Increased instruction or decreased opportunity? How co-surgeons and fellows impact resident training in microsurgery

Microsurgical reconstructions are incredibly demanding, and many plastic surgeons perform these procedures with a co-surgeon (CSM), or a microsurgical fellow (MSF). Although both the CSM and MSF have their benefits, there is currently a lack of understanding of how these additions impact the microsurgical training of residents.

An electronic survey of plastic surgical residents was sent via the American Council for Educators in Plastic Surgery (ACEP) distribution service. Questions included details regarding the level of training, program characteristics, and the use of the CSM/MSF at their institution. A 5-point Likert scale (Very Positive to Very Negative) was used to assess the impact of the CSM/MSF on microsurgical education.

One hundred thirty-four residents with an average of 4 years (SD =1.95) of plastic surgery training completed the survey. The CSM was used at 95 (71%) and MSF at 37 (27%) programs. Residents felt the CSM was positive for their training (45% positive vs. 23% negative), while MSF was seen as more negative (15% positive vs. 57% negative). Residents at programs with the CSM and/or MSF had a significantly more positive outlook (53% CSM and 32% MSF) compared to those training at institutions without (24% CSM and 8% MSF) (p<0.001).

Residents at programs utilizing these tools had a much more positive outlook compared to those without. As institutions adopt CSM or bring MSF into their program, they should consider resident concerns and ensure that the CSM and MSF are a help and not a hindrance to resident learning.