Toward the Assessment of Core Procedural Competencies among Canadian Plastic Surgery Residents

Abstract

Background: Plastic surgery residency training programs are working toward integrating competency-based education into program curriculum and training, a key component of which involves establishing core procedural competencies. This study aims to determine the exposure of graduating Canadian plastic surgery residents to established core procedural competencies. Methods: A retrospective review of case log procedure data using three databases (T-Res, POWER, and New Innovations) from graduating residents at all 10 Canadian English-speaking plastic surgery training programs between 2004 and 2014 was completed. Case logs were coded according to 177 core procedural competencies identified as “core” by the Delphi method among an expert panel of Canadian plastic surgeons. Results: A total of 59,405 procedures were logged by 55 graduating residents across Canada between 2004 and 2014 (average, 1080 ± 352 procedures per resident). Of 13 plastic surgery domains, 44 percent of all procedures were within either hand, upper extremity, and peripheral nerve (28.3 percent) or nonaesthetic breast (16.1 percent). The most frequently performed core procedural competencies (average case logs per resident) included breast reduction (65.3 ± 33.9); open carpal tunnel release (46.7 ± 34.2); breast reconstruction, implant-based (39.6 ± 20.5); and wound management (35.7 ± 28.6). Sixty-two of 177 procedures were logged on average less than once in 5 years of residency, including escharotomy, temporal parietal fascia flap, Guyon canal release, and soft-tissue fillers. Conclusion: This study identifies areas of exposure and underexposure to plastic surgery core procedural competencies, and can help focus surgical education on areas of greater need for surgical skills training and acquisition.

Resident Exposure and Involvement in Core Procedural Competencies within Pediatric Plastic Surgery

“…14 Largely, residents have the most exposure within the domains of hand and nonaesthetic breast. 10 However, when looking across all domains of plastic surgery and all levels of training, pediatrics had the fewest number of logged cases. 10 Few studies have investigated pediatric operative experiences of residents, specifically in plastic surgery.…”

“…10 However, when looking across all domains of plastic surgery and all levels of training, pediatrics had the fewest number of logged cases. 10 Few studies have investigated pediatric operative experiences of residents, specifically in plastic surgery. In the field of general surgery, 59% of residents felt inadequately prepared for their future practice.…”

“…However, studies have demonstrated that residents have both adequate and inadequate exposure to various domains within the specialty. 10,14 Approximately 63% of Canadian residents feel as though their role as a primary surgeon was inadequate throughout their training. 14 Largely, residents have the most exposure within the domains of hand and nonaesthetic breast.…”

“…9 Among these competencies, Canadian graduates reported feeling comfortable in all subdomains of plastic surgery with the exception of pediatrics. 10 Understandably, faculty must balance dueling responsibilities including patient care and resident education. It is unclear how rapidly or at what stage of training competency in pediatric plastic surgery might best be obtained, and whether resident competency in pediatric plastic surgery is due to a deficit in exposure or lack of involvement in pediatric cases.…”

SMaRT Assessment Tool: An Innovative Approach for Objective Assessment of Flap Designs

“…1 Opportunities to perform deliberate practice with the aim of mastering the design of a specific local flap in plastic surgery, 2–4 while simultaneously receiving objective, specific, and practical feedback, remain extremely limited in clinical settings. 5 The transition toward competency-based education has culminated in a surge in popularity of simulation-based training platforms, 6–8 with local flap design remaining notably amenable to simulation-based training. 9 Given that no objective assessment tools exist to evaluate local flap designs, we sought to develop such a tool based on statistical shape analysis.…”