The Impact of COVID-19 on Plastic Surgery Residents Across the World: A Country-, Region-, and Income-level Analysis.

BACKGROUND: The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world. METHODS: We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons. RESULTS: The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006). CONCLUSIONS: Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Human Capital and Productivity in Plastic Surgery Research Across Nations.

BACKGROUND: Understanding country differences in production and human capital in plastic surgery research is crucial in identifying current and future leaders in the field. In this study, we document each country's human capital and productivity in plastic surgery research. METHODS: A web scraping algorithm was deployed on PubMed to retrieve information on every publication and every first author in 10 major research outlets in plastic surgery between 2015 and 2021. Each country's human capital in the field is proxied by the number of first authors affiliated with that country. We compare aggregate patterns and volume trajectories of publications affiliated with 110 countries in the context of their human capital. RESULTS: We find that over the studied period, two countries, the USA and China, are represented in roughly 50% and 45% of global research output and first authors, respectively, in plastic surgery. Specifically in the USA, California has the highest number of affiliated first authors and publications compared with other States. CONCLUSIONS: Our findings reveal the clear dominance of the USA in plastic surgery research production. No specific US State stands out in the nation as much as the USA does in the global ranking of plastic surgery publications. This suggests that US plastic surgeons across the nation aim to publish. Our global analysis also suggests that countries with a higher share of first authors relative to their research output may have greater capacity to expand their research output in the future. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. 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 .

School attendance during a pandemic.

When officials relax school attendance requirements as a prophylactic measure against a pandemic, students of higher prior performance take more absences, while students of lower prior performance keep going to school. Prior performance is positively associated with neighborhood income.