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The Plastic Surgery Hand Curriculum
Jason Silvestre, B.S.1, Anthony J. Taglienti, M.D.2, Joseph M. Serletti, M.D.2, Benjamin Chang, M.D.1.
1The Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2The Perelman School of Medicine, Philadelphia, PA, USA.

PURPOSE:
Designing an effective hand rotation for plastic surgery residents is difficult. We address this knowledge gap by elucidating the critical components of the hand curriculum during plastic surgery residency.
METHODS:
Answer keys for six consecutive administrations of the In-Service Exam for Plastic Surgeons (2008-2013) were reviewed for hand content. Questions were classified by taxonomy, anatomy, and subject. Keyed references were quantified by source and year of publication.
RESULTS:
263 questions addressed the upper extremity over six years (22.4% of all questions). Most questions tested medical decision-making (58.1%). A third of all questions addressed aspects of digits II-V (33.1%) (Table 1). Questions focused on injuries to nerves (13.7%), tendons (13.7%), and soft tissue (11.8%). The Journal of Hand Surgery (American) (20.6%) and Plastic and Reconstructive Surgery (17.6%) were the highest yield sources. References were published a mean of 10.2 years prior to IEPS administration (range, 1-51). Green’s Operative Hand Surgery was the most referenced textbook (43.2%).
CONCLUSION:
These data will enable trainees to study hand surgery topics more efficiently. Faculty can also utilize our results to ensure commonly tested topics are covered during residency training. Thus, our results will help establish a benchmark to improve didactic, clinical, and operative experiences in hand surgery.
Distribution of Hand Questions by Anatomic Focus
Anatomic Focus200820092010201120122013TotalAverage (%) for 2008-2013
Thumb825157284.0 (10.5)
Digits II-V1413141616148714.5 (33.1)
Metacarpals723484284.7 (10.5)
Carpals357423244.0 (9.1)
Distal forearm414534213.5 (8.0)
Mid and proximal forearm515846294.8 (11.0)
Elbow00323191.5 (3.4)
Upper arm434223183.0 (6.8)
No specific area255233203.3 (7.6)


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