Reply: A Structured Facial Feminization Fresh Tissue Surgical Simulation Laboratory Improves Trainee Confidence and Knowledge.

Abstract

Sir: We would like to thank Frendø et al. for their thoughtful response to our study entitled “A Structured Facial Feminization Fresh Tissue Surgical Simulation Laboratory Improves Trainee Confidence and Knowledge.”1 Frendø et al. raise concerns regarding the methodologies utilized in the study and, rightly so, advocate for the utilization of evidence-based learning practices in medical and surgical education. We acknowledge that self-assessments are subjective and may not accurately evaluate trainees’ skills.2 We also agree that it is expected for the lecture to have improved participants’ knowledge of facial feminization surgery, and therefore administering knowledge-based tests may seem unnecessary. However, we utilized such tests to objectively demonstrate that lectures serve as useful supplementations to surgical simulations. Lectures and surgical simulations have become increasingly important due to the imposition of work-hour restrictions for medical trainees3 and, more recently, as a consequence of the coronavirus disease of 2019 pandemic, which will likely impact surgical trainee experience.4 Trainee experience in gender-affirming surgeries is becoming more essential as the frequency of such surgeries is growing as a result of increased social and political support for transgender rights. Just recently, the U.S. Supreme Court ruled that Title VII of Civil Rights Act of 1964 protects transgender employees from discrimination based on sex, marking a milestone for transgender rights. Despite an increase in support for the transgender community and gender-affirming surgeries, formal training of residents in transgender health remains limited in many specialties, including plastic surgery. Without such education, residents and physicians may not be ready to address the health inequities faced by this traditionally marginalized and underserved population.5 While the results of this study may be limited, the utility of a structured training course in a relatively new and rapidly growing field in plastic and craniofacial surgery, where exposure is limited, is not. Incorporation of surgical simulations such as the one described in this study into the curriculum will help promote residents’ knowledge and, potentially, skills relevant to transgender health. We will continue to promote trainee education in this important field and look forward to future works from the plastic surgery community. Sri Harshini Malapati, B.S.Justine C. Lee, M.D., Ph.D.Miles J. Pfaff, M.D., M.H.S.Division of Plastic and Reconstructive SurgeryUniversity of California, Los Angeles David Geffen School of MedicineLos Angeles, Calif.