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A Comparison of Plastic and Orthopaedic Hand Surgery Curricula
Jason Silvestre, BS1 J.Z. Guzman, BS2; Benjamin Chang, MD3; L. Scott Levin, MD4
1Perelman School of Medicine, Philadelphia, PA; 2Icahn School of Medicine, New York City, NY; 3Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA; 4Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA

Background: Orthopaedic and plastic surgery residents receive unique hand surgery training, yet often compete for similar fellowships in hand surgery. This wide variation in training background has historically been viewed as a strength to the specialty, but recent interest has emerged to help unify the core of hand surgery training. The purpose of this study was to examine hand content on the In-Service Exam for Plastic Surgeons (IEPS) and compare it with content on its orthopaedic counterpart.

Methods: Score keys of six consecutive IEPS administrations were reviewed for questions related to the hand or distal forearm (2008-2013). Questions were categorized by taxonomic classification, anatomical location, diagnosis, and treatment. Keyed references were analyzed to determine the most frequently cited sources. Results were compared to a previously published study on the Orthopaedic In-Training Examination (OITE). Comparisons were made via Fisher’s test. It was determined that our sample size was sufficient at a power of >80% to reveal significant p values.

Results: More questions addressed the hand and forearm on the IEPS compared to the OITE (20.3% versus 8.1%, p<0.001). Questions were similar by taxonomy classification, but focused on different anatomical locations. For example, questions on the IEPS more commonly addressed fingers (54.6% versus 33.0%, p<0.001), but questions on the OITE more commonly addressed the wrist (30.4% versus 15.5%, p=0.002). Furthermore, questions on the two exams tested different diagnoses and treatment modalities. Fractures were more common on the OITE (26.8% versus 13.0%, p=0.002), but wounds were more common on the IEPS (18.1% versus 6.3%, p=0.003). Similarly, therapy and rehab was more common on the OITE (7.1% versus 1.7%, p=0.022), but flaps and replants were more common on the IEPS (19.3% versus 10.7%, p=0.046). The focus of the referenced literature in support of the correct answers also differed by exam. The top 3 cited journals for the OITE were Journal of Bone and Joint Surgery, American; Journal of Bone and Joint Surgery, British; Clinical Orthopaedics and Related Research; whereas those for the IEPS were Journal of Hand Surgery, American; Plastic and Reconstructive Surgery; Hand Clinics. The top textbook for the OITE was Hand Surgery Update, and for the IEPS was Green’s Operative Hand Surgery.

Conclusions: Hand curricula for orthopaedic and plastic surgery residents emphasize different diagnoses and treatment modalities. These results will assist educators quantify differences in exposure to hand surgery prior to hand fellowship, and help establish a benchmark for future modifications to the hand surgery curriculum.

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