking across all 6 years, with 312 weeks of training total, the minimum number of weeks spent in general surgery rotations was 32, and the maximum number was 119, with an average of 61 weeks (±21).Programs were subcategorized into 2 groups based on whether they spent more (n = 16) or less (n = 20) than the net average number of weeks in ABPS RC + SS rotations. No significant difference was found in the relative proportion of PRS-aligned general surgery across groups. Programs with <60 weeks of general surgery had a relatively greater proportion of ABPS RC and SS rotations.
These data demonstrate that there exists significant variability in overall duration of general surgery training across integrated PRS training programs. When controlling overall general surgery exposure for variables of interest like PRS-aligned exposure or compatibility with ABPS requirements, we found no discernable educational model or patterns to explain the observed range in exposure. These results warrant reexamination of an ideal general surgery track within the integrated plastic surgery training model that optimizes training for the PRS resident.
自发展以来，综合整形外科学（PRS）住院医师培训计划已经建立了将普通外科培训纳入研究生医学教育的多种方法。项目已经质疑了这种培训的必要持续时间和时间安排。本研究的目的是评估综合 PRS 住院医师培训计划中普通外科暴露的情况。
根据研究生年级（PGY）水平的轮转数据的可用性，纳入了 36 个综合 PRS 住院医师培训计划。轮转以周为单位进行衡量，并保留了计划公布的描述性标题。个别普通外科轮转也分为 PRS 相关、美国整形外科学会（ABPS）规定的临床（RC）或 ABPS 强烈建议（SS）。对 2 个母组中每个子组的相对比例进行了统计分析。
所有 36 个评估的计划都要求在 PGY-1 至 -2 年级进行普通外科轮转。到 PGY-3 时，69%的计划需要普通外科，到 PGY-6 时，只有 25%，并且这些轮转仅限于烧伤、乳房或创伤的 4 至 6 周轮转。纵观所有 6 年，共培训 312 周，普通外科轮转的最短周数为 32 周，最长周数为 119 周，平均 61 周（±21）。根据是否轮转多于（n=16）或少于（n=20）ABPS RC+SS 轮转的平均净周数，将计划分为 2 组。在这两个组之间，PRS 相关的普通外科的相对比例没有显著差异。普通外科轮转少于 60 周的计划，ABPS RC 和 SS 轮转的比例相对较大。
这些数据表明，综合 PRS 培训计划中普通外科培训的总持续时间存在显著差异。当控制对 PRS 相关暴露或与 ABPS 要求的兼容性等感兴趣变量的整体普通外科暴露时，我们没有发现可以解释所观察到的暴露范围的明显教育模式或模式。这些结果值得重新审视综合整形外科学培训模式中的理想普通外科轨道，以优化 PRS 住院医师的培训。
