title: The scope of practice of hand surgery within plastic surgery: the ACAPS national survey to assess current practice and develop educational guidelines.
abstract: BACKGROUND
  There is no consensus among plastic surgeons regarding what constitutes the scope of hand surgery practice. Due to this lack, there is a wide variability in what hand surgery procedures plastic surgery resident will see and participate in during the course of training. We assessed what faculty members of plastic surgery training programs felt were contained within the scope of practice of hand surgery.
  
  
  METHODS
  A survey was sent to all members of the American Council of Academic Plastic Surgeons. Respondents reported size of department, faculty fellowship training, hand surgery call coverage, and amount of elective hand surgery within their training program. They also identified what procedures were within the scope of hand surgery.
  
  
  RESULTS
  Ninety-three responses were received. Thirty-five respondents were certified or eligible for the surgery of the hand examination. Twenty-five respondents had 0 or 1 surgery-of-the-hand surgeon among their faculty. Thirty-nine departments/divisions performed 10 or fewer elective hand surgeries per week. Seventy-eight percent of groups taking hand call reported that all faculty members took hand call regardless of whether they had hand fellowship training. Although nearly all cover hand and wrist infections, only 49% provide care for distal radius fractures.
  
  
  CONCLUSIONS
  In many residency programs, hand surgery exposure is in the setting of trauma and emergencies. The inclusion of complex elective hand surgeries within a plastic surgery practice and residency program allows residents to see the full spectrum of hand surgery. This allows them to make an informed decision regarding whether to seek subspecialty training and continue the participation of plastic surgeons in the full spectrum of hand surgery.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD; †Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA; and ‡Division of Plastic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lifchez
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Friedrich
authors.forename: C Scott
authors.initials: CS
authors.lastname: Hultman
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D005180:Faculty, Medical; D005257:Fellowships and Scholarships; D006225:Hand / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D013038:Specialization; D013518:Surgery, Plastic / Q000193:education / Q000706:statistics & numerical data*; D014481:United States