Craniofacial fellowship training: where are we now?

The authors sought to evaluate current craniofacial training in the United States to achieve perspective on changes over time and to gain insights into possible process improvements.

Following a review of the San Francisco Match listings and an Internet search, an anonymous online survey invitation was sent to all fellows finishing in 2013.

Thirty-three fellows were identified in 29 listed programs and 30 responded (91 percent). All had completed plastic surgery training. A mean caseload of 380 cases (95 percent CI, 307 to 452) was reported. Case analyses permitted subclassification of fellowships into five areas of relative strengths: cleft/intracranial/midface, 35 percent; cleft/general pediatrics, 20 percent; cleft/adult plastics, 20 percent; cleft/facial trauma, 15 percent; and adult plastics/facial trauma, 10 percent of programs. Eighty-six percent were residency-type programs, whereas only 14 percent remained apprenticeships. Fellows cited confidence in any procedure following participation in more than 12 cases, but 20 percent reported not feeling adequately trained following fellowship. Over half (52 percent) thought training could be improved by establishing core areas of exposure and case category minimums.

Fellowships identified as "craniofacial" are actually fairly heterogeneous, offering diverse clinical experiences. Currently, only a minority emphasize traditional cleft, intracranial, and midfacial procedures, with the majority focused more on cleft care, general pediatric plastic surgery, and trauma. Concomitant with an increase in fellowship-trained surgeons has come a change in program structure from apprenticeships to residency-type models. Prospective fellows should consider matching their individual training goals with each program's unique clinical strengths.