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Assessing Hand Surgery Resident Knowledge: A Comparative Analysis of Orthopaedic Surgery and Plastic & Reconstructive Surgery In-Service Training Exams
Amogh Iyer, BSE
1, Alexander Lee, MD
1, Benjamin A Sarac, MD
1, Ryan Schmucker, MD
2, Hisham M. Awan, MD
3; Azeem Tariq Malik, MBBS
1(1)The Ohio State University Wexner Medical Center, Columbus, OH, (2)The Ohio State University Medical Center, Columbus, OH, (3)Hand & Upper Extremity Center, Ohio State University, Hand & Upper Extremity Center, Columbus, OH
Introduction: Hand surgery is a shared sub-specialty between orthopaedic surgery and plastic surgery. While there is significant overlap in the pathologies addressed by orthopaedic and plastic surgery trained hand surgeons, we hypothesized that there are differences in the clinical and educational content taught during the hand rotations for orthopaedic surgery residents and plastic surgery residents.
Methods:This was a retrospective cohort study that utilized hand surgery questions from the 2020-2024 Orthopaedic Surgery In-Training exam and 2019-2023 Plastic and Reconstructive Surgery In-Training Exam. A careful review of both specialties exams was performed. Descriptive and statistical analysis was performed on relevant hand surgery questions.
Results:A total of 366 questions were analyzed [150 (41%) = ORS, 216 (59%) = PRS]. There was a higher proportion of treatment/management questions in the ORS cohort (43% vs 29%; p=0.015), with a heavy operative focus (59% vs. 48%; p=0.015). PRS questions focused more on hand/distal to carpus (71% vs. 30%; p<0.001) and had lower proportion of wrist/carpus/distal radius/ulna related questions (26% vs. 11%; p<0.001). Majority of the ORS questions were trauma-related (46% vs. 41%; p<0.001), whereas PRS questions were mostly related to elective surgery (52% vs. 36.7%; p<0.001). There was a higher percentage of fracture/dislocation questions in the ORS cohort (33% vs. 10%; p<0.001), with majority of those questions related to the elbow (33% vs. 5%; p=0.003). When compared to ORS questions, there was a significantly higher proportion of PRS questions related to nerve (12.5% vs. 10.0%; p<0.001), soft tissue reconstruction/amputation (22.2% vs. 6.7%; p<0.001), tumor (11.1% vs 1.3%; p<0.001) and congenital anomalies (9.3% vs. 6.0%; p<0.001). There was a higher proportion of radiological imaging in the ORS questions (39.3% vs. 8.3%; p<0.001). We observed that PRS questions have a significantly higher number of references per questions (p<0.001). PRS questions were more likely to have a LOE 1 or 2 study referenced in questions (7.4% vs. 2.7%; p=0.098). Up to 24% of PRS questions had a textbook as a reference (vs 6% of ORS questions; p<0.001). ORS questions utilized more recent LOE 1-4 studies (Median 6.5 vs. 8.25 years; p<0.001).
Discussion/Conclusion:
This analysis highlights key content differences in hand surgery content on the ORS and PRS in-service exams. These findings demonstrate how specialty training influences exam content. Future studies can look at how the differences in curriculum affect readiness for hand surgery fellowships which take both plastic surgery and orthopaedic surgery residents.
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