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BACKGROUND: The In-Service Exam for Plastic Surgeons (IEPS) is a national, multiple-choice exam that provides an assessment of plastic surgery knowledge. As a governing body for plastic surgery education, the American Society of Plastic Surgeons (ASPS) is responsible for its yearly administration. For program directors and faculty, exam results can be used to direct educational activity and improve residency curricula. For residents, exam results can identify areas of weakness and topics for future study. Currently, it is unknown how many questions test conditions of the breast on the IEPS as there is much overlap between sections. The purpose of this study was to examine these questions to determine content and referenced material.
METHODS: Digital copies of each IEPS syllabus were reviewed for the most recent six year period (2008 - 2013). This period was selected to reflect a typical trainee’s experience taking the IEPS during plastic surgery residency. Questions were categorized by topic and taxonomy: Level I- general recall, Level II- diagnosis, and Level III- decision-making. Level III questions are expected to require more cognitive effort as they require skills from all levels. Topics were selected from common textbooks and the consensus of authors. Suggested references for each answer were analyzed for source and relative year of publication to each IEPS.
RESULTS: 140 questions related to the breast (average 23 questions per year). Breast questions constituted 12% of all questions during the study period (140/1174). Most questions tested medical decision-making (43%) and general recall (40%). Only 8 questions had an associated photograph (6%). Most commonly tested topics were breast reconstruction (25%), augmentation (21%), congenital breast deformities (16%), and reduction mammaplasty (11%). 304 citations to 71 unique sources were referenced. The highest yield journals were Plastic and Reconstructive Surgery (55%) and Annals of Plastic Surgery (9%). The median year of publication relative to IEPS administration was 6 (range, 1-170). Surgery of the Breast: Principles and Techniques was the most referenced textbook (22%).
CONCLUSIONS: These data will enable future examinees to study topics pertaining to breast surgery more efficiently. Faculty can also utilize these data to ensure commonly tested topics are covered during residency training. Thus, our results will help establish a benchmark to improve didactic, clinical, and operative experiences during plastic surgery training.