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Rare Diseases on the Plastic Surgery In-Service Examination
Nishant Ganesh Kumar, BS1, Brian C. Drolet, M.D.2, Sean Bidic, M.D.3, Scott D. Lifchez, M.D., F.A.C.S.4.
1Vanderbilt University School of Medicine, Nashville, TN, USA, 2Vanderbilt University Medical Center, Nashville, TN, USA, 3American Surgical Arts, Vineland, NJ, USA, 4Johns Hopkins Hospital, Baltimore, MD, USA.

PURPOSE: The Plastic Surgery In-Service Examination (PSITE) is administered annually by the American Society of Plastic Surgeons to comprehensively test residents’ knowledge. In addition, more than 80% of exam participants are practicing surgeons, who take the test as part of continuing medical education. The purpose of this study was to determine the representation of rare diseases tested as part of the comprehensive knowledge on the PSITE.
METHODS: All questions from the 2010 - 2016 In-Service Examinations were reviewed. For each question, the primary diagnosis in the question stem was identified. The diagnosis was defined as rare if it was included in the Genetic and Rare Diseases database produced by the National Institutes of Health.
RESULTS: In total, 1450 questions were analyzed and 159 unique rare diseases were identified. On average, 15.8% of questions from each examination tested a rare disease (range 12.4% - 19.0%). Parry-Romberg disease (n=12), Treacher-Collins Syndrome and compartment syndrome (n=11) appeared most frequently. On section breakdown, the Craniomaxillofacial section had the highest proportion of rare diseases (27.7%) while the Breast and Cosmetic section had the lowest (7.7%).
CONCLUSION: Plastic surgeons frequently encounter rare but important disease processes in clinical practice. Although uncommon, knowledge of such pathology is essential for managing many clinical conditions (e.g., compartment syndrome, necrotizing fasciitis). However, the PSITE may better test residents’ comprehensive knowledge if the proportion of ‘rare disease’ questions better reflects the relative incidence of pathology in clinical practice.


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