title: Variable Operative Experience in Hand Surgery for Plastic Surgery Residents.
abstract: BACKGROUND
  Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs.
  
  
  METHODS
  Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015.
  
  
  RESULTS
  Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015.
  
  
  CONCLUSIONS
  Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation.
authors.affiliation: Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason
authors.initials: J
authors.lastname: Silvestre
authors.affiliation: Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ines C
authors.initials: IC
authors.lastname: Lin
authors.affiliation: Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lawrence Scott
authors.initials: LS
authors.lastname: Levin
authors.affiliation: Division of Plastic Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Benjamin.chang@uphs.upenn.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chang
mesh_terms: D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D013518:Surgery, Plastic / Q000193:education*; D014481:United States
keywords: ACGME; Patient Care; Practice-Based Learning and Improvement; case log; hand; plastic surgery; resident