Abstract
BACKGROUND: Graduating competent surgical residents requires progressive independence during training. Recent studies in other surgical subspecialties have demonstrated overall fewer opportunities for resident independence due to changes in residency regulations, medical-legal concerns, and financial incentives. A survey study was conducted to assess perceived autonomy and preparedness during plastic surgery residency training and to assess factors affecting autonomy. METHODS: Anonymous electronic surveys were sent to attending surgeons and residents of all Accreditation Council for Graduate Medical Education accredited programs during the 2017-2018 academic year. Seventy-two integrated and 42 independent plastic surgery programs were surveyed. Analysis of responses was performed using the Fisher exact and chi-square tests. RESULTS: There were 158 attending surgeon and 129 resident responses. The resident and attending surgeon response rates were 11.7% and 16.8%, respectively. Eighty-seven percent of residents felt their operative experience within residency prepared them for practice. Residents felt least prepared in aesthetics and pediatrics/craniofacial surgery. Attending surgeons perceived that they provided residents graduated autonomy throughout residency. Residents identified the complexity of a procedure, attending surgeon supervision, and time constraints as the largest factors influencing resident autonomy. Attending surgeons noted patient safety as the largest deterrent to autonomy. CONCLUSIONS: In our study, a majority of plastic surgery residents were found to feel prepared for practice after residency; however, preparedness gaps within training still exist in aesthetic and craniomaxillofacial surgery. Plastic surgery programs must work to develop training programs that simultaneously promote resident autonomy, while prioritizing patient safety, and maintaining productivity and financial well-being.