Canadian Plastic Surgery Research Articles

Exploring Skin Tone Diversity in a Plastic Surgery Resident Education Curriculum

Background: Gaps remain in surgical education regarding the representation of skin tone diversity. To improve equity and prevent misdiagnosis leading to worsened health outcomes, efforts must be made to ensure educational photographs are representative of the diverse patient populations plastic surgery residents will be treated in their future practices. Methods: Four study investigators examined 96 h of recorded lecture seminars from a Canadian plastic surgery resident education curriculum from May 2020 to December 2021. Using Fitzpatrick skin type to codify skin tone, photographic images were individually classified and compared. Program lecturers and residents were invited to participate in an online anonymized survey to explore related perceptions of the curricula. Results: A total of 1990 images were included for analysis. Of these, 83.2% were Fitzpatrick types I to III, 13.1% were Fitzpatrick types IV to V, and 3.7% were Fitzpatrick type VI. There was a statistically greater proportion of Fitzpatrick I to III compared to types IV to V ( P < .01), and type VI ( P < .01). Fleiss’ Kappa was calculated to be 0.896, representing near-perfect agreement. In the survey, 61% (14/22) of faculty respondents believe they include enough diversity in their photographs, however, 46% (4 of 9) of resident respondents would like to see more diversity in lecturers’ photographs. Conclusions: There is an underrepresentation of medium (Fitzpatrick types IV-V) and dark (Fitzpatrick VI) images in plastic surgery resident educational images. Providing a curriculum that represents diverse patient populations is crucial to enabling competency and equity of care, particularly in a highly visual field. Incorporating skin tone diversity into educational curricula should be a priority for all plastic surgery programs.

A 5-Year Analysis of Saudi Arabian Applications to Plastic Surgery Residency Training in Canada

Introduction: The goal of this study is to determine factors associated with acceptance into Canadian plastic surgery (PS) residency programs by Saudi Arabian Medical Graduates. Methods: This is a cross-sectional study targeting eligible Saudi Arabian applicants to any Canadian PS residency program between 2017 and 2022. Collected data included demographics, education/licensure, electives in Canada, and letter of reference. The 2 main outcomes analyzed were “invited for an interview” and “offered a residency position.” Results: We reviewed 52 applications. Of these, 18 applicants received an invitation for an interview and 8 were offered a residency training position. Significant variables associated with receiving an invitation for an interview were completing an elective in Canada ( P = .016), having a master's degree ( P = .012), and completion of an English test ( P = .032). The variables most likely to influence receiving a residency position offer are completion of elective training in Canada ( P = .004) and receiving a letter of reference from a Canadian plastic surgeon (95% CI: 0.77 to 76.69: OR: 8.90). Conclusion: Completion of an elective rotation in Canada and obtaining Canadian letters of reference were found to be the most important factors for Saudi Arabian physician applicants to be accepted into a Canadian PS residency program. Other factors that were less critical but improved their chances of being considered include completion of an English assessment test and having a master's degree. This study offers valuable guidance for any Saudi Arabian candidates interested in PS residency in Canada and may aid Canadian programs in their assessment of potential residents.

Gender Representation Among Major Plastic Surgery Society Achievement Award Recipients.

Purpose: Professional achievement awards are an important factor in recruitment, promotion, and faculty review within academic institutions. Studies have shown that subconscious, gender-based assumptions of individuals and their work in traditionally male-dominated fields lead to more positive evaluations of men than women, a phenomenon present among scientific and medical award committees. This study examined gender representation among recipients of major North American plastic surgery society awards over the last 50 years. Methods: Recipient lists of major achievement awards bestowed by ten American and Canadian plastic surgery societies between 1970 and 2020 were accessed online or by direct contact with the society. Awardee gender, institution affiliation, graduation year, fellowship status, and additional major awards received were recorded. Comparisons were made between gender representation among society presidents, board membership, general society memberships, attending physicians, and plastic surgery residency enrolment. Results: Thirty-two major awards given by ten plastic surgery societies were included. Six hundred and twenty-five awards were conferred, of which 47 recipients were female (7.5%). Of the 121 individuals that received multiple major awards, 8 were female. Two-thirds of female awardees (72%) were clinical plastic surgeons and the remainder were scientists. Over the past 50 years, there has been a gradual increase in the proportion of female award winners. Conclusions: Despite a gradual increase in the proportion of female awardees in major plastic surgery societies, female plastic surgeons remain underrepresented among awardees, with less than 10% of major awards conferred to females.

Family Planning Among Canadian Plastic Surgeons and Trainees.

Introduction: Despite increasing advocacy for family leave policies, few studies have described the current landscape and attitudes around family planning in Canadian plastic surgery. The purpose of this study was to survey Canadian plastic surgeons and trainees to examine their experience with family planning, parental leave, and breastfeeding. Methods: An anonymized survey was distributed to all members of the Canadian Society of Plastic Surgeons and all Canadian Plastic Surgery residents through their program administrators. Survey responses were recorded and analyzed through a customized REDCap™ database. Results were reported using descriptive statistics. Results: A total of 87 plastic surgeons and trainees completed the surgery. We found 72.3% of respondents had children; 67.8% felt their colleagues were supportive of parental leave; 45.6% felt that financial concerns affected their decision to take parental leave; 61.6% felt that their career did not influence the number of children they chose to have; 21.0% accessed fertility services and 9.8% used assisted-reproductive technologies; 80% of respondents who breastfeed felt they did not have enough time to pump at work, however, 79% did not experience any discrimination or criticism for pumping at work. Conclusion: Canadian plastic surgeons most often have children after completing training and choose to take shorter parental leaves as their careers progress. Parental leave and breastfeeding practices in the workplace are reported to have increased support from colleagues compared to previous literature. However, Canadian plastic surgeons continue to struggle with infertility and seek fertility services at rates higher than the general population.

Analysis of Additional Degrees in Academic Plastic Surgery Faculty.

Background: As plastic surgery continues to evolve, an increasing number of surgeons are attaining additional degrees (ADs). Prior studies illustrate this trend of increased AD attainment among plastic surgery faculty within the United States. Yet, no such study has documented AD attainment variability and influence within Canadian plastic surgery faculty. Objectives: Our objective was to investigate the relationship between AD attainment and gender, alongside research productivity, and academic rank of Canadian plastic surgery faculty members. Methods: All Canadian academic plastic surgery faculty members were identified and information regarding gender, academic rank, research productivity, timing of AD attainment was recorded. AD was defined as any degree beyond a medical degree or equivalent. Results: A total of 299 faculty members were identified. Of these, 33% (N = 99) attained an AD. A higher percentage of females (40%) obtained ADs compared to males (30%) (P = .0402). When controlling for number of years in practice, there was a significantly larger proportion of females than males with ADs as assistant and associate professor (P = .033). Faculty with ADs were associated with higher research productivity and higher academic rank than those with MDs (P < .05). ADs were commonly obtained post-residency (38%) and most common ADs were MSc (51%) and PhDs (21%). It was found that the Canadian plastic surgeons were less likely to pursue MBAs than US plastic surgeons (P = .002). Conclusion: One-third of Canadian academic plastic surgeons had ADs. Those with ADs present with higher research productivity and academic rank. When segmented by gender, there were significant differences among AD holders. The results of this study will lend support to ongoing endeavors voicing the need for gender equity in academic plastic surgery.

Investigating Gender Differences in Canadian Plastic Surgery Online Patient Education.

The public interest and demand for cosmetic surgery is growing in North America. As practices continue to advertise cosmetic procedures, male consumers must also be given fair consideration in a market targeted mostly towards women. This study investigated the advertising trends of plastic surgery clinics to assess for prevailing gender differences among online Canadian plastic surgery practice advertising. The 2021 College of Physicians and Surgeons directory for each province and territory was utilized to identify all practicing plastic surgeons. A systematic search with Google (Mountain View, CA) was conducted to analyze the websites of Canadian plastic surgery centers in the following manner: "[physician name] [province of practice]." A total of 209 websites and 13,838 images were identified and analyzed. Of these images, 12,386 (90%) were female and 1452 (10%) were male patients or models. Although only 20% had a male services page, 62% of all centers offered gynecomastia procedures. The most common procedures targeting men were blepharoplasty (95%), liposuction (93%), and abdominoplasty (93%). The Prairies region had significantly fewer websites with male-only pages compared with all other Canadian regions. Despite the increase in cosmetic surgery procedures for males, the market for cosmetic surgery procedures targeted towards males remains insignificant. An increase in the advertising of in-demand male cosmetic procedures can allow for a broader consumer market and a subsequent increase in benefits for plastic surgeons.

Impact of the COVID-19 Pandemic on the Wellness of Canadian Plastic Surgery Residents.

Background:On top of preexisting burnout, depression, and anxiety among trainees, the COVID-19 pandemic has introduced novel stressors. The objectives of this study were to determine the effects of the COVID-19 pandemic on Canadian plastic surgery residents’ practice, wellness, and overall training.Methods:Surveys for program directors and residents were created and disseminated to all English-speaking Canadian plastic surgery residency training programs. Survey results were pooled and presented as a percentage of responses for each question.Results:Response rates were 50% (n = 5/10) and 25% (n = 19/77) for program directors and residents, respectively. All program directors believed that the pandemic has a negative effect on resident wellness, 80% (n = 4/5) of which believed that their residents were coping effectively. They rated program support for resident wellness as neutral or supportive. Most programs (80%; n = 4/5) introduced strategies to support resident well-being. Most trainees (84%; n = 16/19) reported the pandemic as having a negative effect on their well-being, with approximately 50% endorsing worse emotional, social, psychological, and physical wellness, as well as feelings of burnout. Some reported difficulties coping (21%; n = 4/19). Residents felt that their wellness was supported externally by their own resilience (89%; n = 17/19), family members (74%; n = 14/19), friends (74%; n = 14/19), their partner (68%; n = 13/19), or co-residents (53%; n = 10/19). Internal support by their program was rated as neutral or negative (63%; n = 12/19).Conclusions:Our findings of negative effects of the COVID-19 pandemic on the wellness of Canadian plastic surgery trainees are concerning. Programs must implement appropriate identification and support strategies to improve resident well-being.

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action.

The global COVID-19 pandemic has brought to light the significant inequities in the delivery of healthcare, vaccine inequity, and differential access to life-saving treatments, which have disproportionately impacted marginalized and racialized populations. In this article, we acknowledge and recognize the centuries-old legacies perpetuating inequity, injustice, and oppression, we discuss the principles of Equity, Diversity, and Inclusion (EDI) and we call our Canadian plastic surgery colleagues and trainees to action. We propose a plan for (1) Education, (2) Mitigating Disparities in the Clinical Setting, and (3) Policy, Societies, and Leadership Education.

The Utility of Online Information Sessions for Medical Student Recruitment in Plastic Surgery: A New Paradigm Amidst the COVID-19 Pandemic.

Background: The COVID-19 pandemic has led to increased barriers for medical students seeking to engage with plastic surgery. Traditional approaches such as pursuing clinical electives broadly are no longer feasible and medical students are seeking innovative approaches for engagement. The current study evaluated the efficacy of online information sessions on medical student perception and proposed a timeline for longitudinal medical student recruitment. Methods: The McGill Plastic and Reconstructive Surgery residency program held an online information session for medical students focusing on a wide array of topics related to plastic surgery and residency. Following the session, an anonymous survey was sent to participants gauging their satisfaction with the event and potential effects it had on career planning. Results: Thirty-four participants completed the survey, comprising more than 60% of annual applicants to Canadian plastic surgery programs. 94% of participants stated that their view of McGill's training program improved and reported a desire for additional sessions from other training programs. 68% of respondents reported being more likely to consider training at McGill and 100% agreed that such sessions could influence their decision to pursue a given training program. Social media was the most common resource used by participants to gain information on training programs. Conclusion: Online information sessions are valuable tools for medical student recruitment and can directly influence their views of a specific training program and affect career planning. Investing in generating high quality content through online forms of communication is paramount as most medical students are turning to these platforms amidst the pandemic.

Medico-legal Closed Case Trends in Canadian Plastic Surgery: A Retrospective Descriptive Study.

Background:To enhance patient safety and prevent medico-legal complaints, we need to understand current trends and impacts. We aimed to characterize Canadian plastic surgery medico-legal patterns in many dimensions.Method:This retrospective descriptive analysis of Canadian Medical Protective Association data between January 1, 2013 and December 31, 2017 included closed regulatory body complaints and civil-legal actions involving plastic surgeons. We excluded class action legal cases and hospital complaints. We collected data on patient allegations, procedure types, healthcare-related patient harms, and peer expert criticisms. The primary outcome of interest was physician medico-legal outcome.Results:We found 414 cases that met the inclusion criteria: 253 (61.1%) cases involved cosmetic procedures and 161 (38.9%) noncosmetic procedures. The annual incidence among plastic surgeon members of regulatory body complaints and civil-legal actions was 12.1% and 6.7%, for a combined incidence of 18.8%. The most common allegations were deficient clinical assessment, inadequate informed consent, delayed or misdiagnosis, and inadequate monitoring. Leading contributing factors were physician–patient communication breakdown, deficient clinical judgments, and inadequate documentation. The top procedural complications included cosmetic deformity, poor scarring, upper extremity stiffness or deficit, major structural injury, and mental health disorder. Less than half of cases (198/414, 47.8%) had unfavorable medico-legal outcomes for the surgeon. Patients were compensated in 86/198 (43.4%) of civil-legal cases.Conclusions:Plastic surgeons experience more medico-legal complaints for cosmetic versus noncosmetic procedures. To minimize medico-legal risks, plastic surgeons should focus on strong physician–patient communication, patient education/consent, thorough clinical assessment, minimizing potentially preventable complications, and maintaining relevant documentation.

An Evaluation of the Content of Canadian Plastic Surgery Residency Websites.

Background: Plastic surgery residency program websites are an important source of information to prospective applicants, especially given the ongoing COVID-19 pandemic and resulting suspension of all visiting electives and in-person interviews. This study aimed to analyze the online content of Canadian plastic surgery residency program websites. Methods: The content of all accredited Canadian plastic surgery residency websites was evaluated using 77-point criteria in the following 10 domains: recruitment, faculty, residents, research and education, surgical program, clinical work, benefits and career planning, wellness, environment, and gender of faculty leadership. Results: All accredited Canadian plastic surgery residency programs (n = 13) were identified using Canadian Resident Matching Service and had their dedicated program websites available for analysis. On average, residency program websites obtained a score of 33.5 (standard deviation = 13.7). The majority of programs did not score differently on the criteria by geographical distribution (P > .05) nor by ranking (P > .05). Conclusions: Most Canadian plastic surgery residency program websites are lacking content relevant to prospective applicants. Addressing inadequacies in online content may support programs to inform and recruit strong applicants into residency programs.

How Comprehensive Are Canadian Plastic Surgery Fellowship Websites?

BackgroundOnline fellowship program websites are more commonly becoming the primary information resource used by prospective applicants. This study aimed to analyze the online content of Canadian plastic surgery fellowship program websites. MethodsThe content of all accredited Canadian Plastic Surgery fellowship program websites was evaluated using a 75-point criterion in the following ten domains: recruitment, faculty, residents/fellows, research and education, surgical program, clinical work, benefits, and career planning, wellness, environment and gender of faculty leadership. ResultsOn average, fellowship program websites obtained a score of 29.9 (SD=12.6). No correlation was detected between program websites and location (P > 0.05) nor by ranking (P > 0.05). ConclusionsMost Canadian plastic surgery fellowship program websites lacked content relevant to prospective applicants. More comprehensive fellowship program websites may be of benefit to prospective applicants and the programs.

Commentary on: Resident Exposure to Aesthetic Surgical and Nonsurgical Procedures During Canadian Residency Program Training.

Competency-based postgraduate medical education is well defined as “an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organized around competencies derived from an analysis of societal and patient needs. It de-emphasizes time-based training and promises greater accountability, flexibility, and learner-centeredness.” 1 Starting in 2020, the newest cohort of Canadian plastic surgery residents must now complete a curriculum based on satisfactorily completing 40 Core Entrustable Professional Activities (EPAs) to graduate. These EPAs are similar to the Plastic Surgery Milestones of the US Accreditation Council for Graduate Medical Education, and both are the product of collaborative efforts from a number of experts in the field. Because aesthetic surgery is considered an essential component of plastic surgery training throughout the world, 5 of Canada’s new Core EPAs are aesthetic in nature. The assessment and technical ability to independently perform breast, body, and facial aesthetic surgery has...

The Presence of Ghost Publications Among Canadian Plastic Surgery Residency Applicants: How Honest Are Canadians?

Background:Physicians with history of unprofessional behaviour during their medical training are shown to be 3 times more likely to have board disciplinary action later in their career. One realm in which unprofessional behaviour takes place is the phenomenon of unverifiable publications or “ghost publications.” To that end, this study aims to assess the rate of ghost publications among a recent cohort of Canadian Plastic Surgery residency applicants to determine if this phenomenon is geographic in nature.Methods:The current study was a retrospective, cross-sectional observational study; a review of all residency applications submitted to a single Canadian Plastic Surgery residency program from 2015 to 2018 was performed and all their listed publications were verified for accuracy. The review was conducted by a third party librarian and a research coordinator blinded to the authors identifying information. “Ghost publication” was defined as any publication listed as “published,” “accepted,” or “in-press” that did not exist in the literature.Results:A total of 196 applications of 186 applicants were submitted over the span of 4 years. A total of 362 publications listed as peer-reviewed articles, belonging to 114 applications were extracted and reviewed. Among the 362 publications listed as peer-reviewed articles, 2 could not be found in the literature (0.55%). Additionally, 42 citations were found with 48 minor differences than what was cited.Conclusions:The rate of ghost publications among recent applicants to a Plastic Surgery residency program is low (less than 1%). Future studies should investigate methods to further improve and instill the value of professionalism in our future plastic surgery trainees.

Resident Exposure to Aesthetic Surgical and Nonsurgical Procedures During Canadian Residency Program Training.

North American residency programs are transitioning to competency-based medical education (CBME) to standardize training programs, and to ensure competency of residents upon graduation. At the centre of assessment in CBME are specific surgical procedures, or procedural competencies, that trainees must be able to perform. A study previously defined 31 procedural competencies for aesthetic surgery. In this transition period, understanding current educational trends in resident exposure to these aesthetic procedures is necessary. The aim of this study was to characterize aesthetic procedures performed by Canadian plastic surgery residents during training, as well as to describe resident performance confidence levels and degree of resident involvement during those procedures. Case logs were retrieved from all 10 English-language plastic surgery programs. All aesthetic procedures were identified, and coded according to previously defined core procedural competencies (CPCs) in the aesthetic domain of plastic surgery. Data extracted from each log included the procedure, training program, resident academic year, resident procedural role, and personal competence. From July 2004 to June 2014, 6113 aesthetic procedures were logged by 55 graduating residents. Breast augmentation, mastopexy, and abdominoplasty were the most commonly performed CPCs, and residents report high levels of competence and surgical role in these procedures. Facial procedures, in particular rhinoplasty, as well as nonsurgical CPCs are associated with low exposure and personal competence levels. Canadian plastic surgery residents are exposed to most of the core aesthetic procedural competencies, but the range of procedures performed is variable. With the implementation of CBME, consideration should be given to supplementation where gaps may exist in aesthetic case exposure.

Pregnancy and parental leave among plastic surgery residents in Canada: a nationwide survey of attitudes and experiences

Small surgical residency programs like plastic surgery can be challenging environments to accommodate parental leave. This study aimed to report the experiences, attitudes and perceived support of Canadian plastic surgery residents, recent graduates and staff surgeons with respect to pregnancy and parenting during training. Residents and staff surgeons were invited via email to participate in an online survey. The results presented here explore experiences of pregnancy and parental leave of current plastic surgery residents and staff surgeons. Residents' and staff surgeons' perceptions of program director support, policies, negative comments and the impact of parental leave on the workload of others were also explored. Although the findings suggest that there may be improvements in the support of program directors, there continues to be a negative attitude in surgical culture toward pregnancy during residency. The perceived confusion of respondents with respect to programspecific policies emphasizes the need for open conversations and standardization of parental leave.

Dr Patricia Clugston-A Spirit of Determination.

Dr Patricia Clugston was a British Columbia native who completed her plastic surgery residency training in Vancouver in 1993 before pursuing a fellowship in Nashville with Dr Patrick Maxwell in 1994. When Dr Clugston returned to Vancouver, she helped to establish a comprehensive and renowned breast reconstruction program. She spent her career advocating for and working towards better treatment options for women seeking breast reconstruction. As a determined surgeon and accomplished athlete, Dr Clugston was truly a tour de force in all aspects of her life. Patty, as she was affectionately known by her colleagues, loved her job. Dr Clugston was an avid advocate for medical education and an outstanding clinical researcher and speaker that established her as a shining star in Canadian plastic surgery. Patty had always lived life to the fullest and was determined that scleroderma would not change this. Her sharp wit, intellectual curiosity, and pragmatism masked an incredible courage as she fought bravely against a cruel disease. Dr Clugston died on March 1, 2005, at the age of 46 surrounded by the loving company of her husband, friends, and family at the Vancouver General Hospital. The Dr Patricia Clugston Chair in Breast Reconstruction was established in her name to honour her legacy and continue to improve the care of patients with breast cancer.

Canadian Plastic Surgery Resident Operative Experience in Hand Surgery

Core procedural competencies (CPCs) in hand surgery have been previously described. However, it is unknown whether plastic surgery residents receive sufficient operative experience with these procedures. This study aimed to determine whether Canadian plastic surgery residents are receiving adequate exposure to CPCs in hand surgery during residency training. Hand surgery case logs recorded by graduating plastic surgery residents at 10 Canadian English-speaking training programs between 2004 and 2014 were reviewed from 3 databases. For each CPC in hand surgery, perceived resident role and self-competence scores were collected and analyzed. Core procedural competencies encompass core essential procedural competencies (CEPCs) and nonessential procedural competencies. There were 55 graduating plastic surgery residents included in the study. A total of 14,909 procedures were logged for 42 CPCs, with an average of 271 procedures/resident. When grouped by subdomain within hand surgery, procedures with the most exposure were related to traumatic finger injuries (29%) and neuropathies (22%). The least common procedures were related to flap reconstructions (0.3%) and muscle release (0.1%). Many residents reported receiving no operative experience (range, 2% to 100%) or between 1 and 10 cases of CEPCs (range, 7% to 50%). Most graduating residents (58% to 72%) did not feel competent independently performing 60% of the most common procedures. There were weak to moderate correlations between role and self-competence, and between postgraduate year and self-competence. Currently, many plastic surgery residents graduate from training programs with little to no exposure for over half of the CEPCs in hand surgery. Given the great diversity in hand surgery CPCs, it is difficult for residents to gain adequate operative experience during their residency in all of the CPCs.

Variable Experience in Microsurgery and Flap-Based Procedures Among Canadian Plastic Surgery Residents

Variable experience in microsurgery and flap-based procedures among Canadian plastic surgery residents. Plastic surgery residencies are transitioning toward a competency-based education model. It is not known whether trainees can realistically achieve proficiency in microsurgical techniques during their training. This study aims to define the operative experience in the core microsurgical flap procedures among Canadian plastic surgery residents. Microsurgical core procedural competencies (CPCs) have been described. A retrospective review was conducted, evaluating case logs recorded by graduating plastic surgery residents at 10 Canadian English-speaking training programs between 2004 and 2014. Perceived role and competence scores were also collected and analyzed. University of Toronto, Toronto, ON, Canada; University of British Columbia, Vancouver, BC, Canada. Among 27 microsurgical CPCs, 2082 procedures were logged and each resident performed an average of 37.9 (±21.7) procedures. Anterolateral thigh flaps, radial forearm-based flaps, and digit replants were the most common; however, 10.9% to 14.5% of residents did not have any operative experience with these flaps. Most residents reported zero operative experience with many of the CPCs (10.9%-100%). Co-Surgeon (50%) and First Assistant (30%) were the most common roles. None of the graduating residents reported feeling competent enough to independently perform 50% of the microsurgery CPCs. There was no difference in perceived roles when programs with ≥5 residents were compared against programs with fewer trainees. There were weak to moderate correlations between role and self-perceived competence, and between Post Graduate Year and self-perceived competence. There is wide variation in resident operative experience in microsurgical CPCs. Many residents graduate with little to no experience in many of the core procedures. Identifying areas of deficiency may help guide curriculum development in the new competency-based education model.

Resident Behaviours to Prioritize According to Canadian Plastic Surgeons.

Many articles have been published outlining the resident selection process for plastic surgery training programs. However, which qualities Canadian plastic surgeons value most in their current residents remains unclear. A national survey study was conducted to identify which attributes surgeons associate with the highest resident performance and which behaviours trainees should prioritize during their training. A literature review was performed to identify studies that documented attributes valued in plastic surgery applicants and characteristics of high-performing surgical residents. These qualities were extracted to construct a survey consisting of both ranking and open-ended questions. After an iterative review process, the survey was disseminated nationally to consultants and trainees of Canadian plastic surgery training programs. Survey responses were obtained from 120 invitees and a weighted rank was calculated for each evaluated attribute. The terms integrity, professional, and work ethic were viewed as the most important attributes prized by surgeons. Dishonesty, lack of dependability, and unprofessionalism were viewed as the most concerning behaviours. Additionally, disinterest and arrogance were identified by the open-ended questions as behaviours surgeons would like to see less frequently in their trainees. When compared to surgeons, trainees undervalued the importance of knowledge and the impact of unprofessional behaviour. With the multiple roles that a resident must fulfill, understanding which attributes are of the most importance will help focus self-directed learning and development within residency programs. Ultimately, instilling the importance of integrity and professionalism is most highly valued by members of the Canadian plastic surgery community.