Improving Readability and Automating Content Analysis of Plastic Surgery Webpages With ChatGPT.

INTRODUCTION: The quality and readability of online health information are sometimes suboptimal, reducing their usefulness to patients. Manual evaluation of online medical information is time-consuming and error-prone. This study automates content analysis and readability improvement of private-practice plastic surgery webpages using ChatGPT. METHODS: The first 70 Google search results of "breast implant size factors" and "breast implant size decision" were screened. ChatGPT 3.5 and 4.0 were utilized with two prompts (1: general, 2: specific) to automate content analysis and rewrite webpages with improved readability. ChatGPT content analysis outputs were classified as hallucination (false positive), accurate (true positive or true negative), or omission (false negative) using human-rated scores as a benchmark. Six readability metric scores of original and revised webpage texts were compared. RESULTS: Seventy-five webpages were included. Significant improvements were achieved from baseline in six readability metric scores using a specific-instruction prompt with ChatGPT 3.5 (all P ≤ 0.05). No further improvements in readability scores were achieved with ChatGPT 4.0. Rates of hallucination, accuracy, and omission in ChatGPT content scoring varied widely between decision-making factors. Compared to ChatGPT 3.5, average accuracy rates increased while omission rates decreased with ChatGPT 4.0 content analysis output. CONCLUSIONS: ChatGPT offers an innovative approach to enhancing the quality of online medical information and expanding the capabilities of plastic surgery research and practice. Automation of content analysis is limited by ChatGPT 3.5's high omission rates and ChatGPT 4.0's high hallucination rates. Our results also underscore the importance of iterative prompt design to optimize ChatGPT performance in research tasks.

Blepharoplasty Online: Critical Analysis of Content and Patient Comprehensibility.

INTRODUCTION: Patients frequently turn to online information for decision-making factors about aesthetic procedures. The quality of online medical content is an essential supplement to clinical education. These resources assist patients in understanding the risks, benefits, and appropriateness of their desired procedure. This study examines the breadth and readability of online blepharoplasty information, elucidating its educational utility. METHODS: A depersonalized Google search was conducted using the Startpage Search Engine, investigating key phrases, "blepharoplasty decision making factors", "eye lift decision making factors", and "eyelid lift decision making factors". The first three pages of results for each search term, totaling 90 links were screened. Data were extracted for various decision-making factors, subspecialty, gender, and readability. RESULTS: Twenty-six websites met inclusion for analysis. Thirteen websites were plastic surgery based, five otolaryngology (ENT), five ophthalmology/oculoplastic, one oral-maxillofacial (OMFS), and two mixed-based practices. Most blepharoplasty webpages identified were that of private practice and male surgeons. Half were subspecialties other than plastic surgery. Thirteen common decision-making factors were identified. The most common factors addressed across all texts were recovery followed by cosmetic and functional goals. The least discussed were genetic factors. Average Readability exceeded the 12th grade. There were no significant differences in readability means among subspecialties. CONCLUSION: This study examines the online blepharoplasty sphere among US-based practices providing clinical education to patients. No appreciable differences among gender, subspecialty, and readability on decision-making factors were found, highlighting a consistency among surgeons. Most websites fell short of readability standards, however, emphasizing a need for clearer information to patients. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lower Extremity Reconstruction with Anterolateral Thigh Free-Flap Anastomoses: A Computational Fluid Dynamic Analysis.

BACKGROUND: The anterolateral thigh free flap is an option for repairing soft tissue defects of the distal lower extremity. This flap uses the descending branch of the lateral circumflex femoral (LCF) artery as the flap vessel. The recipient vessel in these flaps is often the anterior tibial (AT), posterior tibial (PT), or peroneal (P) arteries. Computational fluid dynamic (CFD) evaluation of anastomoses between these vessels can optimize outcomes. METHODS: Thirty-eight CFD models were created to model end-to-side (ETS) and end-to-end (ETE) anastomoses for lower extremity reconstruction. Seven out of thirty-eight models represented ETS anastomoses between the LCF and AT arteries with varying anastomotic angles. Nine out of thirty-eight models represented 45-degree ETS anastomoses between varying diameters of the LCF and AT, PT, and P arteries. Nine out of thirty-eight models represented stenosis on the flap vessel and recipient vessel, pre- and post-bifurcation. Nine out of thirty-eight models represented ETE anastomoses, rather than ETS, with varying vessel diameters. Four out of thirty-eight models represented ETE anastomoses with varying regions and levels of stenosis. RESULTS: Stasis of blood flow in ETS models increased as anastomotic angle increased in a logarithmic relationship (R 2 = 0.918). Flow was optimized overall as flap and recipient vessel diameters approached one another. In ETS models, flap vessel and postbifurcation recipient vessel stenosis were found to substantially increase stasis. CONCLUSION: Selection of flap and recipient vessels with similar diameters can optimize outcomes in microvascular anastomoses. In the context of lower extremity reconstruction with the ALT flap, the PT artery can be recommended as a first-line recipient vessel due to its similar vessel caliber to the LCF and relative ease of surgical access compared with the P artery. Avoidance of areas of stenosis is recommended to ensure laminar flow and reduce the operative difficulty associated with performing anastomoses on nonpliable arteries. Striving for increased acuity of anastomotic angles is recommended to optimize the flow in ETS microvascular anastomoses.

Revisiting Level of Evidence Ratings in Plastic Surgery: A Call to Action.

BACKGROUND: Evidence-based medicine underpins medical and surgical practice, with level of evidence (LOE) being a key aspect that allows clinicians and researchers to better discriminate the methodological context by which studies are conducted and appropriately interpret their conclusions, and more specifically the strength of their recommendations. OBJECTIVES: The aim of this study was to reassess the LOE of articles published in plastic surgery journals. METHODS: To assess the overall LOE of publications from January 1 to December 31, 2021, a review of the following plastic surgery journals was performed: Aesthetic Surgery Journal (ASJ), Annals of Plastic Surgery (Annals), Journal of Plastic Reconstructive and Aesthetic Surgery (JRPAS), Plastic and Reconstructive Surgery (PRS), and Plastic and Reconstructive Surgery Global Open (PRS GO). RESULTS: Of 3698 PUBMED articles, 1649 original articles and systematic reviews were analyzed. The average LOE for each journal was: ASJ 3.02 ± 0.94, Annals 3.49 ± 0.62, JPRAS 3.33 ± 0.77, PRS 2.91 ± 0.77, and PRS GO 3.45 ± 0.70. The collective average LOE was 3.28 ± 0.78. Only 4.4% were LOE 1 and 7.3% were LOE 2. Compared to past studies, PRS showed a significant LOE improvement (P = .0254), while ASJ and JPRAS saw nonsignificant changes; Annals experienced a significant decrease (P = .0092). CONCLUSIONS: ASJ and PRS showed the highest LOE among the journals analyzed. Despite this, low LOE studies remain prevalent in plastic surgery. This paper serves as a call to action for both researchers and academic journals to elevate the standard, offering several strategies to help improve the LOE in plastic surgery.

Trends in Integrated Plastic Surgery Applicant, Resident, and Junior Attending Research Productivity.

INTRODUCTION: Research productivity is critical for matching into integrated plastic surgery residency. This study will identify how pre and intraresidency research productivity correlate with resident/junior attending productivity. MATERIALS AND METHODS: Retrospective review from 2006 to 2015 issues of the American Board of Plastic Surgery's Annual Newsletter to Diplomates was performed to identify newly board certified plastic surgeons. Only surgeons from US medical schools matching directly into integrated programs were included. Residency type/length, graduation year from medical school, and publication counts were recorded for each surgeon. Publications were categorized as preresidency, intraresidency, and junior attending (6 y post residency/fellowship training). RESULTS: Six hundred fifty-five integrated plastic surgery graduates were analyzed. The median number of total publications (preresidency, intraresidency, and junior attending) was 4 (interquartile range [IQR], 1 to 10). Linear regression revealed negligible correlation between preresidency and junior attending publications (r = 0.019, P = 0.002). Total publications and increasing graduation y had a significant correlation of 0.89 (P < 0.001). Graduates of fellowships had significantly increased median total publications compared to those without fellowships (7 IQR, 3 to 18 versus 3 IQR, 1 to 7, respectively, P < 0.001). Dedicated research years during residency were associated with significant (P < 0.001) increases in median total and junior attending publications. Total publications ranged from 3 (IQR, 1 to 6) to 8 (IQR, 7 to 18) for those who completed 5- and 8-y residencies, respectively. CONCLUSIONS: Increased preresidency research productivity is not strongly associated with increased junior attending productivity in integrated plastic surgery. Better markers are completing dedicated research years in residency or fellowship after residency.

Treatment Delay From Onset of Occipital Neuralgia Symptoms to Treatment with Nerve Decompression Surgery: A Prospective Cohort Study.

BACKGROUND: The aim of this study was to a) evaluate the time between onset of occipital neuralgia symptoms and nerve decompression surgery, b) perform a cost comparison analysis between surgical and non-surgical treatment of occipital neuralgia and c) report postoperative results of nerve decompression for occipital neuralgia. METHODS: 1,112 subjects who underwent screening for nerve decompression surgery were evaluated for occipital neuralgia. 367 (33%) patients met the inclusion criteria. Timing of occipital neuralgia symptom onset and pain characteristics were prospectively collected. Cost associated with the non-surgical treatment of occipital neuralgia was calculated for the period between onset of symptoms and surgery. RESULTS: 226 (73%) patients underwent occipital nerve decompression. The average time between onset of occipital neuralgia and surgery was 19 years (7.1-32). Postoperatively, the median number of pain days per month decreased by 17 (0-26, 57%) (p < 0.001), the median pain intensity decreased by 4 (2-8, 44%) (p < 0.001), and median pain duration in hours was reduced by 12 (2-23, 50%) (p < 0.001). The annual mean cost of non-surgical occipital neuralgia treatment was $28,728.82 ($16,419.42-$41,198.41) per patient. The mean cost during the 19-year timeframe prior to surgery was $545,847.75($311,968.90-$782,769.82). CONCLUSION: This study demonstrates that patients suffer from occipital neuralgia for an average of 19 years prior to undergoing surgery. Nerve decompression reduces symptom severity significantly and should be considered earlier in the treatment course of occipital neuralgia that is refractory to conservative treatment to prevent patient morbidity and decrease direct and indirect healthcare costs. IRB REGISTRATION NUMBER & NAME: Weill Cornell Medicine: 23-04025985, Prospective Cohort Study Investigating Long- Term Outcomes After Headache Surgery.The Massachusetts General Hospital: 2012P001527, Correlation of pre-operative pain self-efficacy and post-operative migraine-specific symptoms and disability.

Efficacy and Safety of Migraine Surgery: A Systematic Review and Meta-analysis of Outcomes and Complication Rates.

OBJECTIVE: The objectives of this study are to assess the efficacy and safety of peripheral nerve surgery for migraine headaches and to bibliometrically analyze all anatomical studies relevant to migraine surgery. SUMMARY BACKGROUND DATA: Migraines rank as the second leading cause of disability worldwide. Despite the availability of conservative management options, individuals suffer from refractive migraines which are associated with poor quality of life. Migraine surgery, defined as the peripheral nerve decompression/trigger site deactivation, is a relatively novel treatment strategy for refractory migraines. METHODS: EMBASE and the National Library of Medicine (PubMed) were systematically searched for relevant articles according to the PRISMA guidelines. Data was extracted from studies which met the inclusion criteria. Pooled analyses were performed to assess complication rates. Meta-analyses were run using the random effects model for overall effects and within subgroup fixed-effect models were used. RESULTS: A total of 68 studies (38 clinical, 30 anatomical) were included in this review. There was a significant overall reduction in migraine intensity (P < 0.001, SE = 0.22, I2 = 97.9), frequency (P < 0.001, SE = 0.17, I2 = 97.7), duration (P < 0.001, SE = 0.15, I2 = 97), and migraine headache index (MHI, P < 0.001, SE = 0.19, I2 = 97.2) at follow-up. A total of 35 studies reported on migraine improvement (range: 68.3%-100% of participants) and migraine elimination (range: 8.3%-86.5% of participants). 32.1% of participants in the clinical studies reported complications for which the most commonly reported complications being paresthesia and numbness, which was mostly transient, (12.11%) and itching (4.89%). CONCLUSION: This study demonstrates improved migraine outcomes and an overall decrease in MHI as well as strong evidence for the safety profile and complication rate of migraine surgery.

Current Views on the New United States Medical Licensing Examination Step 1 Pass/Fail Format: A Review of the Literature.

INTRODUCTION: Residency programs have historically used numerical Step 1 scores to screen applicants, making it a career-defining, high-stakes examination. Step 1 scores will be reported as pass/fail starting in January 2022, fundamentally reshaping the residency application review process. This review aimed to identify opinions of physicians and medical students about the new format, identify arguments in support of or against the change, and determine the implications of this change on the residency selection process. METHODS: A comprehensive PubMed review was performed in May 2021 to identify articles that discussed the new Step 1 format. Non-English and duplicate articles were excluded. Data collected from each article included publication year, specialty, subjects, and key findings. RESULTS: A total of 81 articles were included, 26 of which discussed the impact of the new format within surgical fields (32.1%). Remaining articles discussed the implications within the medical community as a whole (n = 33, 40.7%) and nonsurgical fields (n = 22, 27.2%). Studies suggest Program Directors will rely on Step 2 Clinical Knowledge (CK) scores, medical school reputation, applicant familiarity, Dean's letters, recommendation letters, and research in lieu of numerical Step 1 scores. In addition, concerns have been raised that the new format will disadvantage international, osteopathic, and minority applicants while increasing stress surrounding Step 2 CK. CONCLUSIONS: Within the medical community, there are concerns that Step 2 CK will be used to substitute Step 1 and that resident diversity will diminish due to the new Step 1 format. Holistic candidate consideration will be increasingly important.

A 5-Year Analysis of the Integrated Plastic Surgery Residency Match: The Most Competitive Specialty?

INTRODUCTION: The National Residency Matching Program is becoming more competitive across all medical specialties. The match rate for surgical specialties is considerably lower than the overall match rate each year. For those wishing to match into integrated plastic surgery, the magnitude of difficulty is in question. MATERIALS AND METHODS: Public data from 2016 to 2020 on the number of residency programs, number of residency positions, number of applicants, United States Medical Licensing Examination (USMLE) scores, and research experiences were collected for dermatology, categorical general surgery, neurological surgery, ophthalmology, orthopedic surgery, otolaryngology, integrated plastic surgery, integrated thoracic surgery, urology, and integrated vascular surgery. RESULTS: In the 2020 Match, integrated plastic surgery had only 82 programs and 180 positions, and over the 2016-2020 Matches, the growth of integrated plastic surgery was a mere 6.9 positions per year. For matched 2020 applicants, integrated plastic surgery had the highest USMLE Step 1 score (249), highest USMLE Step 2 score (tied at 256), and second highest number of abstracts/presentations/publications (19.1). CONCLUSIONS: The limited availability of residency spots in integrated plastic surgery, in conjunction with the quality of the applicant pool, makes it one of the most competitive matches. Candidates should understand this context before applying as to not risk going unmatched.

Open Versus Laparoscopic Surgical Management of Rectus Diastasis: Systematic Review and Pooled Analysis of Complications and Recurrence Rates.

BACKGROUND: Rectus diastasis (RD) is defined as widening of the linea alba and laxity of the abdominal muscles. It can be treated via a wide array of both conservative and surgical modalities. Due to the quickly evolving nature of this field coupled with the multiple novel surgical modalities described recently, there is a need for an updated review of surgical techniques and a quantitative analysis of complications and recurrence rates. METHODS: A systematic review of PUBMED and EMBASE databases was preformed to retrieve all clinical studies describing surgical management of RD. Pooled analyses were preformed to assess recurrence and complication rates after both open and laparoscopic RD repairs (after controlling for herniorrhaphy). RESULTS: A total of 56 papers were included in this review. In patients who underwent both an RD and a herniorrhaphy, there was no significant difference in recurrence rates between open (0.86%) and laparoscopic repairs (1.6%) (p > 0.05). Similarly, in patients who underwent RD repair without a herniorrhaphy, there was no significant difference in recurrence rates between open (0.89%) and laparoscopic repairs (0%) (p > 0.05). The most common complications reported were seroma, skin dehiscence, hematoma/post-operative bleeding, and infection. After controlling for a herniorrhaphy, there were no significant difference in total complication rates between open and laparoscopic RD repair. The total complication rates in patients who underwent an open RD repair with a herniorrhaphy were 13.3% compared to 14.5% in patients who underwent laparoscopic repairs (p > 0.05). Similarly, the total complication rates in patients who underwent RD repair without a herniorrhaphy were 11.8% in patients who underwent open repairs compared to 16.2% in their counterparts who underwent laparoscopic repairs (p > 0.05). CONCLUSION: Both open and laparoscopic approaches are safe and effective in repairing RD in patients with and without concurrent herniorrhaphy. Future research should report patient reported outcomes to better differentiate between different surgical approaches.

Board Certification in Cosmetic Surgery: An Examination of Online Advertising Practices.

BACKGROUND: Aesthetic surgery patients commonly use online resources to select a surgeon. The American Board of Plastic Surgery is the American Board of Medical Specialties member board that certifies plastic surgeons. The American Board of Cosmetic Surgery (ABCS) provides aesthetic surgery credentials through a non-American Board of Medical Specialties-recognized process. This study examines use of the phrases "plastic surgery" and "plastic surgeon" by ABCS-certified surgeons when advertising online. METHODS: Diplomates of the ABCS were identified from the ABCS Web site. Professional Web sites, Facebook business pages, and Instagram profiles were located by online search. Use of the descriptor "plastic" and ABCS board certification on practice Web sites, Facebook business page categorization, and plastic surgery-related hashtag use on Instagram were recorded. RESULTS: A total of 298 non-American Board of Plastic Surgery-certified ABCS diplomates were included. One hundred eighty-nine (69.5%) categorized their Facebook business page as "plastic surgeon." Within Instagram posts, 123 (57.2%) used #plasticsurgeon, and 172 (80.0%) used #plasticsurgery. On professional Web sites, 90 (30.4%) identified themselves as a "plastic surgeon," 123 (41.6%) characterized their practice as "plastic surgery," and 196 (68.5%) used their ABCS credential to identify as a "board-certified" cosmetic surgeon. CONCLUSIONS: Diplomates of the ABCS frequently use "plastic surgeon" and "plastic surgery" in online advertisements despite a lack of accredited plastic surgery training or board certification. Furthermore, most ABCS diplomates use their ABCS credentials to market themselves as "board-certified" cosmetic surgeons, potentially violating American Medical Association-supported truth in advertising laws in some states and increasing public confusion regarding different board certifications.

The Aging Surgeon: Evidence and Experience.

BACKGROUND: With doctors in short supply and a strong demand for surgeon services in all areas of the United States, urban and rural, there are pressures to remain in active practice for longer. Even with an older workforce, there are currently no requirements for when a surgeon must retire in the United States. OBJECTIVES: The aim of this article was to highlight the importance of the aging surgeon to the medical community and to provide an evidence-based overview of age-related cognitive and physical issues that develop during the later stages of a surgeon's career. METHODS: A search of the PubMed/MEDLINE database was performed for the phrase "aging surgeon." Inclusion criteria were applied to include only those articles related to surgeon age or retirement. Additional reports were handpicked from citations to substantiate claims with statistical evidence. RESULTS: The aging surgeon contributes extensive experience to patient care, but is also prone to age-related changes in cognition, vision, movement, and stress as it relates to new techniques, surgical performance, and safety measures. Studies show that although surgeons are capable of operating well into their senior years, there is the potential of decline. Nevertheless, there are proven recommendations on how to prepare an older surgeon for retirement. CONCLUSIONS: Age-related trends in cognitive and physical decline must be counterbalanced with wisdom gained through decades of surgical experience.

Surgical Management of Occipital Neuralgia: A Systematic Review of the Literature.

BACKGROUND: Occipital neuralgia (ON) is a primary headache disorder characterized by severe, paroxysmal, shooting or stabbing pain in the distribution of the greater occipital, lesser occipital, and/or third occipital nerves. Both medical and surgical options exist for treating headaches related to ON. The purposes of this study are to summarize the current state of surgical ON management through a systematic review of the literature and, in doing so, objectively identify future directions of investigation. METHODS: We performed a systematic review of primary literature on surgical management for ON of at least level IV evidence. Included studies were analyzed for level of evidence, therapeutic intervention, study design, sample size, follow-up duration, outcomes measured, results, and risk of bias. RESULTS: Twenty-two studies met the inclusion criteria. All 22 studies used patient-reported pain scores as an outcome metric. Other outcome metrics included complication rates (7 studies; 32%), patient satisfaction (7 studies; 32%), quality of life (7 studies; 18%), and analgesic usage (3 studies; 14%). Using the ROBINS-I tool for risk of bias in nonrandomized studies, 7 studies (32%) were found to be at critical risk of bias, whereas the remaining 15 studies (68%) were found to be at serious risk of bias. CONCLUSIONS: Greater occipital nerve decompression seems to be a useful treatment modality for medically refractory ON, but further prospective, randomized data are required.

Majority of Most-Cited Articles in Top Plastic Surgery Journals Do Not Receive Funding.

BACKGROUND: Plastic surgery faculty, residencies, and institutions are frequently judged on the quantity and quality of their research output. Some of the most impressive individuals in the specialty receive financial support in the form of grants and payments to help with research ideas. OBJECTIVES: The authors sought to discern if funding directly correlates to greater impact in the top plastic surgery journals as measured by citations. METHODS: Using the Web of Science database, the authors identified the 50 most-cited articles in each of the top plastic surgery journals from January 1975 to August 2020. The articles were scanned for funding sources and categorized as industry, federal, foundational, and institutional, while stratifying by decade. RESULTS: Between 16 journals, 13.3% of the most-cited articles received funding, 2.6% of which came from industry, 5.4% from government, 4.4% from foundations, and 0.86% from institutions. The percentage of most-cited articles and the proportion that received funding were both correlated with decade (P = 0.0017 and P = 0.043, respectively). However, only the percentage of articles was found to significantly increase over time (P = 0.0068). CONCLUSIONS: Although funding leads to meaningful publications, this study showed that financial support is not required to have an influence in plastic surgery research.

Decreasing Surgical Site Infections in Plastic Surgery: A Systematic Review and Meta-analysis of Level 1 Evidence.

BACKGROUND: Although many interventions are implemented to prevent surgical site infections (SSIs) in plastic surgery, their supporting evidence is inconsistent. OBJECTIVES: The goal of this study was to assess the efficacy of methods for decreasing SSIs in plastic surgery. METHODS: A systematic review and meta-analysis were performed to compare the effects of SSI prevention methods. All the studies were assessed for quality of evidence according to the GRADE assessment. RESULTS: Fifty Level 1 randomized controlled trials were included. The most common interventions for preventing SSIs were antibiotic prophylaxis, showering, prepping, draping, and the use of dressings. Current evidence suggests that antibiotic prophylaxis is largely unnecessary and overused in many plastic surgical procedures, with the exception of head and neck oncologic, oral craniofacial, and traumatic hand surgeries. CONCLUSIONS: Efficacy of antibiotic prophylaxis in plastic surgery is dependent on surgery type. There is a lack evidence that showering and prepping with chlorohexidine and povidone reduces SSIs.

Survey Based Assessment of Burnout Rates Among US Plastic Surgery Residents.

PURPOSE: The purpose of this study was to analyze the rates of burnout and contributory factors among US plastic surgery residents. METHODS: The Maslach Burnout Inventory Human Services Survey was emailed to program coordinators of American College of Graduate Medical Education-accredited plastic surgery residencies. Scores are provided for 3 subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. Normative scoring tables (low, average, high) were used for comparison. Residents were asked questions relating to their personal life (age, postgraduate year, marital status, and program characteristics). RESULTS: One hundred thirteen residents responded. The average age was 31.6 years (range, 25-43 years) and postgraduate year of 4.6 (range, 1-10). There were equal male and female respondents. Most were from integrated-only residencies (n = 59, 52.2%). On average, the majority reported working 50 to 80 hours per week (n = 93, 82.3%), spending the majority of time in tertiary referral centers (n = 107, 94.7%). Most received and took 3 weeks of vacation per year (n = 68, 60.7%). Furthermore, 65.5% met the definition of burnout by their scores from at least 1 subscale.The number of hours worked per week significantly correlated with increased scores in the EE and DP subscales. Residents who worked more than 80 hours per week had significantly higher scores in the EE and DP categories. Residents who had less than 2 weeks of vacation per year trended toward experiencing more EE (EE; 46.0, P = 0.077). The type of program (independent vs integrated), sex, having a significant other outside of the home, kids, and local family support did not significantly affect burnout scores for any subscales. CONCLUSIONS: Burnout exists among plastic surgery residents especially in the DP subscale. Working longer hours and less vacation correlates with increased rates of burnout among residents.

Longitudinal Assessment of Aesthetic Plastic Surgery Training in the United States: The Effect of Increased ACGME Case Log Minimum Requirements.

BACKGROUND: In 2014, the Accreditation Council for Graduate Medical Education (ACGME) increased the minimum required aesthetic surgery cases for graduation from plastic surgery residency from 50 to 150. To date, there has been no research into how this has impacted resident aesthetic surgery training focusing on the resident perception. OBJECTIVES: We sought to evaluate resident perception and satisfaction with their aesthetic surgery training before and after the ACGME case log requirement increase to assess its impact on training and comfort level. METHODS: A survey was administered to all graduating senior residents attending the Senior Residents Conference of the ASPS Annual Meeting in 2014 and 2017. The survey evaluated senior resident aesthetic surgery experience and their confidence and satisfaction with their training. RESULTS: The response rate was 70% in 2014 and 45% in 2017. There was an increase in the number of programs with resident-run cosmetic clinics (14% increase) and designated aesthetic rotations (33% increase) during that time. Resident-run cosmetic clinics were consistently considered the most valuable form of aesthetic training for residents. There also was a substantial increase in the percentage of residents feeling prepared to incorporate aesthetic surgery into their practice after graduation, increasing from 36% to 59% in 2017. The majority of responding residents felt that the ACGME case log requirement increase in 2014 was beneficial for their aesthetic surgery training (68%). CONCLUSIONS: The recent ACGME case log requirement increase for aesthetic surgery training has had a positive effect on resident comfort with aesthetic procedures and their ability to incorporate them into future practice.

A National Curriculum of Fundamental Skills for Plastic Surgery Residency: Report of the Inaugural ACAPS Boot Camp.

BACKGROUND: The Inaugural American Council of Academic Plastic Surgeons Plastic Surgery Boot Camp program was developed in response to ongoing changes in graduate medical education. The Boot Camp is a hands-on, practicum-based, 3-day course to introduce core concepts in plastic surgery for new plastic surgery residents (in both integrated and independent tracks). METHODS: The course was held in Pittsburgh in July to August 2015. There were 43 attendees (35 integrated/8 independent) representing 22 residency programs across 15 states. Faculty was composed of 8 local personnel and 5 visiting. Lecture topics and practical sessions covered the full spectrum of plastic surgery. All trainees completed an online survey evaluation both during the course and at 6 months. RESULTS: Participant responses were overwhelmingly positive. A total of 72% of respondents rated the Boot Camp ≥ 8 on a 1 to 10 scale (10 is excellent) for the overall course rating; 79% of respondents agreed or strongly agreed with the statement that the simulation scenarios were realistic; and 75% of participants agreed or strongly agreed with the statement that they found simulation-based training to be a valuable way to teach this material. Respondents reported an increase in comfort and confidence across topics after attending the Boot Camp at both 0- and 6-month time points. Instructors received positive evaluations across all topics. CONCLUSIONS: This successful inaugural course serves as a benchmark for development of a logistical blueprint, business plan, and curriculum for a proposed expansion to regional centers, to potentially encompass all incoming residents in plastic surgery.