Charting the Course: Examining Trends and Proposing Improvements for the Plastic Surgery In-Service Examination

The plastic and reconstructive surgery (PRS) in-service examination (ISE) is an annual written examination designed to evaluate an examinee's knowledge across all PRS topics. With a broad testable content base and plethora of resources, it is difficult for PRS residents to know what to prioritize when studying. This study aims to investigate which PRS topics are most heavily represented on the ISE and which references are most commonly cited while also comparing it to the annual exams of other surgical subspecialties.

ISEs from 2012 to 2022 were accessed through the American Council of Academic Plastic Surgeons website. Data extracted for each question included category, number of associated references, year of publication for each reference, journal for each reference, and whether the reference was accessible via PubMed.

There were 6809 total references and 1161 unique references. The two most common PRS references were Plastic and Reconstructive Surgery (80.9%) and Journal of Hand Surgery (15.8%). The two most common nonplastic surgery references were New England Journal of Medicine (1.8%) and World Journal of Surgery (1.8%). The two most frequently represented question categories were Local Anesthetics (4.7%), and Breast Reconstruction (4.7%). A total of 84.9% of references were available through PubMed.

The annual PRS ISE tests examinees on their comprehensive PRS knowledge. The extensive scope of references used as evidence on this examination can make studying overwhelming and inaccessible. Small changes in the approach of question writers, residents, and residency programs can streamline and lessen the burden associated with preparing for this examination.