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Trends in Operative Performance for Independent and Integrated Plastic Surgery Residents: How Soon Do Independent Residents Catch Up?
Meredith L. Meyer, MD1, Ricardo J. Bello, MD, MPH2, Damon S. Cooney, MD, PhD2, Gedge D. Rosson, MD2, Scott D. Lifchez, MD2, Carisa M. Cooney, MPH2.
1Inova Fairfax Medical Center, Falls Church, VA, USA, 2Johns Hopkins University, Baltimore, MD, USA.

Purpose: This study aimed to differentiate between integrated (PGY4-PGY6) and independent (PGY1-PGY3) plastic surgery residents regarding their operative competency and evaluate whether any discrepancy exists between these groups during plastic surgery training.
Methods: We compared independent and integrated plastic surgery residents at our institution using operative performance data from the Operative Entrustability Assessment (OEA), a validated assessment tool that provides residents with real-time feedback about their operative performance and documents that performance at point-of-care. Independent PGY1, PGY2, and PGY3 were categorized as PGY4, PGY5, and PGY6, respectively. We analyzed OEA evaluator scores for the two groups over time, using Wilcoxon rank-sum test to compare groups.
Results: During 2013-2016, 2,570 OEAs were completed for residents at PGY4-6. Of these, 1,389 (54.1%) were logged by independent and 1,181 (46%) by integrated residents. OEA evaluator scores were slightly lower for independent track residents throughout the first three quarters of PGY4 (p<0.001, p<0.001, and p=0.029, respectively). However, this difference was no longer statistically significant during the fourth quarter of PGY4 (p=0.220). As residents progressed in their training, this difference also was not detectable at PGY 5 (p= 0.781) or PGY 6 (p= 0.524).
Conclusions: OEA data demonstrates independent plastic surgery residents perform slightly lower than their integrated colleagues during the first three quarters of their first year. However, they readily demonstrate a statistically comparable level of competency after this period, indicating minimal drawbacks to incorporating independent residents with integrated residents in plastic surgery training programs.


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