Size Matters? The Relationship Between Residency Program Size and Operative Experience in Plastic Surgery-A 9-year...

Residency program size, defined by the number of residents trained per graduating class, is regulated by the Accreditation Council for Graduate Medical Education (ACGME). In plastic surgery, operative case volume is a key training metric; however, the impact of program size on resident case volumes remains unclear. This study evaluates the relationship between program size and plastic surgery resident case volumes across a 9-year period.

This retrospective cohort study used ACGME case logs from all graduating plastic surgery residents in ACGME-accredited plastic surgery residency programs in the United States from 2014 to 2023. Primary variables of interest included program size (≥3 residents per graduating class or <3 residents per graduating class) and the total number of cases logged.

A total of 1902 graduates were included. Residents in large programs performed a similar average number of total cases compared with residents in small programs (2387 versus 2241, respectively; P = 0.154). When stratified by independent (P = 0.278) and integrated (P = 0.938) training pathways, case volumes were not significantly different between residents at large and small programs. Residents in large programs logged significantly more breast cases than those in small programs (570 versus 491; P = 0.001). No detectable differences were observed in aesthetic (P = 0.633), craniofacial/head and neck (P = 0.839), hand/nerve (P = 0.549), and other (P = 0.123) domains. Average case volumes remained stable over time, irrespective of program size.

Residents across large and small programs logged comparable case volumes regardless of training pathway, with operative exposure remaining stable over time. These findings demonstrate robust plastic surgery training despite differences in the number of graduating trainees per cohort.