Toward outcomes-based plastic surgery training: A needs assessment of recent graduates

Background: The Accreditation Council for Graduate Medical Education Outcomes Project mandates data-driven improvements to training programs. Few outcomes measures exist in plastic surgery. The purpose of this study was to determine how well we presently train plastic surgery residents within the context of the council's competencies and how well those competencies are practiced after residency. Methods: Plastic surgery graduates from 2000 to 2005 were surveyed using a new questionnaire organized around the accreditation council's competencies. Scores from individual item responses were averaged to create a composite score reflecting the quality of training and practice of each competency. Composite scores were then compared using nonparametric analyses. Data regarding currently used assessment tools were also measured. Results: The response rate was 21 percent. The respondent sample was representative of current plastic surgeons. Overall, the competencies were considered important, with increasing awareness in more recent years. Practice-based learning and improvement appeared to be the best taught, and systems-based practice appeared to be the most poorly taught. There were differences between independent and integrated formats but they did not support one over the other. Women did not rate their training as highly as men did in some areas, and open comments suggested there were significant issues at some programs. Conclusions: Recent graduates view plastic surgery training as excellent. The competency domain in greatest need of attention is systems-based practice. We must broaden our use of assessment instruments for more valid results and investigate gender differences in our training programs. These results describe the outcomes of current plastic surgery training and serve as a needs assessment for improvement and as a baseline for future comparison.