Comparison of quantitative educational metrics between integrated and independent plastic surgery residents

The purpose of this study was to compare residents in the integrated and independent tracks of plastic surgery residency training using several quantitative educational metrics. The Harvard Combined Plastic Surgery Residency Training Program offers an ideal model for this comparison, as it is the largest in the country and operates both tracks simultaneously.

The authors compared several quantitative educational metrics of all 22 independent and 24 integrated residents matched into the Harvard Program since its inception. These quantitative educational metrics include medical school reputation, United States Medical Licensing Examination (USMILE, Philadelphia, Pa.) step 1 scores, publication productivities during different educational periods (preresidency and pre-plastic surgery training), in-service scores, exit rankings (overall and operative skills), and percentage of M.D./Ph.D. residents.

Integrated residents graduated from more highly ranked medical schools than independent residents (mean tier, 1.5 versus 2.3; p = 0.0345), had higher United States Medical Licensing Examination step 1 scores (mean, 235 versus 220; p = 0.0234), and had higher preresidency publication scores (mean, 68 versus 14; p = 0.015). There are more M.D./Ph.D. residents in the integrated than in the independent track (33.3 percent versus 4.4 percent; p = 0.027). Independent residents had higher pre-plastic surgery training publication scores (mean, 77 versus 6; p = 0.0003). In-training quantitative educational metrics were similar between the two tracks (p > 0.05 in all cases). To address potential caveats of the study, all publication scores were compared with and without correction for the presence of M.D./Ph.D. residents, which yielded similar results. The authors also compared the match ranks of all their residents and found them to be statistically comparable between the two tracks.

In the Harvard Program, the integrated residents had better preresidency quantitative educational metrics, whereas the independent residents had better pre-plastic surgery training quantitative educational metrics. In training quantitative educational metrics were remarkably similar between the two tracks. In conclusion, this study, a systematic comparison between the two tracks, offers not only a valid foundation for future study of long-term outcome results but also a starting point from which to improve on the educational experience of residents in either track.