The Fading Flame: Declining Burn Surgical Exposure in Plastic Surgery Residency Training: A 9-year Review of 1902...

Burn surgery is a core competency in plastic surgery training. However, variability in operative exposure across demographic groups, training pathways, and geographic regions remains poorly characterized. This study examines national trends in burn case volume among integrated and independent plastic surgery residents, with attention to gender, underrepresented minority status, program size, geographic location, and the effect of COVID-19.

A retrospective cohort analysis of Accreditation Council for Graduate Medical Education case log data from 2014 to 2023 was conducted. All graduating integrated and independent plastic surgery residents in the United States were included. Burn case volume was compared across demographic groups, program characteristics, and training pathways.

A total of 1902 residents were included (1043 integrated, 859 independent). Integrated residents performed significantly more burn cases than independent residents (215.8 ± 260.3 versus 102.4 ± 178.4; P < 0.001). No significant differences were observed between gender, underrepresented minority status, or program size. Burn case volume remained stable during the COVID-19 pandemic. Significant geographic variations were observed. Namely, integrated residents from Western and Southern programs logged significantly more cases than those from Northeastern and Central programs. (P < 0.001) On the other hand, independent residents from Western and Central programs logged significantly more burn cases compared to their counterparts from Northeastern and Southern programs (P < 0.001).

Integrated residents have greater exposure to burn cases compared to their independent counterparts. Burn case exposure among residents remains robust and equitable across genders and underrepresented minorities. Geographic disparities exist and warrant further investigation.