Preparation for Hand Surgery Fellowship: A Comparison of Resident Training Pathways

Area of Science:

• Surgical Education
• Orthopedic Surgery
• Plastic Surgery

Background:

• Hand surgery is a subspecialty accessible after general, orthopedic, or plastic surgery residency.
• This study investigates variations in hand surgery training across these residency pathways.

Purpose of the Study:

• To compare the extent of hand surgery experience among residents completing general surgery, orthopedic surgery, and plastic surgery programs.
• To identify disparities in resident exposure to hand surgery procedures.

Main Methods:

• Analysis of Accreditation Council for Graduate Medical Education case logs from 2009-2018 for graduating residents.
• Categorization of hand surgery cases according to ACGME standards.
• Comparison of case volumes between general surgery, orthopedic surgery, and plastic surgery residents using one-tail ANOVA.

Main Results:

• A total of 19,159 residents were analyzed (11,189 general surgery, 7,290 orthopedic, 1,040 plastic surgery).
• Plastic surgery residents performed the highest number of hand surgeries, while general surgery residents performed the fewest.
• Plastic surgery residents significantly outperformed orthopedic residents in all hand surgery categories (p < 0.01).

Conclusions:

• Significant differences exist in resident preparation for hand surgery fellowships.
• The lack of uniform hand surgery exposure presents an opportunity for improving surgical education.
• Individualized training, targeted education, and seeking clinical challenges are recommended to optimize resident development.