The Plastic Surgery In-service Training Examination: An In-depth Reference Analysis (2021)

INTRODUCTION: The “core surgical principles” section was added to the Plastic Surgery In-Service Training Exam (PSITE) in 2016. To our knowledge, assessment of the “core surgical principles” references has not been performed previously. The main objective is to characterize the references provided as supporting evidence of the PSITE syllabi, including those on the novel “core surgical principles” section. In addition to analyzing the newly instituted “core principle section,” the secondary aims of this study are to determine (1) the most frequently referenced journal and textbooks, (2) the publication lag of journal and textbook references, and (3) the impact factors for referenced journal articles in five consecutive PSITE syllabi. It is our hope that such an analysis will allow for better preparation for the examination and more relevant focus of educational efforts on the part of residents, fellows, and program directors. METHODS: We analyzed the references from five consecutive PSITE syllabi (2016–2020). We collected the following information from each question: year of the examination, question section, the total number of references per question, source of publication of each reference, and year of publication of each reference. We assessed the top journals and textbooks that provided supporting references for the questions. Mean and median were used to summarize continuous variables, while percentages and proportions were used to present categorical data. To compare the JIF and publication lag among the sections and examination years, we used the Kruskal–Wallis one-way analysis of variance test. A P value of <0.05 was considered statistically significant. RESULTS: We analyzed 1250 questions and 3436 references. Plastic and Reconstruction Surgery (PRS) was overall the most frequently referenced journal followed by Journal of Hand Surgery (American Volume) and Annals of Plastic Surgery. The most commonly referenced textbooks were Plastic Surgery (by Neligan), Green’s Operative Hand Surgery, and Grabb and Smith’s Plastic Surgery. Regarding the “core surgical principles” section, PRS remained the most frequently cited journal, followed by the Journal of the American Medical Association (JAMA), New England Journal of Medicine (NEJM), Annals, and Aesthetic Surgery Journal. “Core surgical principles” contained the largest number of unique journals (n = 209) among all test sections. Within the “core” section, Statistics in Medicine was the most frequently referenced textbook followed by Grabb and Smith’s Plastic Surgery, Guyton and Hall Textbook of Medical Physiology, Plastic Surgery (by Neligan), Principles and Practice of Pediatric Plastic Surgery, and Essential Medical Statistics. There were significant differences in JIF between the sections (P < 0.0001) with references in “core surgical principles” having the highest mean JIF (9.6 ± 19.5). The median journal publication lag for the all references was 6 years (IQR, 3–10). CONCLUSIONS: The main plastic surgery texts and literature were used to support approximately half of the answers within the “core surgical principles” section. The references within this section originated from the largest number of different journals, thus highlighting the breadth and variety of this content and the challenges in preparing for this section.