Plastic Surgery Milestones Competencies and Chief Year Cosmetic Case Volume: Is There a Relationship?
Ilana G. Margulies, MS, Paymon Sanati-Mehrizy, MD, Hope Xu, BA, Felipe Molina-Burbano, BA, Peter J. Taub, MD, MS.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
PURPOSE: The Milestones program in Plastic Surgery was established by the Accreditation Council for Graduate Medical Education (ACGME) in 2014 as a means of providing standardized competency based evaluations in Plastic Surgery education. The assessment consists of thirty-six Milestones that evaluate a range of reconstructive, cosmetic, and general competencies in a manner that addresses a resident's achievements in patient care and medical knowledge in competencies where this distinction is appropriate. However, despite the widespread belief that clinical exposure is fundamental to competency achievement, to our knowledge, there have been no studies evaluating the association between levels of achievement in specific Plastic Surgery Milestones competencies and volume of cases performed by residents in those clinical areas. Therefore, we sought to begin exploring this topic by evaluating the association between volume of cosmetic cases performed by chief residents and their levels of achievement in respective Milestones competencies.
METHODS: A retrospective review of operations performed by chief residents at our primary training institution was conducted for eight residents graduating from 2015 – 2018. Cosmetic cases were isolated and classified by type of operation. The association between cosmetic case volume and levels of achievement in respective Milestones competencies was performed using Spearman's rank correlation coefficient (p < 0.05).
RESULTS: No significant association existed between volume of chief year cosmetic cases at our primary training institution and levels of achievement in Milestones competencies in Facial Aesthetics Patient Care (r = 0.53, p = 0.18), Facial Aesthetics Medical Knowledge (r = -0.58, p = 0.25), Non-Cancer Breast Surgery Patient Care (r = 0.43, p = 0.29), Non-Cancer Breast Surgery Medical Knowledge (r = -0.58, p = 0.13), Cosmetic Trunk and Lower Extremity Patient Care (r
= 0.23, p = 0.64), and Cosmetic Trunk and Lower Extremity Medical Knowledge (r = -0.58, p = 0.25) (Figure 1).
CONCLUSION: The lack of significant association between chief year cosmetic case volume and levels of achievement in respective Milestones competencies is an interesting finding that potentially lends support to the position that competency achievement in surgical education does not have a linear relationship with clinical exposure. However, the relative minimal variation of Milestones levels achieved by chief year residents may have limited our ability to detect a significant association. Thus, we hope that this study provokes further investigation of the relationship between Milestones competencies and resident case volume throughout all years of Plastic Surgery education.
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