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Plastic Surgery Resident Operative Performance Trends: How Soon Do Independent Residents Catch Up?

Meyer, Meredith L., MD; Bello, Ricardo J., MD, MPH; Cooney, Damon S., MD, PhD; Rosson, Gedge D., MD; Lifchez, Scott D., MD; Cooney, Carisa M., MPH

Plastic and Reconstructive Surgery – Global Open: September 2017 - Volume 5 - Issue 9S-2 - p e1463
doi: 10.1097/GOX.0000000000001463
ACAPS Abstracts

From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.

Presented at the American Council of Academic Plastic Surgeons 4th Annual Winter Retreat, December 9–11, 2016, Chicago, Ill.

Disclosure: Ms. Carisa Cooney, Dr. Scott Lifchez, and Dr. Damon Cooney are co-inventors of the Operative Entrustability Assessment and co-advisors and equity holders for its parent company, EduMD, LLC, for which Ms. Cooney is the vice president. No other authors have a financial interest in any of the products, devices, or drugs mentioned in this article. The Article Processing Charge for this abstract was paid for by the American Council of Academic Plastic Surgeons.

ACAPS: American Council of Academic Plastic Surgeons (ACAPS) Winter Retreat, in Chicago, Illinois, December 9–11, 2016.

Carisa M. Cooney, MPH, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., JHOC 8161, Baltimore, MD 21287, E-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Many plastic surgery training programs are eliminating their independent training track or transitioning independent positions into integrated ones.1–4 Examining differences between independent and integrated residents may help programs determine the value in maintaining their independent training pathways. This study aimed to differentiate between integrated (PGY4-PGY6) and independent (PGY1-PGY3) plastic surgery residents regarding their operative competency. This comparison evaluates whether any discrepancy exists between independent and integrated residents’ surgical skills during their plastic surgery training and when independent residents catch up if so.

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We compared independent and integrated plastic surgery residents at our institution using operative performance data from the Operative Entrustability Assessment (OEA), a validated assessment tool that provides residents with real-time feedback regarding their operative performance and documents that performance at point-of-care.5 Independent PGY1, PGY2, and PGY3 were categorized as PGY4, PGY5, and PGY6, respectively. We analyzed OEA evaluator scores for the 2 groups over time, using Wilcoxon rank-sum test to compare groups.

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Between September 2013 and October 2016, 2,570 OEAs were completed for PGY4-6 level residents. Of these, 1,389 (54.1%) were logged by independent and 1,181 (46%) by integrated residents. OEA evaluator scores were slightly lower for independent track residents throughout the first 3 quarters of PGY4 (P < 0.001, P < 0.001, and P = 0.029, respectively). However, this difference was no longer statistically significant during the fourth quarter of PGY4 (P = 0.220). As residents progressed in their training, this difference also was not detectable at PGY 5 (P = 0.781) or PGY 6 (P = 0.524) levels.

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OEA data show that independent plastic surgery residents demonstrate slightly lower operative competency than their integrated colleagues during the first 3 quarters of their first year. However, they consistently demonstrate a statistically comparable level of competency after this period. This indicates minimal drawbacks exist in incorporating independent residents with integrated residents in plastic surgery training programs.

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Michael Cohen assisted with data extraction for Operative Entrustability Assessment data. He was not compensated for this contribution. We thank the residents and faculty at the Johns Hopkins School of Medicine Department of Plastic and Reconstructive Surgery in making use of and continuously providing feedback on the Operative Entrustability Assessment.

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1. Charting outcomes in the Match 2005. Available at 2005. Accessed December 8, 2016.
2. Charting outcomes in the Match 2010. Available at 2010. Accessed December 8, 2016.
3. Charting outcomes in the Match 2016. Available at: 2016. Accessed December 8, 2016.
4. Plastic surgery residency Match report. Available at 2016. Accessed December 8, 2016.
5. Cooney CM, Cooney DS, Bello RJ, et al. Comprehensive observations of resident evolution: a novel method for assessing procedure-based residency training. Plast Reconstr Surg. 2016;137:673678.
Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.