Can Plastic Surgery Residents Accurately Self-Assess Their Skills? Insights from a Structured Event

Background: Plastic surgery residency is unique in requiring trainees to master a wide range of surgical skills. While skill evaluation and self-assessment are common in training, direct comparisons using objective measures are rare. This study aimed to evaluate the accuracy of resident self-assessment through a structured, skill-based event. Methods: We reintroduced our PRS Olympics event, consisting of four skill-based stations: (1) subcuticular suturing, (2) Z-plasty flap creation, (3) tendon repair, and (4) microanastomosis. Each station was filmed and timed. Residents received their own videos and evaluated their performance using a combined checklist and global rating scale (GRS). Expert faculty were also provided the videos and assessed performance using the same scales. All residents were assigned coded identifiers to ensure blinding of reviewers. Results: All twelve residents participated in our PRS Olympics event, with two residents per PGY level. Three residents (PGY 2, 3, and 4) did not complete self-evaluations, and PGY 1–2 residents did not participate in the microanastomosis station due to time constraints. There was no significant difference between resident and attending scores for subcuticular suturing (self: 46.67 ± 2.38 vs expert: 44.78 ± 1.78, p=0.581) or microanastomosis (65.33 ± 7.89 vs 72.83 ± 6.35, p=0.132). However, residents scored themselves significantly higher than experts in Z-plasty (53.33 ± 2.50 vs 40.67 ± 2.29, p=0.003) and tendon repair (48.22 ± 3.39 vs 38.89 ± 2.64, p=0.002). When analyzed by seniority (PGY 1–3 juniors vs PGY 4–6 seniors), juniors consistently scored lower than seniors in both self- and attending-assessments, though differences were not significant. Interestingly, only seniors showed significant overestimation compared to experts in tendon repair (52.40 ± 2.06 vs 41.80 ± 2.06, p=0.024) and Z-plasty (56.60 ± 0.25 vs 43.40 ± 2.87, p=0.011). Conclusion: Resident self-assessment aligned with expert scores in suturing and microanastomosis but was overestimated in tendon repair and Z-plasty, especially among senior level residents. Structured events like the PRS Olympics may help identify gaps in self-awareness and guide targeted training.