The State of Burn Care Training During Plastic Surgery Residency

Effect of Training Backgrounds on Plastic Surgery Leadership: A Logistic Regression Analysis

Background

Although career choices are often shaped by training and mentors, it is not clear how training backgrounds have influenced whether plastic surgeons pursue leadership positions. Analysis of these training pathways can serve as a key component of career planning for future leaders.

Methods

The American Board of Plastic Surgery's annual Newsletter to Diplomates was used to collate surgeons receiving board certification between 2002 and 2013. Online public profiles were used to collect training background data about each surgeon, including fellowship training, board certification year, MBA degree, otolaryngology or maxillofacial surgery training before commencing plastic surgery training, and leadership positions in surgery. A logistic multinomial regression was used to test the effect of training backgrounds on different types of leadership positions.

Results

In total, 2190 plastic surgeons were included in the analysis. Factors increasing the probability of holding any type of position included fellowships in microsurgery, craniofacial, and hand; an international fellowship; multiple fellowships; a fellowship not otherwise specified; and MBA degree. Training background factors affected probabilities differently for each of the studied positions including chair/chief, vice chair/vice chief, program director, plastic surgery medical director, other institutional positions, and national society positions.

Conclusions

Training backgrounds of plastic surgeons in leadership positions are multifaceted, involving a mix of intrinsic and extrinsic factors such as additional educational pursuits, subspecialty training, duration of practice, and practice setting. This analysis can help direct current trainees who aspire to future leadership in plastic surgery.

Setting an agenda for a national pediatric trauma system: Operationalization of the Pediatric Trauma State Assessment Score

ABSTRACT

Pediatric trauma system development is essential to public health infrastructure and pediatric health systems. Currently, trauma systems are managed at the state level, with significant variation in consideration of pediatric needs. A recently developed Pediatric Trauma System Assessment Score (PTSAS) demonstrated that states with lower PTSAS have increased pediatric mortality from trauma. Critical gaps are identified within six PTSAS domains: Legislation and Funding, Access to Care, Injury Prevention and Recognition, Disaster, Quality Improvement and Trauma Registry, and Pediatric Readiness. For each gap, a recommendation is provided regarding the necessary steps to address these challenges. Existing national organizations, including governmental, professional, and advocacy, highlight the potential partnerships that could be fostered to support efforts to address existing gaps. The organizations created under the US administration are described to highlight the ongoing efforts to support the development of pediatric emergency health systems.It is no longer sufficient to describe the disparities in pediatric trauma outcomes without taking action to ensure that the health system is equipped to manage injured children. By capitalizing on organizations that intersect with trauma and emergency systems to address known gaps, we can reduce the impact of injury on all children across the United States.

Plastic Surgery in Burn Care: A Call for Enhanced Burn Surgery Training Within Plastic Surgery Residency Programs

ABSTRACT

A 10 year cohort of patients admitted to a verified burn unit were analyzed to assess the role of plastic surgeons in the operative management of those patients. All 3843patients were admitted during this study period. Of these, 1509 of those patients underwent surgical procedures. Plastic surgeons performed 658 operations on these patients, including acute and delayed reconstruction of hand and facial burn injuries. In this population, plastic surgeons played a critical role in acute and reconstructive burn injuries in anatomically complex areas. This series illustrates the need for plastic surgery training in burn care.

The health workforce conundrum for burn care in Uttar Pradesh, India: a qualitative exploration

Delivering specialised care for major burns requires a multidisciplinary health workforce. While health systems 'hardware' issues, such as shortages of the healthcare workforce and training gaps in burn care are widely acknowledged, there is limited evidence around the systems 'software' aspects, such as interest, power dynamics, and relationships that impact the healthcare workforce performance. This study explored challenges faced by the health workforce in burn care to identify issues affecting their performance. Qualitative in-depth interviews were conducted with a purposively selected sample (n = 31, 18 women and 13 men) of various cadres of the burn care health workforce in Uttar Pradesh, India. Inductive coding and thematic analysis identified three major themes. First, the dynamics within the multidisciplinary team where complex relations, power and normative hierarchy hampered performance. Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn injuries and multitasking. Third, dynamics between specialised burn units and broader health systems are narrated in challenges due to inadequate first response and delayed referral from primary care facilities. These findings indicate that burn care health workers in India face multiple challenges that need systemic intervention with a multipronged human resource for health framework.

Exploring Trends in Immediate Postresidency Career Paths: A Multi-year Analysis of Plastic Surgery Resident Graduates Across the United States

Background

Plastic surgery is one of the most diverse specialties in medicine. Because of the competitiveness of plastic surgery residency, applicants are entering the field with increased experience and more developed interests in specific specialties. Programs and prospective applicants may find it beneficial to know trends in the career paths of recent graduates.

Objectives

To identify trends in postresidency career paths for plastic surgery graduates.

Methods

Data from all integrated plastic surgery residency programs were analyzed from 2013 to 2022. Eighty-eight residency programs were analyzed for review. Residency websites were the primary source of data. Postresidency career paths were categorized into subspecialty fellowships, academic practice, or private practice. Secondary data included program rank, size of the program, associated fellowship program, associated independent program, and program location.

Results

Seventy-three programs met the inclusion criteria. Private practice was the most common immediate postgraduation path. Microvascular and aesthetic fellowships demonstrated maximum growth in the last 10 years, followed by hand fellowships. Programs ranked in the top 25 by Doximity reputation were significantly associated with graduates going into craniofacial (P = .05) and microvascular fellowship (P = .021), and immediate academic practice (P = .011). Lower-ranked programs were correlated with higher levels of graduates entering directly into private/community hospital practice (ρ = 0.327).

Conclusions

Life after residency is a necessary consideration for training physicians. Understanding trends in postresidency career paths could help programs and prospective applicants make more informed decisions on what programs may offer the best opportunities to pursue their desired career path.

Level of Evidence 5

Practice Profile of Practicing Plastic Surgeons: A 20-year Review of Plastic Surgery Statistics

Background

Evaluation of practice patterns by American Board of Plastic Surgery (ABPS) diplomates allows for a greater understanding as to how the field is progressing. Understanding evolving procedural trends can give insight into plastic surgeons' subspecialty focus and influence resident training to prepare them for future practice.

Methods

American Society of Plastic Surgeons member only projections for aesthetic and reconstructive procedures were reviewed from 1999 to 2018 in 5-year increments to identify shifts in frequency between the beginning (1999-2003) and end (2014-2018) of the timeframe. Tracer utilization for all four ABPS modules were also examined between 2014 and 2018. Descriptive statistics were performed to identify significant changes (P < 0.05) in subspecialty focus and procedure trends.

Results

Annual procedure incidence between 2014 and 2018 was compared with that between 1999 and 2003. The annual number of procedures more than doubled from 3,244,084 to 6,628,082. Among reconstructive procedures, there was a statistically significant increase in the number of breast reconstruction, breast implant removal, and maxillofacial surgery procedures, and a statistically significant decrease in the number of procedures focused on reconstruction of birth defects, burn injuries, and hand anomalies. In aesthetic surgery, significant increases were seen in the number of augmentation mammoplasty, abdominoplasty, and mastopexy procedures, with significant decreases in the number of blepharoplasty and rhinoplasty procedures.

Conclusions

Understanding the changing practice patterns of ABPS diplomates is essential to define the direction that our specialty is taking over time, and to guide program directors in plastic surgery on areas of focus for appropriate training of plastic surgeons.

Thinking like a Lawyer-Human Rights and Their Association with the Plastic Surgeon of Today

Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR). LEVEL OF EVIDENCE V: "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

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.

Who manages burn injuries in children? A program director survey evaluating burn training during pediatric surgery fellowship

PURPOSE

Burn is one of the leading causes of injury and death in children. Currently, the Residency Review Committee does not require general surgery residents to rotate on a burn service. With many trainees no longer receiving burn training during residency, we sought to evaluate the exposure to burn management in pediatric surgery training programs.

MATERIAL AND METHODS

An electronic survey was sent to program directors at accredited pediatric surgery training programs (56) during the 2020 academic year. Case log reviews were performed for 2005-2019. Descriptive statistical analysis was performed.

RESULTS

Thirty-six program directors participated in the survey (64%), and 56% reported having an inpatient and outpatient component for burn management. Nearly 20% of program directors reported having no burn management at their institution. Fifty-four percent of responding programs had fellow participation in burn management. Over a fifteen-year period, case logs identified a median of 0-2 burn cases logged each year for graduating fellows. Logistically, 65% of burn centers relied on general pediatric surgeons for management.

CONCLUSION

Pediatric surgery trainee involvement in burn management varies with many programs offering no designated burn training. Increasing exposure to pediatric burn management during training is needed to provide improved care for this patient population.

LEVEL OF EVIDENCE

III, Retrospective Review.

Impact of interprofessional in situ simulations on acute pediatric burn management: Combining technical and non-technical burn team skills

OBJECTIVE

This study aimed to evaluate the impact of interprofessional in situ simulations on the technical and non-technical skills of pediatric burn teams in acute burn management.

METHODS

This quasi-experimental study consisted of a one-group pre- and post-test design conducted in a pediatric burn center in Turkey. The sample consisted of nine interprofessional burn team members. Data collection tools consisted of the following: descriptive data form, burn technical skills checklists, simulation evaluation form, and Anesthesiologists' non-technical skills in Denmark rating form.

RESULTS

We found no statistically significant difference between the pre- and post-test scores for technical (p = 0.285) and non-technical skill (p = 0.180) scores. Burn team members evaluated the highest score in almost all criteria for in situ simulations.

CONCLUSION

The interprofessional in situ simulations did not improve the burn teams' acute burn management; however, according to a self-report, burn team members were satisfied with the interprofessional in situ simulation experiences and achieved their own gains.

Plastic surgical trainees' perspectives toward burn surgery in Australia and New Zealand: Changes in the last 17 years?

INTRODUCTION

An emerging amount of literature emphasises the ever-growing shortage of burn surgeons worldwide. Despite burn surgery being a fundamental competency in the Australia and New Zealand plastic and reconstructive surgery training curriculum, a perceived lack of interest amongst trainees exists. The aim of this study was to investigate Australasian plastic surgery trainees' interest in burn surgery as a career and compare with the Brown and Mills survey in 2004.

METHODS

An electronic survey was distributed to all Australian and New Zealand plastic and reconstructive surgery trainees during the March 2021 registrar trainee conference. This anonymous survey was adapted from the original survey conducted by Brown and Mills in 2004, with additional questions to determine the perceived importance of burns surgery as a subspecialty of plastic and reconstructive surgery, and to elicit possible solutions to the issue of workforce shortage. A reminder email was sent one month following the conference to improve the response rate. The survey was hosted by Survey Monkey (San Mateo, California, USA).

RESULTS

The survey was distributed to all 121 trainees and 71 (58.7%) responded. An increase in interest amongst trainees in pursuing a career in burn surgery was found, with 34 trainees (48.6% of respondents) interested, mostly on a half time or sessional basis. The three most common barriers to practising burn surgery remain unchanged, and were nature of burn operations, nature of burn care and on-call commitments; inadequacy of exposure or training ranked fourth. We found a strong overall response that burn surgery and burn care remained an important component of plastic and reconstructive surgery.

DISCUSSION

Inadequate exposure or training has evolved to present a bigger barrier in this study compared to a similar study conducted 17 years ago. Burn units and training bodies may offer additional job placements to address these feelings of insufficient exposure. Facilitating employment of burn surgeons on a half-time or sessional capacity is a sustainable model, and will arguably improve clinical service provision. Strong and early mentorship and allocation of commensurate resources and funding will help to address the high workload.

CONCLUSIONS

Interest in burn surgery has improved over the last 17 years and the most common deterrents persist, namely nature of burn operations, nature of burn care and on-call commitments. However, many of these issues are modifiable or amenable to change. The opportunity exists for relevant stakeholders to address some of these concerns raised, and thereby addressing the issue of burn surgeon shortage.

[COVID-19 and plastic surgery: aesthetic surgery or essential medical care? - Impact of the COVID-19 pandemic on patient care in the plastic surgery department at an university hospital]

Einleitung  Im Frühjahr 2020 machte die COVID-19-Pandemie weitreichende Veränderungen und Maßnahmen in bisher nie dagewesenem Ausmaß notwendig. Diese Maßnahmen zielten einerseits darauf ab die Ausbreitung der Virusinfektion einzudämmen, und andererseits die landesweite Krankenversorgung weiterhin zu gewährleisten, insbesondere um im Falle einer größeren Anzahl an mit COVID-19 infizierten Patienten ausreichend Intensivkapazitäten zur Verfügung zu haben. In Bezug auf operative Fächer bedeutete dies das temporäre Aussetzen des Elektivprogramms auf unbestimmte Zeit. Ziel dieser Studie war es die Auswirkung dieser Maßnahmen auf das Behandlungsspektrum eines plastisch-chirurgischen Zentrums zu evaluieren.

Methode  Die Operationszahlen der klinischen Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie der medizinischen Universität Graz während des sog. Lockdowns von 16.3.2020 bis 26.4.2020 (6 Wochen) sowie 2 Wochen davor wurden retrospektiv erhoben. Die Daten wurden zum korrespondierende Vorjahreszeitraum verglichen. Untersucht wurden u. a. Operationsspektrum, Dringlichkeit, Indikation und Komplikationsraten.

Ergebnisse  Durch den Wegfall des Elektivprogramms kam es während des Lockdowns im Jahresvergleich zu einem signifikanten Rückgang der OP-Zahlen um 57,5 % (2019: 353, 2020 150 Fälle). Während des Lockdowns wurden im Jahresvergleich signifikant mehr Notfall- und Akuteingriffe durchgeführt (2019: 41, 2020: 58 Fälle, p < 0,001). Außerdem wurde eine signifikante Häufung von Selbstverletzungen bzw. Suizidversuchen beobachtet (2019: 0, 2020: 16 Fälle, p > 0,001). Hinsichtlich Privat- und Arbeitsunfällen gab es keine signifikanten Unterschiede. Es zeigte sich auch kein signifikanter Unterschied bezüglich der Komplikationsrate (2019: 6,8, 2020: 10 %, p = 0,219).

Zusammenfassung  Ein signifikanter Anteil plastisch-chirurgischer Operationen an einem Universitätsklinikum mit überregionalem Versorgungsauftrag besteht aus Notfalloperationen, akuten und dringenden medizinisch notwendigen Operationen. Während des Lockdowns wurden Operationen ohne signifikanten Anstieg der Komplikationsrate durchgeführt. Trotz sämtlicher Herausforderungen während der Pandemie konnte eine qualitativ konstante Patientenversorgung auf höchstem Niveau gewährleistet werden. Um die während des Lockdowns angehäuften weniger dringenden, jedoch ebenso wichtigen Fälle zeitgerecht und in entsprechend hoher Qualität abzuarbeiten, wird eine Erweiterung der Operationskapazitäten mit Steigerung der Bettenanzahl und der Ambulanzkapazität notwendig sein. Die vorliegenden Ergebnisse zeigen, wie wichtig die Plastische Chirurgie für die medizinische Versorgung insbesondere in Krisenzeiten ist.