Comparing Operative Performance between Independent and Integrated Plastic Surgery Residents

Background: Anecdotally, faculty report that independent residents' operative skills differ from those of their integrated peers. This study compared operative competency between integrated (postgraduate years 4 to 6) and independent plastic surgery residents. Methods: The authors compared independent (postgraduate years 1 to 3) and integrated (postgraduate years 4 to 6) plastic surgery residents at their institution using operative performance data from the Operative Entrustability Assessment, a validated five-point assessment tool that provides residents with real-time feedback about their operative performance, documenting performance at the point of care. Independent postgraduate year 1, 2, and 3 residents were categorized as postgraduate year 4, 5, and 6 residents, respectively, for comparison. The authors analyzed attending physician (evaluator) Operative Entrustability Assessment scores over time using the independent t test. Results: From July 1, 2013, to June 30, 2018, Operative Entrustability Assessments were completed at one training program for residents in postgraduate years 4 to 6: 1886 (47.4 percent) by independent [n = 12 (37.5 percent)] and 2094 (52.6 percent) by integrated [n = 20 (62.5 percent)] residents. Evaluator scores were lower for independent track residents throughout the first two quarters of postgraduate year 4 (quarter 1 delta, -0.49 point, p < 0.001; quarter 2 delta, -0.36 point, p < 0.001). However, this difference was no longer statistically significant during the third and fourth quarters of postgraduate year 4 (p = 0.192 and p = 0.228, respectively). No difference was detectable at postgraduate year 5 (p = 0.095) or postgraduate year 6 (p = 0.877). Conclusions: Operative Entrustability Assessment data demonstrate that differences between independent and integrated plastic surgery residents regarding operative skills (0.49 of 5 points) and amount of time needed for independent residents to catch up (6 months) is minimal and resolves during the third quarter of independent postgraduate year 1. Programs can design curricula to facilitate independent residents' plastic surgery skill acquisition during their first two quarters.