gms | German Medical Science

Objectives/Interrogation: Pursuit of hand surgery fellowship in the United States is primarily sought after by those with residency training in orthopaedic surgery or plastic surgery. Given these different pathways to reach fellowship, there currently remains uncertainty regarding the disparities in case volume or exposure which may exist between both these training pathways. This study sought to highlight the case volumes of residents over a 5-year period and identify any differences.

Methods: The Accreditation Council for Graduate Medical Education (ACGME) case logs between 2012 and 2016 were obtained for residents in orthopaedic surgery and plastic surgery programs. National mean number of procedures performed per resident were extracted and organized into one of 12 procedure categories. Chi-square analysis was employed to evaluate whether the distribution of cases varied across the study period for each training pathway.

Results and Conclusions: Procedures sharply differed between residents and fellows in plastic surgery and orthopaedic surgery (Table 1 [Tab. 1]).

Orthopaedic surgery trainees performed a lower proportion of the following procedures: incision/excision, repair/reconstruction, amputation, nerve repair/reconstruction, neuroplasty, primary closure, and skin graft. Conversely, plastic surgery trainees performed fewer intro/removal, open or closed fracture treatment, arthroscopy, and replant/revascularization procedures (Figure 1 [Fig. 1]).

Overall disparities exist in case exposure between plastic surgery and orthopaedic surgery trainees. Overall, orthopaedic surgery trainees do not appear to be receiving a similar proportion of soft tissue and nerve procedure volume as do their plastic surgery counterparts prior to hand fellowship.