Continuing medical education in emergency plastic surgery for referring physicians: A prospective assessment of educational needs

Background: Continuing medical education for referring physicians is an essential part of raising the profile of plastic surgery and improving patient care. The authors conducted a prospective cohort study to assess the educational needs of emergency and primary care physicians who refer patients to the on-call plastic surgeon. Methods: The following information was collected for telephone referrals from emergency and primary care physicians over a 1-year period: date, location of referral center, population of referral center, distance between referral center and tertiary care hospital, patient age, presenting problem, anatomical location of the problem, and treatment plan proposed by the plastic surgeon. In addition, the 50 physicians who most frequently referred patients were surveyed to identify which topics they perceived to be of the highest educational utility and which were frequently encountered. Results: There were a total of 1077 referrals to on-call plastic surgeons mostly for trauma (83 percent) and injuries involved primarily the upper extremity (65 percent) or head and neck regions (26 percent). Five percent or more of all referrals involved mandible, phalangeal, metacarpal, or zy- gomatico-orbital complex fractures, minor burns, flexor tendon injuries, single digits requiring revision of an amputation, and extensor tendon injuries. Referring physicians reported that the topics of most educational utility were management of hand infections, minor burns, nasal fractures, boxer's fractures, complex facial lacerations, frostbite, metacarpal fractures, and scaphoid fractures. Conclusions: To have the greatest potential affect on changing physicians' behavior and improving patient care, continuing medical education should focus on traumatic injuries to the upper extremity and head and neck regions. A prioritized list of topics should include management of minor burns, hand fractures, hand infections, nasal infections, and complex facial lacerations.