Downloaded from http://journals.lww.com/plasreconsurg by BhDMf5ePHKbH4TTImqenVKt+hMvjzYvLRJQedVZJJ0ZL9SBJFRW5QZ3AlLKuq0VKoZ4nD4XowKw= on 08/31/2020 Copyright © 2020 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 351e P lastic surgery training programs attract some of the most highly qualified applicants, with matched integrated residents consistently demonstrating the highest average board scores, highest number of research experiences and publications, and greatest Alpha Omega Alpha Honor Medical Society membership compared to other specialties. 1–9 The decades-long debate on Disclosure: Ms. Cooney, Dr. Cooney, and Dr. Lif- chez are co-inventors of MileMarker/the Operative Entrustability Assessment, the software tool used in this study to evaluate residency performance, as well as equity holders and scientific advisory board members in the start-up company EduMD, LLC, for which Ms. Cooney is also the vice president. Drs. Meyer, Bello, Aravind, and Rosson have no disclo- sures to report. Copyright © 2020 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000007091 Carisa M. Cooney, M.P.H., C.C.R.P. Meredith L. Meyer, M.D. Pathik Aravind, M.B.B.S. Ricardo J. Bello, M.D., M.P.H. Gedge D. Rosson, M.D. Scott D. Lifchez, M.D. Damon S. Cooney, M.D., Ph.D. Baltimore, Md. Background: Anecdotally, faculty report that independent residents’ operative skills differ from those of their integrated peers. This study compared opera- tive competency between integrated (postgraduate years 4 to 6) and indepen- dent plastic surgery residents. Methods: The authors compared independent (postgraduate years 1 to 3) and integrated (postgraduate years 4 to 6) plastic surgery residents at their in- stitution using operative performance data from the Operative Entrustability Assessment, a validated five-point assessment tool that provides residents with real-time feedback about their operative performance, documenting perfor- mance at the point of care. Independent postgraduate year 1, 2, and 3 resi- dents were categorized as postgraduate year 4, 5, and 6 residents, respectively, for comparison. The authors analyzed attending physician (evaluator) Opera- tive Entrustability Assessment scores over time using the independent t test. Results: From July 1, 2013, to June 30, 2018, Operative Entrustability Assess- ments were completed at one training program for residents in postgraduate years 4 to 6: 1886 (47.4 percent) by independent [n = 12 (37.5 percent)] and 2094 (52.6 percent) by integrated [n = 20 (62.5 percent)] residents. Evalu- ator scores were lower for independent track residents throughout the first two quarters of postgraduate year 4 (quarter 1 delta, −0.49 point, p < 0.001; quarter 2 delta, −0.36 point, p < 0.001). However, this difference was no longer statistically significant during the third and fourth quarters of postgraduate year 4 (p = 0.192 and p = 0.228, respectively). No difference was detectable at postgraduate year 5 (p = 0.095) or postgraduate year 6 (p = 0.877). Conclusions: Operative Entrustability Assessment data demonstrate that differ- ences between independent and integrated plastic surgery residents regarding operative skills (0.49 of 5 points) and amount of time needed for independent residents to catch up (6 months) is minimal and resolves during the third quarter of independent postgraduate year 1. Programs can design curricula to facilitate independent residents’ plastic surgery skill acquisition during their first two quarters. (Plast. Reconstr. Surg. 146: 351e, 2020.) From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine. Received for publication May 22, 2019; accepted February 14, 2020. Presented at the American Council of Academic Plastic Surgeons 4th Annual Winter Retreat, in Chicago, Illinois, December 9 through 11, 2016; and the 37th Annual Meet- ing of the Association for Surgical Education, in San Diego, California, April 20 through 22, 2017. Comparing Operative Performance between Independent and Integrated Plastic Surgery Residents SPECIAL TOPIC