Correlation Between Fellowship Applications and Work Hour Restrictions on Microsurgical Performance
Edward I. Chang, MD, FACS1, Matthew M. Hanasono, MD1, Stefanos Boukovalas, MD2, Jun Liu, PhD1, Patrick B. Garvey, MD1, Charles E. Butler, MD1, Jesse C. Selber, MD1.
1The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 2The University of Texas Medical Branch, Galveston, TX, USA.
PURPOSE: While fellowship applications provide a broad overview of an applicant's accomplishments, it is not clear if the solicited data correlate with clinical performance. The study aims to examine the correlation between microsurgical fellowship applications and work hours with microsurgical skills.
METHODS: Microsurgery fellows from 2010-2014 were reviewed and prospectively evaluated using the previously validated Structured Assessment of Microsurgical Skills (SAMS) tool at the start and end of the fellowship, in an animal laboratory model and clinical microsurgical cases.
RESULTS: Twenty-nine fellows were included. During the laboratory evaluation, female gender was associated with significantly higher SAMS scores, while graduating from a top ten undergraduate university correlated with higher clinical scores. Phi Beta Kappa (PBK) and Alpha Omega Alpha (AOA) status were associated with significantly lower laboratory SAMS scores. Training in a combined or integrated plastic surgery residency was associated with significantly higher clinical and laboratory SAMS scores. Training prior to the 80-work week restrictions trended towards higher scores but did not reach statistical significance. By the conclusion of the fellowship, there were no differences in SAMS scores based on any of the factors on the microsurgery fellowship applications.
CONCLUSION: Combined plastic surgery training, as opposed to the independent pathway, was strongly associated with higher SAMS scores in both laboratory and clinical performance. Performance in the laboratory differed from clinical performance, and work hour restrictions had no impact on SAMS scores. The 1-year fellowship was sufficient to level any performance differences observed at the beginning of the fellowship.
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