J. Silvestre1, I. C. Lin1, L. S. Levin1, B. Chang1 1Perelman School Of Medicine,Division Of Plastic Surgery,Philadelphia, PA, USA
Introduction: Pre-requisite for hand surgery fellowship training in the United States encompass plastic, orthopedic, and general surgery residency training. Recent attention has sought to optimize hand surgery training in the US, and the purpose of this study was to determine the baseline operative experience in hand surgery for these three specialties.
Methods: Operative case log data for chief residents were obtained from the American Council of Graduate Medical Education (2011-2014). Data were grouped by specialty and compared by the number of total hand surgery procedures, fracture repair, soft tissue reconstruction, and digital amputations. Statistics for interspecialty comparisons utilized a one way analysis of variance (ANOVA) with a cutoff of p < 0.05 for significance.
Results: Data were available for 4,355 general surgery, 2,687 orthopedic, and 640 plastic surgery residents. Total number of hand operations by plastic surgery residents increased 13.6% over the study period, and those of orthopedic residents decreased 21.7%. Plastic surgeons reported the most hand cases (372.3 +/- 192) followed by orthopedic (260.3 +/- 120) and general surgery (0.6 +/- 0.1) (p < 0.05). Plastic surgeons performed more soft tissue reconstructions (60.7 vs 45.6) and digital amputations (14.9 vs 6.5) than their orthopedic colleagues (p < 0.05). Orthopedic residents reported more fracture repairs (78.2 vs 44.1, p < 0.05).
Conclusion: Relative to their orthopedic and plastic surgery trained colleagues, general surgery residents lack substantial hand surgery experience. Considerable inter-specialty variability exists regarding the types of hand operations performed during residency. These differences identify areas of strength and weakness prior to hand surgery fellowship training.