Hand Surgery Questions on the Plastic Surgery In-service Training Examination: Analysis of Content and References

The Plastic Surgery In-service Training Examination (PSITE) provides residents and faculty with an objective evaluation of hand surgery knowledge during plastic surgery residency training. The purpose of this study was to understand tested hand surgery concepts and references to optimize study efforts during plastic surgery residency.

We reviewed hand surgery questions on 6 consecutive PSITEs (2016-2021). Questions were classified by taxonomy and clinical subject area. Answer references were quantified by source and year of publication.

A total of 235 questions tested hand surgery (16% of all PSITE questions) and 60 questions had an associated image (26%). Questions required direct level I-recall (37%), level II-interpretation (28%), and level III-medical decision-making skills (35%). The most frequently tested hand surgery topics were trauma (31%), reconstruction (20%), and functional problems (17%). There were 667 references to 130 unique journals. Journal of Hand Surgery (American volume), 34% and Plastic and Reconstructive Surgery (17%) were the highest yield primary sources. The median lag from publication to PSITE was 7 years (interquartile range, 7 years) with a mode of 2 years. Green's Operative Hand Surgery was the most referenced textbook (54% of textbook references).

This study creates an objective benchmark for hand surgery knowledge training during plastic surgery residency. Efforts focused on the most commonly tested topics and references can enhance resident preparation in hand surgery.