Comprehensive Rotation Analysis of Integrated Plastic Surgery Residency in the United States: Clarification of Rotation Metrics

Introduction

Plastic surgery training favors the integrated model, necessitating evaluation of all rotations to ensure comprehensive training. The American Board of Plastic Surgery and the American Council of Graduate Medical Education set rotation guidelines, yet programs adopt diverse curricula. This study examines trends in rotation blocks amid rising integrated programs.

Methods

Data from 2012 to 2023 from the National Resident Matching Program and the American Council of Educators in Plastic Surgery provided match statistics and the current program list. The study identified 89 accredited integrated plastic surgery programs, collecting rotation schedules via official websites or direct contact between January and March 2024. It analyzed rotations, categorizing them into plastic surgery or nonplastic surgery, with the latter divided into 18 specific categories.

Results

Over the decade, integrated programs increased by 68%, whereas independent programs decreased by 33%, with a 20% reduction in general surgery months. Analysis of 73 of 89 programs showed an average of 10.3 mo in general surgery rotations. Although not significant, departmental programs had fewer general surgery months than divisional programs. There were also no significant differences when stratified by association with an independent residency or incoming resident cohort sizes. Considerable variability in subspeciality rotations is noted.

Conclusions

The ideal combination of rotations is still being defined, reflecting the unique priorities of each program. This variability suggests ongoing experimentation with the structure and emphasis of rotations to find the most effective educational approach, with a general movement toward increasing early plastic surgery exposure and reducing nonplastic surgery rotations in the initial years.