Variable Experience in Microsurgery and Flap-Based Procedures Among Canadian Plastic Surgery Residents

Dear Program Directors: There Are Numerous Entrustable Professional Activities on a Burns Rotation!

Background: Burn care has long been an integral part of the scope of plastic surgery, but the time allocated to exposure for plastic surgery residents is under threat due to the range of sub-specialities competing for their time. As part of the Competence by Design approach to plastic surgical training, residents are provided with a list of 52 "Entrustable professional activities' (EPA's) to ensure that core skills and knowledge are acquired. Methods: This survey, distributed via email using a link to Survey MonkeyTM, sought to determine which EPA's were available for completion by plastic surgeons in training during the burn rotation at a major academic burn centre in Canada. Via investigator consensus, 26 of the 52 EPA's were included for assessment; the remaining 26 were not regarded as relevant to the burn centre rotation and therefore better acquired elsewhere. Results: Thirty two residents who underwent a burn rotation between 1 January 2015 and 31 December 2021 completed the anonymous survey. Seventeen of the 26 EPA's evaluated were judged by more than 75% of respondents as being readily amenable to completion during the burn rotation. Most of these EPA's relate to the comprehensive care of patients with acute burn injuries, the management of an in-patient plastic surgery service, and associated quality improvement processes. Residents who completed rotations less than three months in duration had less opportunity to complete a further 8 EPA's in comparison to those who had longer rotations, especially with respect to the care of patients undergoing complex wound care and burn reconstruction. Conclusions: In addition to threatening seamless service delivery at burn centres, reduced resident exposure to the burn rotation may compromise the delivery of burn care in the community. The results of this survey refute any argument that the burn service is a "low yield" rotation from an EPA acquisition perspective.