Clefts, and Craniofacial Cases: Trends in Congenital Craniofacial Exposure Among Plastic Surgery Residents Nationwide: A Review of 1902 Graduates

Background: Congenital craniofacial anomalies represent a critical domain in plastic surgery training, requiring technical expertise, multidisciplinary collaboration, and exposure to specialized congenital cases. Although the Accreditation Council for Graduate Medical Education mandates pediatric plastic surgery experience, variability in training opportunities exists across programs. Understanding how factors such as program size, training pathway, geographic region, resident demographics, and the COVID-19 pandemic impact surgical exposure is essential for ensuring equitable and comprehensive education. Methods: A retrospective cohort study was conducted using Accreditation Council for Graduate Medical Education case log data from graduating US plastic surgery residents between 2014/2015 and 2022/2023. All accredited integrated and independent programs were included. Variables assessed included resident gender, underrepresented minority status, training pathway, program size, geographic region, and COVID-19 era. Results: A total of 1902 residents (1043 integrated; 859 independent) were included. The overall mean case volume was 115.3 ± 52.5. Integrated residents logged significantly more cases than independent residents (122.2 ± 57.3 versus 106.8 ± 46.0, P < 0.001). No significant differences were observed by gender or underrepresented minority status. Independent residents from larger programs completed more cases than those from smaller programs (119.5 ± 51.1 versus 102.2 ± 43.0, P < 0.001). Regionally, residents in Western programs performed significantly more cases than peers in other regions ( P < 0.001). Case volumes remained stable over time, with no significant impact of COVID-19. Conclusions: Exposure to congenital craniofacial surgery has remained stable nationally, even through the COVID-19 pandemic, although significant differences exist by training pathway, program size, and geography.