Hand surgery is a unique subspecialty in which one can train after completion of either a plastic, orthopedic, or general surgical residency. This study compared hand surgery experience in residency among these different training pathways.
The Accreditation Council for Graduate Medical Education case logs of graduating residents in general surgery, orthopedic surgery, and plastic surgery were evaluated for the years 2009 through 2018. Cases were grouped according to the council’s categories for hand surgery. Comparisons between specialties were made using a one-tail analysis of variance with a 95 percent confidence interval.
There were 19,159 residents total in the study period: 11,189 general surgery, 7290 orthopedic surgery, and 1040 plastic surgery residents. General surgery residents performed the fewest total hand operations per individual resident; plastic surgery residents performed the most. Plastic surgery residents performed 166 percent more hand operations per resident than orthopedic surgery residents, who performed 31,512 percent more hand operations than general surgery residents. Analysis of variance demonstrated significant differences in hand surgery experiences of residents in these specialties for each category with a 95 percent confidence interval. Plastic surgery residents performed more operations than orthopedic surgery residents in all categories studied, including tendon, nerve, amputation, soft-tissue, fracture, and vascular cases (p < 0.01 for each category).
There are significant differences in the preparation of resident trainees for entry into a hand surgery fellowship. The lack of uniform exposure to hand surgery represents an opportunity to best tailor fellowship training. Orthopedic and plastic surgery residents have wide exposure to hand surgery, but plastic surgery residents participate in a greater volume of hand operations. General surgery residents have significantly less exposure to hand surgery, which may impact preparation for hand surgery fellowship. Fellowship directors and society governing boards should recognize the diverse backgrounds among individuals trained in general, orthopedic, and plastic surgery early in the fellowship year and address the expected differences. The education of fellows should be individually optimized with both targeted education and encouragement for trainees to seek out broad training during hand surgery fellowship.

Copyright © 2021 by the Association of American Medical Colleges.