Should All Plastic Surgery Residency Programs be Integrated?
“Plastic Surgery Resident Operative Performance Trends: How Soon Do Independent Residents Catch Up?” brings up a question being considered by many residency programs, do we keep our independent program? Our institution, like most, began with an independent model. Five years ago, my co-resident and I were the first to match into the newly created integrated program. Initially, many of the attending surgeons were resistant to the idea. They were accustomed to fully trained and board eligible surgeons. But as integrated residents we were fresh out of medical school, not seasoned surgery residents. We barely knew how to do post-operative orders. Over time though, they realized we weren't completely useless. We were fresh surgeons that they could mold. They wouldn't have to break us of our bad habits. There were many other benefits as well. Despite spending time with all the surgical services, are underlying focus remained on plastic surgery. We were learning plastic surgery from day one and entered our plastic surgery years with a larger plastics knowledge base and technical skill set than our independent counterparts. Now, our program is just awaiting the funding to slowly phase out the independent model and become fully integrated.
This study suggests the advantages of an integrated model only lasts about 9 months as assessed by their evaluation tool, the Operative Entrustability Assessment. After those initial three quarters, the residents scored statistically no different. This would be expected as the tool evaluates operative ability. Independent residents typically begin as fully trained board eligible general surgeons that have developed adept technical skills and are comfortable operating independently. However, another assessment tool, the American Society of Plastic Surgeons In-Service Self-Assessment Examination for Residents, indicates that advantages gained in knowledge base last the entire three years.
The 2017 norm table for the exam is broken down not just by year, but also by program. A 4th year integrated resident that answers 71% of answers correctly scores 65, while a 1st year integrated scores 90. The same score for the final year integrated is 30, but 74 for the independent. This gap widens rather than narrows with progressing years.
Despite the difference of in-service scores, and to the point of the abstract, our program does not differentiate between integrated and independent residents. As the abstract states, “…minimal drawbacks exist in incorporating independent residents with integrated residents…” At our institution, we support this statement. We function as one and the same and are considered interchangeable.
