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Integrated/Combined vs. Independent Plastic Surgery Training Survey
Kenneth Fan, BS, Jason Roostaeian, MD, Christina J. Tabit, BA, Neil Tanna, MD, MBA, James P. Bradley, MD.
UCLA, Los Angeles, CA, USA.

Purpose: As dictated by the Residency Review Committee for Plastic Surgery(RRC-PS) of the Accreditation Council for Graduate Medical Education(ACGME), several pathways exist for admissibility to the American Board of Plastic Surgery(ABPS) exam(Figure 1).1 The authors aim to differentiate between Combined/Integrated vs. Independent methods of training with regards to quality of trainees and caliber of graduating surgeons, and to evaluate the effectiveness of objective criteria in predicting the outcome of plastic surgery residents.
Methods: To compare Combined/Integrated to Independent residency program training, we conducted: 1) A web-based survey for ASPS members looking at their experience and practice outcomes (n=1056); and 2) Interviews of Plastic Surgery faculty looking at the quality of trainees (n=72). First, member survey was divided into: 1) Background information, 2) Research credentials, 3) Pathway satisfaction, 4) Postgraduation activities, 5) Current practice, 6) Academic affiliation. Second, faculty teacher interviews focused on: 1) Knowledge base, 2) Diagnostic and treatment judgment, 3) Technical abilities, 4) Research capabilities, and 5) Prediction of future career success.
Results: The ASPS member survey showed no difference (p>0.05) between Combined/Integrated vs. Independent trainees towards practice type (cosmetic /reconstructive), practice volume or academic achievements. Combined/Integrated trained surgeons are 3 times more likely to recommend their training pathway (Figure 2) and 2 times more likely to enter fellowship after residency (Figure 3). AOA membership correlated with more likely to have an academic practice at 5 and >10 years, and higher professorship titles. Faculty evaluations showed Combined/Integrated residents were superior in ‘knowledge’ (49% vs 32%) but Independent residents were superior in ‘Technical ability’ (51% vs 20%) and ‘Research’ (57% vs 19%) (Figure 4). Most faculty were unable to choose a pathway producing superior residents.
Conclusions: With regard to future practice outcomes, there was not a superior training pathway. With regard to quality of trainees, there were differences in faculty evaluations but there was no consensus on a better pathway.


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