title: Gaps in exposure to essential competencies in hand surgery fellowship training: a national survey of program directors.
abstract: BACKGROUND
  Graduate medical education has moved towards competency-based training. The aim of this study was to assess hand surgery program directors' opinions of exposure gaps in core competencies rated as essential for hand surgery training.
  
  
  METHODS
  We surveyed the 74 ACGME hand surgery fellowship program directors. Respondents rated their opinion of 9 general areas of practice, 97 knowledge topics, and 172 procedures into one of three categories: essential, exposure needed, or unnecessary. Program directors also rated trainee exposure of each component at their respective program. Moderate and large exposure gaps were respectively defined as presence of at least 25 and 50 % of programs rating trainees as not having proficiency in the component at the end of training.
  
  
  RESULTS
  Sixty-two of 74 program directors (84 %) responded to the survey. For the 76 knowledge topics and 98 procedures rated as essential, a majority of the knowledge topics (61 %; n = 46) and procedures (72 %; n = 71) had at least a moderate exposure gap. In addition, 22 % (n = 17) of the essential knowledge topics and 26 % (n = 25) of the essential procedures had a large exposure gap.
  
  
  CONCLUSIONS
  This study illuminates the discrepancies between what is believed to be important for practicing hand surgeons and graduates' proficiency as perceived by program directors. The field of hand surgery must work to determine if program directors have unrealistic expectations for what is essential for practicing hand surgeons or if reforms are needed to improve exposure to essential skills in hand surgery training.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340 USA.
authors.forename: Erika Davis
authors.initials: ED
authors.lastname: Sears
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340 USA.
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Larson
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340 USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
keywords: Competencies; Competency-based training; Hand surgery fellowship; Hand surgery training; Medical knowledge; Patient care