Challenges and influencing factors in hand surgery subspecialty training: a nationwide survey of orthopedic, plastic, and hand surgery residents in Türkiye.

Abstract

Objective: This study aimed to identify the factors influencing the decisions of orthopedic and plastic surgery residents in Türkiye regarding their pursuit of a subspecialty in hand surgery, as well as to evaluate the challenges faced during hand surgery training. Methods: A national survey was conducted among residents in orthopedic and trauma surgery (n=92), plastic surgery (n=84), and hand surgery (n=12). The survey, developed from literature reviews and previous studies, was distributed online, and responses were collected via Google Forms. Orthopedic and plastic surgery residents responded using a 4-point Likert scale, while hand surgery residents answered multiple-choice questions. The collected data were analyzed to determine factors influencing career choices, training adequacy, and the challenges faced by residents. Results: The analysis revealed a negative correlation between the high volume of emergency hand surgery cases and residents' inclination toward the subspecialty (r=-0.217, P < .05). Theoretical training was significantly linked to enhanced hand surgery knowledge and skills (r=0.213, P < .05), whereas the lack of adequate training infrastructure negatively affected residents' experience (r=0.390, P < .05). Financial concerns and heavy workloads were identified as major challenges, with 33.3% of hand surgery subspecialty residents considering quitting their program. The study also highlighted a lack of continuity in training, insufficient exposure to elective hand surgery cases, and limited access to international educational opportunities. Conclusion: The findings indicate a need to enhance both the theoretical and practical aspects of hand surgery training in Türkiye. By addressing financial and workload-related concerns, improving clinical exposure, and expanding access to microsurgical tools and training resources, it may be possible to increase interest in the subspecialty and ensure a sustainable workforce of hand surgeons in the future. Level of Evidence: N/A.