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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Comparison of Quantitative Educational Metrics Between Integrated and Independent Plastic Surgery Residents
Lifei Guo, M.D., Ph.D.1, Edward Kim2, Judith Friend, M.A.1, Dennis Orgill, M.D., Ph.D.1, Julian J. Pribaz, M.D.1.
1Harvard Plastic Surgery Program, Boston, MA, USA, 2Harvard University, Cambridge, MA, USA.

Purpose: Plastic Surgery is the only specialty that employs two significantly different educational tracks for residency training: integrated and independent. The purpose of this study is to compare the two tracks using several quantitative educational metrics (QEMs). The Harvard Plastic Surgery Residency Program offers an ideal model for this comparison as it is the largest in the country and operates both tracks simultaneously.
Methods: We compared several QEMs of all 22 independent and 24 integrated residents matched into the Harvard Program since its inception. The QEMs were categorized into three groups.
(1) Pre-residency QEMs, which included USMLE 1 score, medical school rank, and pre-residency total publications productivity,
(2) Pre-plastic-surgery-training QEM, which was the total publication productivity from the end of medical school to the beginning of plastic surgery training. For integrated residents, this covered the period they were in the general surgery portion of their training; for independent residents, it included the period from the end of medical school to the beginning of the plastic surgery training through whichever prerequisite residency, fellowship training or other research positions they held.
(3) In-training QEMs, which included in-service scores and exit rankings (overall and operative skills).
USMLE 1 scores, in-service scores and exit rankings were compared using Fisher's Exact test. Medical schools were categorized into four tiers according to the latest U.S. News & World Report and compared using the Fisher's Exact test. Publication productivity was scored by aggregating all peer-reviewed publications of each resident weighed by journal impact factors and authorship positions. These were divided into 2 QEMs: pre-residency and pre-plastic-surgery-training and compared using the Wilcoxon rank sum test.
Results: Integrated residents graduated from more highly ranked medical schools than independent residents (tier 1.5 vs. 2.3, p = 0.039), had higher USMLE 1 scores (235 vs. 220, p = 0.015), and higher pre-residency publication scores (68.1 vs. 13.6, p = 0.015). There have been more MD/PhDs in the integrated than the independent track (33.3% vs. 4.3%, p = 0.015). Independent residents had higher pre-plastic-surgery-training publication scores (77.1 vs. 6.4, p = 0.0003). In-training QEMs were similar between the two tracks (p > 0.05 in all cases).
To address potential caveats of the study, all publication scores were compared with and without correction for the presence of MD/PhD residents, which yielded similar results. We also compared the residency match ranks of all our residents and found them to be statistically comparable between the two tracks.
Conclusion: Plastic surgery is a very competitive specialty and we strive to attract the best qualified applicants. In the combined Harvard program, the integrated residents had better pre-residency QEMs while the independent residents had a better pre-plastic-surgery-training QEM. In training QEMs were remarkably similar between the two tracks. In conclusion, this study, a systematic comparison between the two tracks, offers not only a valid foundation for future study of long term outcome results but also an angle through which we may improve upon the educational experience of residents in either track.


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