Plastic Surgery Training Programs Research Articles

Assessment of Microsurgery Simulation Course Access in Plastic Surgery Training Programs.

Microsurgery requires complex skill development with a steep learning curve for plastic surgery trainees. Flap dissection courses and simulation exercises are useful to acquire these skills. This study aims to assess plastic surgery training programs' access to and interest in microsurgical courses. A survey was distributed to plastic surgery residency and microsurgery fellowship program directors (PDs). The survey collected program demographics and attendance of trainees at structured microsurgical skills or flap dissection courses. We assessed if PDs thought trainees would benefit from instructional courses. There were 44 residency PD responses (44/105, 41.9%, 36 integrated, 8 independent), and 16 fellowship PD responses (16/42, 38.1%). For residency PDs, 54.5% (24/44) sent residents to flap courses, and 95% (19/20) of remaining PDs felt residents would benefit from attending. In addition, 59.1% of programs (26/44) sent residents to microsurgical skills courses, and 83.3% (15/18) of remaining PDs felt residents would benefit from attending. When examining fellowship PDs, 31.2% of programs (5/16) sent fellows to flap dissection courses and 10/11 of remaining PDs felt fellows would benefit from attending a course (90.1%). Half of programs (8/16) sent fellows to microsurgical skills courses, and 7/8 remaining PDs felt fellows would benefit from attending (87.5%). Only half of the plastic surgery trainees have access to microsurgical skills and flap dissection courses. The majority of residency and fellowship PDs feel that training courses are valuable. Expanding access to these courses could provide a significant benefit to microsurgical education in plastic surgery training.

Building Sustainable Reconstructive Microsurgery in Countries with Limited Resources: The Rwandan Experience.

Reconstructive microsurgery practice has been well adopted in developed countries, but this has not been the same in low- and middle-income countries (LMICs). Injuries related to road traffic accidents are highest in these countries, with 93% of the world's fatalities on the roads occurring in LMICs. The objective of this study was to highlight the need for sustainable microsurgery in LMICs and share strategies undertaken in Rwanda. We review the contemporary literature about the needs and challenges facing reconstructive microsurgery in LMICs. We describe the strategies undertaken in Rwanda towards developing microsurgery. We also report the outcomes of the first ever microsurgery visiting professorship organized in the country and the steps taken towards achieving sustainable microsurgery practice in Rwanda. There is a huge unmet need for reconstructive microsurgery in LMICs. Most of the microsurgical operations in these countries are done in short term surgical mission setups. No data focusing on sustaining reconstructive microsurgery in LMICs has been described in the contemporary literature. There is a 2.5-fold increase in the number of trained plastic surgeons in Rwanda over the past 5 years, with increasing skills in microsurgery and opportunities for formal overseas fellowships. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable microsurgery services is possible in countries with limited resources. In our experience, the fly-in-fly-out microsurgical missions aimed at mainly providing surgical care to patients seem to have a limited long-term impact and sustainability. We recommend integrating these missions into planned microsurgical initiatives of pre-existing local plastic surgery training programs.

The Influence of Training Pathway, Institution Type, Gender, and a Global Pandemic on Post Graduation Career Plans in Plastic Surgery.

Anecdotal statements are often made about what percentage of residents go into fellowship versus private practice versus academia after graduation. However, few objective studies have been completed on this topic. This project is designed to shed light on the career choices of plastic surgery residents immediately after graduation from 2018 to 2022. A secondary objective was to determine whether the COVID-19 pandemic had any measurable impact on postgraduation plans. After obtaining institutional review board approval, publicly available data were obtained from institution websites or via program queries. Comparison between pre-COVID-19 and post-COVID-19 (2018-2019 versus 2020-2022), integrated versus independent, and private versus public cohorts were analyzed using Fisher exact test. A two-sided P value less than 0.01 was considered statistically significant. Data were collected for 690 graduates across 64 plastic surgery training programs. Responses were obtained from 60 of 88 (68%) integrated and 30 of 47 (64%) independent programs. Most graduates pursued fellowship training (61%), followed by private practice (28%), academic practice (5%), or military post (1%). Independent residents were more likely to pursue private practice (40% versus 26%, P = 0.001), whereas integrated residents were more likely to pursue fellowship (49% versus 70%, P < 0.0001). Public institution graduates were more likely to go into private practice (37% versus 23%, P = 0.0002), whereas private institution residents were more likely to pursue fellowship (55% versus 72%, P < 0.0001). Public institutions were more likely to graduate women (45% versus 35%, P = 0.009). The COVID-19 pandemic (P = 0.31) had no impact on postgraduation plans. This study demonstrates that training pathway and institution type have a significant impact on postgraduation plans, whereas a global pandemic does not. This information can be used by educators, residents, and medical students as they plan for the future.

Preoperative Preparatory Talk (PPT): Developing Operative Expertise of Plastic Surgery Trainees by Three Rounds of Preceptor-Trainee Discussions.

Background Plastic surgery training requires the trainee to assist in surgeries to improve their on-table decision making and hone their surgical skills, but this results in an increased risk of intraoperative complications and increased operative time. It is important to have a training method that orients the trainee toward the surgery to ensure patient safety. Materials and Methods A training method called preoperative preparatory talk (PPT) was devised in which the preceptor orients the trainee toward the planned surgery in three phases. Comparison and statistical analysis of mean operative times of four stages of free flap surgeries after PPT and without PPT were done. Objective Structured Assessment of Technical Skill (OSATS) scores of surgical trainees were also documented for surgeries done with and without PPT and statistical analysis was done for comparing these scores. Results Statistical analysis via unpaired t -test confirmed that after applying PPT, there was a significant decrease in time taken in three out of four stages of free flap surgeries: flap planning and harvesting, recipient site preparation and vessel dissection, and flap division and partial inset. Trainees were found to be better oriented toward the surgery which resulted in a better performance on table that was confirmed by statistical analysis of OSATS score via unpaired t -test. Conclusion PPT ensures better learning for the resident and improves patient safety because of better orientation of the operating team toward the procedure and operating steps. This reduces the operative time of free flap surgeries. We recommend this training method to be incorporated in plastic surgery training programs.

In-person, Hybrid, and Virtual Grand Rounds in Plastic Surgery: Impact and Participant Perceptions

Background: Many plastic surgery residency programs adapted to the COVID-19 pandemic by implementing virtual grand rounds. This study aimed to assess the impact of virtual grand rounds and how attendees perceived virtual grand rounds to inform future programmatic planning. Methods: This was a quality improvement initiative involving a cross-sectional survey and retrospective review of administrative records for the 2017–2018 (in-person) and 2021–2022 (virtual) academic years for two academic plastic surgery training programs in Boston, MA. Respondents were residents, fellows, and faculty within the two multisite plastic surgery residency training programs. Results: There were 39 respondents (51% faculty, 41% residents, and 8% fellows). There was no evidence of different preferences for the format of future grand rounds (P = 0.08), with most preferring hybrid, defined as in person for speakers and others who could attend. Most respondents indicated a more accessible learning environment (86.8%) and lack of in-person interaction (82.1%) as reasons for liking and not liking virtual grand rounds, respectively. Excluding outliers, attendance in 2021–2022 was on average 7.4% points greater than that in 2017–2018 (P &lt; 0.001), or six to seven more individuals at each session. There were significantly more out-of-state speakers in 2021–2022 (84%) as compared to 2017–2018 (28%) (P = 0.0008). Conclusions: Virtual grand rounds improved attendance and the geographic diversity of speakers. Attendees preferred a hybrid format for future grand rounds, citing advantages and disadvantages to both in-person and virtual formats.

The Impact of Social Media on Applicants’ Perceptions of Plastic Surgery Training Programs

Given recent COVID-19 restrictions on in-person visiting subinternships and interviews, this study sought to evaluate the program information that was most influential to future plastic surgery applicants as they researched residency programs on social media. An electronic survey targeting medical students interested in plastic surgery was deployed to assess the importance of various information sources in forming perceptions of residency programs. Applicants were invited to participate through an Instagram "Story" (where the survey was embedded) and through an electronic survey link sent via email to interested program applicants and interviewees. There were 83 respondents, among which 92% were current medical students planning to apply to Plastic Surgery. The most utilized resources that informed program interest were: mentors (86%), peers/partners (60%), and geographic location preference (55%). Among social media content, applicants most desired posts about resident life (66%) and team bonding activities (61%). Overall, 72% of respondents agreed/strongly agreed that social media played a role in informing their interest to apply to a specific residency program. The study demonstrated that prospective plastic surgery applicants expect programs to have a social media presence, and thus, programs should invest time and thought in their social media strategy. While electronic sources are not the most important sources of information rated among applicants, social media plays an influential role in guiding interest in specific programs. To best inform applicant perspectives during the recruiting process, programs should prioritize content that gives a picture of "resident life" and team dynamics.

Assessment of the Educational Environment of Plastic Surgery Training Programs in Iran using the PHEEM Questionnaire: A Cross-sectional Study

Assessment of the Educational Environment of Plastic Surgery Training Programs in Iran using the PHEEM Questionnaire: A Cross-sectional Study

How Consistent are International Rotations Between Plastic Surgery Training Programs?

All 101 integrated and independent plastic surgery program directors/coordinators were asked to participate. The survey identified the requirements and details of existing international rotations. In total, 57 programs responded (56% response rate) to the survey. An estimated 54% of all programs offered international rotations to their residents, and 94% of these programs obtained institutional approval. Additionally, 69% of these programs have received national approval. Institutional requirements for programs to provide international rotations vary significantly across institutions, which results in disparate experiences for residents and poses potential risks to international partners. This study will help promote transparency regarding international rotation requirements and better equip faculty to enhance international rotations that cater to the needs of the institution, residents, and most importantly, the host countries.

Educational and Clinical Outcome Measures in an Integrated Hand Service

BackgroundWe recently sought to integrate our orthopaedic and plastic hand surgeons with the goal of improving education, patient care, and providing seamless, continuous coverage for our trauma center. Our hypothesis was that integration could serve both the orthopaedic and plastic surgery training programs well and provide more consistent care for the trauma patients. Materials and MethodsProgram director approval was granted for blinded analysis of case logs from plastic and orthopaedic surgery programs from 2012 through 2019. Data on mean and total number of hand cases were analyzed and compared for both specialties. Institutional Review Board approval was granted for a retrospective review of patient outcomes. ResultsFor both orthopaedic and plastics resident trainees, the mean number of hand cases increased during this study period suggesting that the integration had a favorable impact on both programs. The mean number of hand cases for orthopaedic residents rose from 163 to 246. The mean number of hand cases for plastic surgery residents rose from 218 to 295. Patient outcomes as reflected in length of stay and time to consultation also improved. ConclusionTo improve hand surgical training and patient care, an integrated orthoplastics approach to hand surgery was implemented at our institution. Plastic surgery trainees are completing more hand surgery cases in an integrated model (p < 0.001), including fracture care (p < 0.047). Orthopaedic surgery trainees have doubled the percentage of integumentary and microsurgery cases in the integrated model (p < 0.001). The educational and clinical changes affected in an integrated model have changed the paradigm for educating future hand surgeons at our institution.

Discrepancies in Gender Representation Between Integrated and Independent Plastic Surgery Programs.

Despite increasing female representation in integrated plastic surgery training programs, independent programs have lower representation and slow improvement in female enrollment. Self-reported resident data were used to investigate trends of female representation in integrated and independent programs. Data were collected from Accreditation Council of Graduate Medical Education resources of active residents' characteristics. Self-reported gender data were collected for integrated, independent, and general surgery programs from annual reports since 2009. χ2 analysis was conducted to compare female enrollment of integrated programs, independent programs, general surgery programs, and general surgery programs with matriculation-year adjustment. In 2008, 89 independent programs had nearly identical percentage of female enrollment with 30 integrated programs at 23.8% and 23.1%, respectively. Differences in representation between independent and integrated programs became significant in 2012, with independent programs demonstrating 25.1% female enrollment compared with 30.5% in integrated programs. This trend of higher female representation in integrated programs has persisted since 2012. To correct for preexisting disparity in general surgery programs, we compared female enrollment of independent programs with female enrollment of that class' general surgery matriculation-year 5 years earlier. In all examined years, general surgery still had proportionally higher female enrollment compared with independent programs, even with conservative 5-year matriculation adjustment. Dramatic differences in female enrollment were found between integrated and independent programs, with representation in integrated programs rising more quickly. Adjustments for previous rates of female enrollment in general surgery did not yield explanation for low independent program enrollment. Increasing female representation in independent training models will continue to create a more diverse workforce.

32. Gender Surgery Training in Plastic &amp; Reconstructive Surgery Programs: A Description of the Current Academic Landscape

Background: The volume of gender affirmation surgery has increased steadily in recent years. Gender surgery as a subspecialty is an increasingly prevalent component of plastic and reconstructive surgery practice; however, the gender surgery education landscape has not been described in detail. The purpose of this study is to describe the current gender surgery training landscape and determine program-specific predictors of gender surgery training. Methods: Plastic and reconstructive training programs in the United States (US) and Canada were included in this retrospective study. Data collected from November 2021 to February 2022 included dedicated gender affirmation surgery rotations, presence of gender surgery fellowships, number of integrated residents, program-specific subspecialty rotation durations, and presence of a research year in the training program. Data were obtained from publicly available sources and program coordinators, residents, fellows, and faculty were contacted directly for additional data. Univariate and linear and logistic regression models were used to establish relationships between gender surgery rotation duration, presence of gender fellows, and program details. Results: Ninety-four plastic and reconstructive surgery residency programs in the United States and Canada were included in this study. Two (2.13%) residency programs had gender surgery rotations in (6 weeks and 12 weeks, each). The number of months residents rotated on gender surgery was significantly predicted by increased number of integrated residents (β = 0.074, p = 0.041), increased number of aesthetic surgery fellows (β = 0.281, p = 0.012), and more months on craniofacial/pediatrics (β = 0.024, p = 0.012). Six (6.38%) residency programs had gender surgery fellows. The presence of gender surgery fellows was significantly predicted by more integrated plastic surgery residents (β = 0.829, p = 0.049) and the presence of a research year in the plastic surgery training program (β = 2.351, p = 0.019). Conclusion: The volume of gender surgery is increasing in North America; however, formalized training for gender surgery in plastic surgery remains limited. The presence of gender surgery training is currently best predicted by factors associated with larger academic institutions, including increased number of integrated plastic surgery residents, research years, and fellows.

23. Creating and Implementing a Wellness-inspired Resident Educational (WIRE) Curriculum

Background: More than 70% of surgical trainees reported symptoms of burnout prior to the start of the COVID-19 pandemic. Unaddressed, burnout can result in diminished quality of life, reduced career satisfaction, decreased productivity, and elevated risk of suicidality, especially amongst physicians. Traditional plastic surgery residency curricula have not addressed physician burnout or strategies for managing its sequelae. Methods: Our department create and implemented the Wellness-Inspired Resident Education (WIRE) curriculum. The goals of this initiative are to prepare residents for life after residency, provide residents and faculty with the tools necessary to maximize their personal wellness, and create opportunities for networking with leaders in the field. Feedback obtained from residents who participate in our curriculum is used to shape the following year. Results: The WIRE curriculum was initiated in March 2021 consisting of a leadership retreat and 1-2 wellness lectures per month. Feedback obtained from residents who participated in the sessions indicated a desire for improved balance between educational and wellness inspired didactic sessions, in addition to creating better integration of the sessions such that personal time was not further affected. In the following year, 6 topics were chosen, including three resident-selected topics. Sessions were held on a bimonthly basis and were fully integrated into the didactic schedule. Additionally, a resident wellness retreat was planned for the Fall. Residents were surveyed following conclusion of the academic year, with 90% of residents indicating a desire for more informal wellness events in addition to formal sessions as part of the planned curriculum. Resident-selected topics with more than 50% interest amongst surveyed residents included malpractice, financial planning, recovering from complications and bad interactions, making an impact, mentoring, innovation and invention, conflict resolution, and ergonomics. Conclusion: The WIRE curriculum is an opportunity to better prepare trainees for life after residency and to improve everyday wellness. This curriculum is resident-driven, allowing topics to reflect interests and respond to current and potential future stressors of trainees, while increasing resident buy-in. It is our hope that this curriculum be considered as an addition to plastic surgery training programs across the country.

22. Paradigms for Plastic Surgery Training Programs in sub-Saharan Africa

Background: Sub-Saharan Africa (SSA) is one of the world’s geographic regions with the greatest need for expanded plastic surgery training and infrastructure to address its burden of surgical disease. The present study reviews the educational structure and existing training programs in Plastic and Reconstructive Surgery (PRS) throughout SSA to provide transparency as to the educational paradigms and help identify where unmet needs are the greatest. Methods: The respective websites of the College of Surgeons of East, Central, and Southern Africa (COSECSA), the West African College of Surgeons (WACS), and the Colleges of Medicine of South Africa (CMSA) were reviewed by the authors. Additionally, anecdotal evidence informed by authors who have trained or are currently members of these colleges was utilized when available website information was lacking. Results: After completing medical school and a governmentally sponsored internship, COSECSA, including 19 countries, requires 2 years of general surgery training prior to 3 years of PRS. There are currently 13 accredited programs in COSECSA to train PRS trainees, with 5 graduates completing their training in 2020. CMSA similarly requires 2 years of general surgery and 3 years of PRS training at one of the 8 accredited programs in South Africa. WACS, including 14 countries, requires 2.5-3 years of general surgery in addition to 3 years of PRS. There are 32 accredited programs, 29 in Nigeria and 3 in Ghana, approved for 116 resident positions. In April 2022, 5 WACS trainees passed their exams to become board certified plastic surgeons. The ratio of PRS-accredited programs to the number of countries in each region is demonstrated. Conclusion: The requirements for plastic surgery training in SSA are fairly consistent throughout the region. However, COSECSA, which includes the largest number of African countries, has less than 1/3 the ratio of accredited programs per country compared to any other region in SSA. Increased transparency and collaboration between SSA and other African regions will help each of these programs continue to expand to meet their surgical needs.

Geographic Trends of International Medical Graduate Residents and Faculty in US Plastic Surgery Training Programs.

Of the academic plastic surgeons in the United States, 13.6% are international medical graduates (IMGs). The objective of this study was to identify the countries from which IMGs obtained their medical degrees and the states they matched in. We sought to establish a correlation between IMG faculty and residents in plastic surgery programs. Plastic surgery program Web sites were reviewed. The primary outcome of interest was the country IMG residents had obtained their medical degrees from. Secondary outcomes of interest were program state location, IMG resident postgraduate year, and programs' number of IMG faculty. One hundred one programs were screened. A total of 39 states were represented; there were 1262 current residents, of which 92 (7.3%) were IMGs. International medical graduate residents received their medical degrees from 46 different countries. The most common countries were England (n = 6 [6.5%]) for IMG residents and Canada (24.5%) for IMG faculty. The most common region represented for residents was South America (n = 44 [47.8%]). The highest proportions of IMGs per total state plastic surgery residents were found in West Virginia (33.3%) and Minnesota (25%); 13.5% and 15.6% of program directors and program chairs were IMGs, respectively. There was a statistically significant difference between the proportion of IMG residents in programs that had an IMG program director versus programs with no IMG program director (P = 0.016). No such statistically significant difference was found between the proportion of IMG residents in given programs with IMG chairs (P = 0.55). There were significantly more IMG faculty in programs with IMG chairs (P = 0.001). The number of IMG faculty was positively correlated to the number of IMG residents in a given program (P = 0.0001, r = 0.39). International medical graduate residents constitute a small but appreciable portion of current plastic surgery residents; the majority have earned their degrees from the South America region. International medical graduate plastic surgery residents are more likely to be recruited to programs that have an IMG program director and a higher number of IMG faculty. International medical graduate faculty have a strong representation in academic plastic surgery, as evidenced by the percentage of IMG program directors and chairs. Programs with IMG chairs had a greater number of IMG faculty.

Assessment of the Educational Environment of Plastic Surgery Training Programs in Iran using the PHEEM Questionnaire: A Cross-sectional Study.

Clinical educational environments play a substantial role in the teaching of medical residents and fellows. In order to improve the quality of clinical education, its status should be evaluated. Therefore, we aimed to inquire about the educational environment of Plastic Surgery fellows in two teaching hospitals in Tehran, Iran using the Postgraduate Hospital Educational Environment Measure (PHEEM). In this descriptive cross-sectional study, Plastic Surgery fellows studying in two teaching hospitals in Tehran, Iran, in 2022 were included. The Persian version of the PHEEM questionnaire was applied for assessing the clinical educational environment. The collected data were analyzed by SPSS software version 22. Twenty six Plastic Surgery fellows were studied, 15.4% of whom were women (n=4) and 84.6% were men (n=22). The mean total score of the PHEEM questionnaire was 89.68±26.02. The highest mean score was in the teaching dimension (35.08), while the lowest mean score was in the social support dimension (25.42). Most dissatisfaction among Plastic Surgery fellows were in the field of social support. It is necessary to adopt proper educational policies to improve the supportive resources for Plastic Surgery fellows.

Recommendations on Attaining Departmental Status: A Survey of Division Chiefs Turned Department Chairs.

In 2009, the Association of Academic Chairmen of Plastic Surgery, now known as the American Council of Academic Plastic Surgeons (ACAPS), published a white paper endorsing the conversion of plastic surgery divisions into autonomous departments, motioning for other national organizations to follow suit. ACAPS' rationale outlined 11 factors intended to promote the favorability of attaining departmental status within an institution. Through surveying division chiefs turned founding department chairs who successfully executed this transition, we evaluate the practicality and efficacy of these guidelines. A survey was distributed to founding chairs of plastic surgery departments that were established after ACAPS' 2009 white paper. Information pertaining to institutions' demographic information and respondents' utilization of the principles and suggestions espoused in the white paper was obtained. The survey achieved an 86% response rate. The average time needed for the transition was 22 ± 12 months. Four of seven chairs were familiar with the 2009 ACAPS white paper. Garnering support from hospital administrators and institutional stakeholders, having fiscal profitability within the institution, and coordinating an integrated plastic surgery training program were ranked as the top three most important factors, respectively. This study assesses ACAPS' recommendations on transitioning from a division to a department on the basis of perceived utility by academic leaders who recently navigated the process. The most frequently cited factors for a successful transition included rallying support from institutional stakeholders and ensuring profitability. Additionally, aligning the timing with a concurrent transition of leadership can expedite the process.

26. Heavy Rotation: Changing Consensus in Integrated Residency Training Program Rotation Schedules

Background: As plastic surgery training evolves, ongoing appraisal of the 6-year integrated curriculum is warranted. We performed the current study to describe inter-program variance in structured US plastic surgery curricula. Methods: In August 2021, we obtained rotation schedules from plastic surgery training program websites. When unavailable, we requested schedules from program coordinators. Individual blocks were each recorded as one of 52 rotations and sorted as follows: led by plastics faculty (“Core Plastics”), hosted by non-plastic surgeons within the scope of plastic surgery (“Off-Service”), and rotations outside the scope of plastic surgery (“General Surgery”). Within these categories further characterization was performed using descriptive statistics. Results: Of 84 US programs, rotation schedules were obtained for 71.4% (n=60): 50.0% (n=42) listed complete data on their websites, 3.6% (n=3) listed partial data on their websites and provided additional data upon request, 17.9% (n=15) listed no data on their websites and provided data upon request, and 28.6% (n=24) provided no data online or upon request. The most common program structure was the “2 + 4” model (n=29, 48.3%) followed by the “1 + 5” (n=16, 26.7%), the combined “3 + 3” (n=13, 21.7%), and the “0 + 6” (n=2, 3.3%) models. Overall, programs offered 51.3 (SD±5.5) months of core plastic surgery, 12.4 (SD±4.1) months of general surgery, and 7.8 (SD±2.7) months off-service. All programs offered mixed plastic surgery [mean=28.5 (SD±14.2) months] followed by ENT and dermatology. The most common plastic surgery rotations were hand, mixed cosmetics, and craniofacial/pediatrics. Most programs offered either electives [n=31, 2.3 (SD±1.2) months] or research time [n=22, 2.0 (SD±0.9) months]. Many programs offered experience in areas beyond ACGME requirements such as neurosurgery [n=19, 1.0 (SD±0.1) months], thoracic surgery [n=14, 1.0 (SD±0.3) months], and/or urology [n=6, 1.0 (SD±0) months]. Conclusion: Our findings show that >75% of integrated plastic surgery training programs featured a majority (?4 years) of specialty-specific training with only 21.7% continuing the “3 + 3” model. While many programs provided data upon request, more than half did not include rotation schedules on their websites, potentially influencing competitive candidates’ decisions to apply. Continued transparency around plastic surgery training curricula can help program directors further refine their programs.

21. Nationwide Resident Access to Elective Rotations - A Survey Study

Background: This study seeks to assess the current status of elective rotations offered in PRS residency programs throughout the country while also qualifying resident and alumni experiences and identifying barriers to offering electives. Design: Two prospective surveys were created for: (1) program leadership; (2) residents, fellows and alumni’s that have graduated in the last 5 years. Methods: Multi-institutional survey study Of 532 programs, 45 leaders (1) and 102 residents, fellows and/or recent graduates responded to the survey (2). Results: Fifty –six percent of respondents stated that their institution offered electives, 62% of which permitted residents to participate in regional, national, and international rotations primarily in the fifth and sixth years of training. Types of elective rotations completed included: aesthetic, craniofacial, gender, hand, and microsurgery. 53% responding programs denied barriers to offering elective rotations. When programs noted barriers, the most common were: cost to resident/department (28%), institutional GME policy (22%), and lack of service coverage at the home institution (22%). There was no difference between departments versus divisions offering electives (56.3% vs. 57.1%, p=0.95). Programs that didn’t offer electives spent an average of 14.6 months on general surgery compared to 9.4 months for programs that did offer electives (p=0.06). For programs which didn’t currently offer elective rotations, 71% indicated a desire to do so. Conclusion: The primary goal of plastic surgery training programs is to produce plastic surgeons of the highest caliber with regards to safety and competence. While several regulatory bodies ensure that programs adhere to a similar standard, not all programs have opportunities for residents to experience the breadth of our multi-faceted specialty. Elective rotations constitute an excellent supplement to a well-rounded training where gaps may exist.

Identifying US Plastic Surgery Training Programs that Effectively Establish Gender and Ethnically Diverse Faculty.

Background:Successful strategies to improve the representation of female and ethnically underrepresented in medicine (UIM) physicians among US plastic and reconstructive surgery (PRS) faculty have not been adequately explored. Accordingly, we aimed to identify programs that have had success, and in parallel gather PRS program directors’ and chiefs/chairs’ perspectives on diversity recruitment intentionality and strategies.Methods:We conducted a cross-sectional analysis of the demographic composition of female and UIM faculty of PRS residency training programs. Separate lists of programs in the top quartile for female and UIM faculty representation were collated. Additionally, a 14-question survey was administered to program directors and chiefs/chairs of all 99 Accreditation Council for Graduate Medical Education-accredited PRS residency programs. The questions comprised three domains: (1) demographic information; (2) perceptions about diversity; and (3) recruitment strategies utilized to diversify faculty.Results:Female and UIM faculty representation ranged from 0% to 63% and 0% to 50%, respectively. Survey responses were received from program directors and chiefs/chairs of 55 institutions (55% response rate). Twenty-five (43%) respondents felt their program was diverse. Fifty-one (80%) respondents felt diversity was important to the composition of PRS faculty. Active recruitment of diverse faculty and the implementation of a diversity, equity, and inclusion committee were among the most frequently cited strategies to establish a culturally sensitive and inclusive environment.Conclusions:These findings reveal that female and UIM representation among US PRS faculty remains insufficient; however, some programs have had success through deliberate and intentional implementation of diversity, equity, and inclusion strategies.

Virtual Surgical Subinternships: Course Objectives and a Proposed Curriculum.

Background:Due to the recent COVID-19 pandemic, patient care and medical education have faced many significant changes. The Association of American Medical Colleges and the American Council of Academic Plastic Surgery officially recommended halting all student rotations and interviews for the year. This change has unfortunately fallen squarely at the onset of a vital season for education and recruitment of plastic surgery subinterns. This article presents a curriculum for a single institution’s virtual surgical subinternship to help inspire ideas and inspiration for programs developing their own virtual subinternships.Methods:The goals for the virtual surgical subinternship are focused on student preparation for residency and remain similar to those outlined by the core competencies for in-person rotations. The first virtual subinternship in plastic surgery modeled after the curriculum presented was offered as a 2-week course starting May of 2020.Results:The components of the curriculum include a self-study syllabus, virtual case reviews, virtual suture laboratory, educational teleconferences, participation in research, and mentorship meetings. The 2-week course has approximately 25 hours of conferences and teaching, involving direct interaction with residents and faculty, and approximately 15 hours of self-directed learning.Conclusions:To the authors’ knowledge, this was the first virtual subinternship offered for rising fourth-year medical students. They strongly encourage other residency training programs to offer similar virtual learning opportunities for medical students, particularly for those without access to a home plastic surgery training program. The curriculum presented in this article is simply to provide ideas, inspiration, and a potential framework for programs wishing to create similar virtual learning opportunities.