Experience with surgical resident training in a combined program in plastic surgery

Healthcare reform may impact graduate medical education (GME) to reduce both specialty training positions and the length of training in these programs. General Surgery residencies often provide prerequisite training for surgery specialty training and will be affected by these changes. The purpose of this study is to identify the quality, outcome, and differences between PGYI-PGYIII categorical general surgery residents (GS) and matched prerequisite plastic surgery residents (PS). Concurrent comparisons analyzed American Board of Surgery Inservice Training Examinations (ABSITE) data from 1980-1992 as well as the surgery operative logs (SOL) and the curriculum of matched residents from 1989-1992. Outcome was assessed by board performance and from a piloted questionnaire to all PS graduates of the combined (3-year GS and 2-year PS) program. ABSITE analysis demonstrated satisfactory performance for both PS and GS at each PGY level, with significant increases each year for GS, but only between PGYI and PGYII for PS; there was a significant difference between PS and GS at all PGY levels. SOL analysis paralleled the curriculum and demonstrated more plastic surgery for PS compared to GS, with no difference in general surgery or hand surgery. PS program graduate respondents (32/44-72.7%) identified that the GS training/PS training was appropriate (71.9%/93.8%), effective (90.7%/93.8%) and of appropriate duration (87.5%/75.1%). 87.5 per cent of PS graduates completed ABPS certification. Combined PS training in all PS programs would reduce GME payments by over $20 million. Combined PS training is effective, appropriate, resource-efficient, and has an excellent outcome, but it requires a specific curriculum and close coordination between General Surgery and Plastic Surgery programs.