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BACKGROUND: The In-Service Exam for Plastic Surgeons (IEPS) is a multiple-choice examination taken by plastic surgery residents to provide an assessment of plastic surgery knowledge. This yearly exam provides trainees an opportunity for self-assessment and direction for future study by identifying areas of weakness. The purpose of this study was to (1) examine questions related to cosmetic surgery on the IEPS for subject matter and (2) determine the most referenced literature sources.
METHODS: The American Society of Plastic Surgeons (ASPS) distributes a score key for each IEPS administration. We reviewed each key for the six examinations between 2008 and 2013. This period was selected to reflect the duration of integrated plastic surgery residency. Questions were classified by surgical or non-surgical procedure, anatomy, and a question taxonomy classification system. The following taxonomy was used: Level I- general recall, Level II- diagnosis, and Level III- decision-making. Higher level questions require greater cognitive effort and assume the skills of lower levels. Suggested references were analyzed to determine the the most frequently referenced sources and relative year of publication. Linear regression was used to determine any trends in the percentage of questions related to cosmetic surgery over time.
RESULTS: 301 questions tested topics in cosmetic surgery (26% of all questions). This percentage was stable over the study period (p>0.05, average 50 questions per year). Most questions required medical decision-making (65%) over diagnostic (16%) and recall (19%) skills. Surgical procedures were tested most commonly (84%) over minimally invasive procedures (16%). Breast (25%) and trunk (18%) were the most common anatomical areas, of which augmentation mammoplasty (12%) and body contouring (15%) were the commonest procedures. Rhinoplasty (11%) and blepharoplasty (10%) were also commonly tested. The most common non-surgical procedures were lasers (5%), neuromodulators (4%), and fillers (3%). Analysis of references revealed Plastic and Reconstructive Surgery (PRS, 58%), Clinics in Plastic Surgery (7%), and Aesthetic Surgery Journal (6%) as the most referenced journals. The mean year of publication relative to IEPS administration was 5 (range, 1-58). The two most referenced textbooks were Art of Aesthetic Surgery: Principles and Techniques (13%) and Plastic Surgery by Mathes et al. (13%).
CONCLUSIONS: A typical integrated plastic surgery resident will be commonly tested on cosmetic surgery procedures throughout residency. Results from this study suggest articles in PRS can be recommended during journal clubs and conferences for cosmetic surgery. These results will enable residents study these topics more efficiently and help guide faculty to optimize cosmetic surgery experiences during residency training.