A Review of Craniofacial Training Programs in North America

Abstract

Introduction: The specialty of craniofacial surgery has expanded rapidly since the landmark surgeries of Dr. Paul Tessier. The expansion of fellowship programs over the last 50 years has been seen in both numbers and structure. This growth has been complemented by the continued expansion of skill sets that fellows are experiencing. However, the exposure to these skill sets are varied. The study had 2 objectives: (1) Create a clearer picture of the skill sets that fellows are exposed to during training and (2) provide some threshold of case numbers shared by programs that may be used to establish shared expectations for the fellow’s experience. Method: A comprehensive database was created and placed on the webpage for the American Society of Craniofacial Surgery (ASCFS). Fellows in the year 2017 to 2018 were asked to input their case logs. The cumulative data base was categorized into 9 groupings, capturing surgeries of the facial skeleton, cleft surgeries and specialty surgeries in the area of microsurgery, facial reanimation, and ear reconstruction. These 9 groupings were used to establish 3 tiers that provided an opportunity to discover thresholds of experience that captured consistent skill sets for the majority of the programs. Results: A total of 6018 cases were entered into the cumulative database of which 3469.5 cases were placed into 9 specified groups. Group 1 (craniosynostosis) had 578 cases (mean = 30.4, SD = 22.3). Sixteen of the 19 programs participating (84.2%) were found to be at or above the 20th percentile ranking for this procedure (20th percentile = 10 cases). Group 2 consisted of Mandibular distraction (144 cases), Group 3 midface skeletal surgeries (87), Group 4 facial trauma (641.5), Group 5 orthognathic surgery (506), Group 6 cleft surgeries (1303.5), Group 7 microsurgery (67), Group 8 facial reanimation (40.5), and Group 9 ear reconstruction (113). Percentile rankings were found for each group. Three tiers were created for comparison, Tier 1 (group 1), Tier 2 (groups 2-6), Tier 3 (groups 7-9). When a 20th percentile threshold for case numbers was created for groups 1 to 5, 77.9% of all programs met this criteria (95% CI: 63.7%-92.1%). When group 6 was included 78.9% of programs met the 20th percentile (95% CI: 67.9%-90.0%). Conclusion: Fellows are receiving consistent exposure to areas of training related to manipulation of the facial skeleton with the exception of midface surgeries. The study also demonstrates a significant volume of both cleft surgery and facial trauma. The majority of the participating programs meet a threshold of 20% for skill sets associated with our subspecialty. These thresholds could be used as guides by fellowship programs and the ASCFS to better monitor our training goals.