J. Silvestre1, B. Chang1, L. S. Levin1 1Perelman School Of Medicine,Division Of Plastic Surgery,Philadelphia, PA, USA
Introduction: Surgical residents in the United States receive unique hand surgery training yet these differences are poorly defined in the literaure. The purpose of this study was to compare didactic hand surgery training for orthopedic and plastic surgery trainees.
Methods: Digital syllabi of the Plastic Surgery In-Service Training Exam (PSITE) and Orthopedic In-Training Exam (OITE) were analyzed for hand surgery content (2009-2013). Content outlines for the American Board of Surgery In-Training Examination (ABSITE) were analyzed because syllabi are unpublished. Topics were categorized via the content outline for the Surgery of the Hand (SOTH) Exam. Differences were elucidated via Fisher’s test and presented as means ± standard error of mean.
Results: The ABSITE had no content specific to hand surgery. Relative to the OITE, the PSITE had greater hand representation (20.3% versus 8.1%, p < 0.001) with more yearly hand questions (40 ± 3 vs 24 ± 2, p < 0.001). PSITE questions were longer, less often level I-recall type, and less often image-based. PSITE questions focused more on finger and hand/palm anatomy, whereas OITE questions were more wrist-based. The PSITE emphasized wound management and muscle/tendon injuries, but underemphasized fractures/dislocations. References differed, but Journal of Hand Surgery (American) and Green’s Operative Hand Surgery were overwhelmingly represented on both exams. The PSITE had a greater publication lag for journal references (10.7 ± 0.5 years vs 9.0 ± 0.6, p = 0.035).
Conclusion: Hand surgery is under-represented on the ABSITE. Differences in plastic surgery and orthopedic hand training may account for the differences in passage rates of the SOTH Exam. These data may assist educators in optimizing hand surgery training in the United States.