A Comparison of Case Volume in Craniofacial Surgery by Plastic Surgery Residency Training Model.

BACKGROUND: Plastic surgeons in the United States are trained under 2 residency training models: integrated and independent. This study analyzes the variability of craniofacial surgery cases performed both between and within training models. METHODS: Case volume data from national data reports of 5 plastic surgery resident cohorts were analyzed (2011-2015). Craniofacial surgery case volumes across 4 major categories and 23 subcategories were compared between training models via t tests. Differences in intramodel variability were compared with F tests. Fold differences were calculated between mean case volumes and minimum requirements in craniofacial surgery. RESULTS: A total of 526 independent/combined (64%) and 292 integrated (36%) plastic surgery residents were included. Integrated residents reported more cases classified as congenital defect (118.8 ± 49.3 vs 110.3 ± 42.9, P = 0.013), neoplasm (202.0 ± 79.7 vs 163.2 ± 60.8, P < 0.001), and trauma (149.0 ± 61.8 vs 127.0 ± 52.0, P < 0.001), but not aesthetic (122.3 ± 68.6 vs 116.5 ± 50.5, P = 0.201). Integrated residents reported more case volume in 12 case subcategories, whereas independent/combined residents reported more cases in 3 case subcategories. Integrated residents had greater intramodel variability in 12 case subcategories, whereas independent/combined residents had greater intramodel variability in 2 case subcategories. Fold differences between mean case volumes and minimum requirements ranged from 1.8 times to 6.0 times. CONCLUSIONS: Integrated residents tended to report significantly more craniofacial surgery cases and exhibit greater intrapathway variability. More research is needed to understand the impact of disparate case volume on core competency training in craniofacial surgery during plastic surgery residency.

The Impact of Training Pathway on Breast Surgery Cases Performed during Plastic Surgery Residency.

BACKGROUND: Operative volume is a critical component of surgical resident education. This study compares reported breast surgery case volume between resident training pathways in plastic surgery. METHODS: This retrospective cohort study reviewed case logs of plastic surgery residents in the independent/combined and integrated training pathways. Breast surgery case volume was compared via t tests across two major categories: reconstructive and aesthetic. Differences in intra-pathway variability were compared with F tests. Five consecutive cohorts of plastic surgery residents (n = 818): independent/combined (n = 526, 64%) and integrated (n = 292, 36%) at Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs, were included (2011-2015). RESULTS: Independent/combined residents reported significantly more aesthetic cases than integrated residents, but similar reconstructive cases. Independent/combined residents reported more breast augmentations, mastopexy, cosmetic breast fat grafting, and other cosmetic breast cases. Within the reconstructive category, independent residents reported more breast reconstruction fat grafting cases while integrated residents reported more breast reconstruction with pedicle flap, other breast reconstruction, and breast reduction cases. Independent residents had greater intra-pathway variability in five case subcategories, while integrated residents had greater variability in one case subcategory. CONCLUSIONS: Disparities in breast surgery case volume exist by plastic surgery residency training pathway. Given the importance of case volume to residents and faculty, these disparities may warrant greater attention. 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 www.springer.com/00266.

Longitudinal Assessment of Adult Cases Performed by Graduating Urology Residents in the United States: 2010-2018.

INTRODUCTION: This study analyzed longitudinal growth trends, intra-resident variability and adult case volume performed at the completion of urology residency training. METHODS: National case logs of urology residents graduating from 2010 to 2018 were analyzed (1,072 residents). Compound annual growth rates were calculated for case volumes in adult case categories. Intra-resident variability was calculated as the percent difference between the 90th and 10th percentiles. Mean reported case volumes were compared with minimum requirements with the Student's t-test. RESULTS: Cases were performed in the role of surgeon (range 83% to 89%), assistant surgeon (range 8% to 13%) and teaching surgeon (range 2% to 4%), and total annual cases increased during the study period (compound annual growth rate 0.9%). The breakdown of cases performed by major case category was general urology (range 30% to 33%), endourology/stone disease (range 21% to 24%), oncology (range 19% to 21%), reconstructive surgery (range 13% to 14%) and laparoscopic surgery (range 10% to 13%). Urology residents consistently reported more cases than the minimum requirement (p <0.001) by severalfold (percent difference range of 170% to 550%). Mean intra-resident variability ranged from 198% for general urology to 333% for laparoscopic surgery among major case categories, with decreasing compound annual growth rates for intra-resident variability during the study period. In 2018, 2 residents did not report minimum case requirements (1.6%). CONCLUSIONS: Reported case volume in adult urology is increasing and exceeds minimum requirements by severalfold. Future studies are needed to understand the impact of higher resident case volumes on clinical competency.

Disparities in Pediatric Operative Experience during Urology Residency Training.

OBJECTIVE: To understand trends in pediatric cases performed during urology residency including intraresident variability and cases performed relative to required minimums. MATERIALS AND METHODS: Case logs of urology residents graduating from 2010 to 2018 were analyzed. Temporal trends in reported pediatric case volume were assessed via ANOVA tests and calculation of compound annual growth rates (CAGRs). Percent differences between the 90th and 10th percentiles of residents were calculated to assess intraresident variability. Reported case volumes were compared with minimum requirements with t tests. RESULTS: 1072 residents from 306 urology residency programs were represented in this study. Minor pediatriccases increased from 2010 to 2018 (105.4 ± 54vs 124.6 ± 65, P = .004, CAGR = 2.1%) while major pediatric cases decreased (83.9 ± 40vs 60.8 ± 30, P < .001, CAGR = -3.9%). Orchiopexy (range, 23%-27%), hypospadias (range, 19%-21%), and hydrocele / hernia (range, 15%-19%) were the highest volume case categories. Mean intraresident variability in reported case volumeswas 338% for minor pediatric (CAGR = 0%) and 382% for major pediatric (CAGR = 1.8%). Mean reported case volumes exceeded the minimum requirement for each case category by several fold (P < .001, range, percent difference 232-675%). All urology residents reported minimum pediatric case requirements in 2018. CONCLUSION: Urology residents report more cases than minimum requirements for pediatric urology by several folds. Future research is needed to understand the implications of increasing intraresident case volume variabilities on residency training in pediatric urology.