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Low Levels of Evidence for Clinical Management Questions on the Plastic Surgery In-Service Training Exam
Jason Silvestre, B.S., Anthony J. Taglienti, M.D., Jospeh M. Serletti, M.D., Benjamin Chang, M.D..
The Perelman School of Medicine, Philadelphia, PA, USA.

PURPOSE:
The In-Service Exam for Plastic Surgeons (IEPS) is written by the American Society of Plastic Surgeons (ASPS). Examinees reasonably infer that tested material reflects the Society’s vision for the core curriculum of plastic surgery knowledge to be mastered during residency. The purpose of this study was to examine the levels of evidence (LOE) on which credited answers to IEPS clinical management questions are based.
METHODS:
Three consecutive IEPS administrations (2012-2014) were reviewed for clinical management questions. Recommended citations in support of credited answers were reviewed for LOE assigned according to the ASPS ratings level scale. Independent sections were analyzed for differences in LOE.
RESULTS:
251 of the 600 questions reviewed tested clinical management (42%). The comprehensive (49%) and extremity (50%) sections had more clinical management questions than the craniofacial (37%) and breast/cosmetic sections (31%) (p<0.05). Only 8% of studies were classified as high quality studies (Level I-II). Overall, the number of studies categorized by LOE is presented in Figure 1.
CONCLUSION:
A significant portion of IEPS questions test clinical management skills (42%) and most are supported with low LOE. This observation is consistent with low LOE in the plastic surgery literature and a constantly evolving standard for clinical practice. Educators should recognize, however, the potential for biases of individual question writers.


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