Plastic Surgery Training Research Articles

'Virtual Mentorship is a No-Brainer': The Application of a Virtual Mentorship Programme for Prospective Plastic Surgery Trainees.

Aims This study aimed to evaluate the effectiveness of a virtual mentorship programme in plastic surgery designed for medical students and foundation doctors in the United Kingdom. The programme sought to enhance understanding of common and emergency conditions, provide guidance on the application process for speciality training, and facilitate networking opportunities. Materials and methods The programme consisted of six sessions delivered via Microsoft Teams (Microsoft® Corporation, Redmond, WA) over a four-month period from May to August 2024. Participants completed online pre- and post-mentoring questionnaires. Wilcoxon signed-rank test was used to compare paired data responses. Results Ten participants completed both questionnaires; 90% were medical students, and 10% were foundation-year doctors. There was a significant increase in the understanding of common plastic surgery conditions and emergencies (p < 0.05), as well as improved knowledge of the application processes for core surgical training (p < 0.05) and higher speciality training (p < 0.05). Interest in the speciality significantly increased (p < 0.05), and participants were more likely to seek in-person mentorship (p < 0.05). The programme was well-received, with 100% rating it as 'excellent' or 'very good'. Conclusions The virtual mentorship programme effectively enhanced foundational knowledge, career preparation, and mentor-mentee relationships. Its implementation is recommended both alone and in combination with traditional face-to-face mentorship.

A Survey of Upper Extremity Musculoskeletal Ultrasound Use in a Surgical Practice.

Purpose: The purpose of this study is to gather the practices and perceptions among upper extremity surgeons regarding the use of musculoskeletal ultrasound for diagnostic and therapeutic intervention. Methods: A 36-question survey was developed from a literature review and author consensus. This survey was then piloted among a small group of hand surgeons prior to distribution. The survey included respondent characteristics, use of ultrasound in their current practice, referral patterns for ultrasound, and interest in incorporating ultrasound into practice and residency training. The refined survey was distributed to the Canadian Society of Plastic Surgeons, and Wrist and Elbow Society of Canada, as well as plastic surgery training programs. A reminder email was sent at 3 weeks and again at 8 weeks. Results: There were 152 responses after 505 survey invitations (30% response rate). Of these responses, 140 were complete (92%). Diagnostic ultrasound was used by 16 respondents (11%) for a myriad of pathologies. Only 5% used ultrasound for guided injections in a clinic or office setting. Money, time, lack of training, and lack of billing code were the major barriers to ultrasound implementation for 124 (89%) hand surgeons. Most respondents (84%) believe that ultrasound training should be incorporated into residency training. Ninety-one respondents (60%) are interested or very interested in incorporating ultrasound into their current practice. Conclusions: Ultrasound is a valuable resource that is seldom used as a point of care by Canadian hand surgeons due to several barriers. Survey results suggest that upper extremity surgeons are keen to have ultrasonography be part of residency education and most wish to adopt it into their future practice.

Specialists Versus Trainees: Long-Term Secondary Deformity After Unilateral Cleft Lip Repair.

Unilateral cleft lip repair is a common procedure in plastic and reconstructive surgery to restore both function and aesthetics. The long-term outcomes of these surgeries can be influenced by various factors, including the experience and position of the surgeon performing the procedure. This study aims to investigate whether there is a significant difference in long-term secondary deformities based on whether the surgery was performed by a specialist or a trainee. This is a retrospective cross-sectional study among unilateral cleft lip patients based on their data records. The study aims to assess the long-term secondary deformity in relation to the position of the surgeon (specialist or trainee) in patients who underwent unilateral cleft lip repair surgery at the Reconstructive Sciences Unit at Hospital Universiti Sains Malaysia (HUSM). Of the 50 patients, the majority (74%) were operated on by a specialist with more than five years of experience. Only 13 patients (26%) were operated on by trainees in the plastic and reconstructive surgery training program. Long-term secondary deformity had no significant relationship with the surgeon's position (chi-squared (χ2)(1) = 5.89, p = 0.08). Long-term secondary deformities were less likely following unilateral cleft lip repair performed by a specialist or senior surgeon. However, the relationship between these secondary deformities and the surgeon's position (specialist or trainee) was statistically insignificant. Therefore, this study urges trainees to be more involved in simple cleft surgeries to enhance their surgical skills and achieve the best outcomes.

The impact of COVID-19 on Australian plastic and reconstructive surgery trainees: a survey study

Introduction: The COVID-19 pandemic had a significant impact on the training of plastic and reconstructive surgeons and the wellbeing of surgical trainees internationally. The aim of this study was to evaluate the impact of the COVID-19 pandemic on Australian plastic and reconstructive surgery trainees. Method: A web-based self-administered survey was distributed by the Australian Society of Plastic Surgeons to all Australian plastic and reconstructive surgery registrars in October 2021. A questionnaire developed to assess the impact of the COVID-19 pandemic on plastic and reconstructive surgery trainees in the United States of America was adapted for the Australian context. Subgroup analysis evaluated differences in responses between early and late Surgical Education and Training trainees and between Australian states. ​Results: Of 103 Australian plastic and reconstructive surgery trainees invited to participate, 24 responded (23%). Of these, 52 per cent were in their first two years of training. Total working hours were reduced for 61 per cent of respondents, 54 per cent reported less direct operative supervision, and 75 per cent reported missing out on critical operative learning experiences due to elective operating changes. Overall impact on trainee education was reported to be negative by 71 per cent of respondents. Self-assessed overall wellbeing was negatively impacted in 92 per cent of respondents: all reported feeling isolated from colleagues and 67 per cent reported burnout due to changes during the pandemic. Positive innovation in plastic and reconstructive surgery unit management was reported by 29 per cent of respondents. There were no statistically significant differences in responses between early and late Surgical Education and Training trainees. There were some differences identified in senior supervision and frequency of organised teaching between states. Conclusion: Australian plastic and reconstructive surgery trainees in our cohort reported that the COVID-19 pandemic had a negative impact on their clinical training opportunities, formal education and wellbeing. These findings should be considered in planning for future periods of significant disruption to try to mitigate the negative impacts on trainees.

Addressing workforce distribution and improving care: insights from trainees

Introduction: Plastic surgeons are maldistributed in New Zealand. Regional centres have fewer surgeons and lower surgeon to population ratios than larger metropolitan areas. There is no published data on the future work intentions of plastic surgical trainees in New Zealand. This study examines the career preferences and intentions of plastic surgery trainees in New Zealand as well as perceived barriers to working in a regional centre. Methods: An anonymous online survey was sent to 31 current plastic surgery trainees and recent graduates. Data collected included demographic information, rural background, previous experience in regional centres, family responsibilities, preferred work locations, aspirations for private practice and work–life balance preferences. Results: A total of 25 trainees completed the questionnaire, with a response rate of 81 per cent. A significant proportion of trainees have prior experience in smaller regional centres. Family-friendly work environments and employment for partners were identified as important considerations. The top-ranked regional centres to work in included Queenstown/Wānaka, Hawkes Bay, Nelson and Whangārei. Factors such as the presence of other plastic surgeons, leave policies, after-hours call arrangements and access to a private operating facility were considered essential. Financial considerations, access to quality schooling or childcare, employment opportunities for partners, opportunities for teaching and unit expansion were also important factors. Conclusion: The results of this survey provide insight into the personal and professional factors influencing the career decisions of plastic surgery trainees in New Zealand. The findings highlight the need for strategic workforce planning and engaging relevant stakeholders to address the maldistribution of plastic surgeons, ultimately improving access to specialised care and reducing healthcare disparities for New Zealanders.

Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees-Part 1: Anatomy and Physiology.

The velopharyngeal (VP) port separates the nasopharynx from the oropharynx and is bordered by the velum, lateral pharyngeal walls, and posterior pharyngeal wall. Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the VP port, affecting speech and swallowing. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 1, the authors focus on the anatomy and physiology of the velopharyngeal port, the anatomy of cleft palate, and the causes of VPD. There are 3 types of VPD: velopharyngeal insufficiency, involving structural deficits; velopharyngeal incompetence, resulting from neuromuscular issues; and velopharyngeal mislearning, due to maladaptive speech habits. VPD is commonly associated with cleft palate due to anatomic disruptions that impair velopharyngeal function. However, there are numerous causes of noncleft VPD, including congenital or acquired structural defects, neuromuscular conditions, and developmental/behavioral factors. Diagnosis and management of VPD require a multidisciplinary approach involving, at a minimum, surgeons and speech-language pathologists. Plastic surgery trainees often receive education on the surgical treatment of VPD, but without a foundational knowledge of the disease spectrum and speech pathology, the complex terminology can impede a thorough understanding of its diagnosis and management. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.

Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees Part 3: Objective Assessment and Surgical Decision-Making.

Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the velopharyngeal (VP) port, affecting speech and swallowing. After an auditory-perceptual speech evaluation by a speech-language pathologist, objective assessment of the VP port is required to determine the need for surgical intervention. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 3, the authors focus on the modalities for objective VP port assessment, including both direct and indirect methods. Direct imaging techniques such as videofluoroscopy, nasoendoscopy, and MRI are detailed for their strengths and limitations in visualizing VP port function and preoperative planning. Indirect assessments, including nasometry and aerodynamic measurements, are also briefly discussed. The decision-making process for surgical intervention is explored, emphasizing factors such as the severity and etiology of VPD, VP closure patterns, palatal length, orientation of the levator veli palatini, and other patient-specific considerations. The authors review the surgical options for repair including palatoplasty procedures (Furlow palatoplasty, straight-line intravelar veloplasty, and palatal lengthening buccal myomucosal flaps) and pharyngoplasty procedures (posterior pharyngeal flaps and sphincter pharyngoplasty), highlighting their indications, techniques, and potential complications. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.

Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees Part 2: Speech Fundamentals and Perceptual Speech Assessment.

Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the velopharyngeal (VP) port, affecting speech and swallowing. The gold standard for diagnosis is auditory-perceptual speech evaluation by a specialized speech-language pathologist. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism, (2) fundamental speech terminology and principles of perceptual speech assessment for VPD, and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 2, the authros begin with the concepts and terminology required to understand the perceptual speech assessment of VPD, including resonance, articulation, and the differentiation between consonants and vowels. We review the types of speech samples used for evaluation such as single-word articulation tests, syllable repetition, sentence repetition, and spontaneous connected speech. Finally, we discuss the auditory-perceptual speech assessment for VPD, including the assessment of resonance, nasal air emission, articulation, and voice quality. The use of rating scales like the Pittsburgh Weighted Speech Scale (PWSS) and the Cleft Audit Protocol for Speech-Augmented-Americleft Modification (CAPS-A-AM) is highlighted. In addition, the significance of intraoral examinations, visual-tactile-auditory evaluations, and the assessment of voice quality are covered. Most textbook chapters discussing this topic assume a foundational knowledge of speech-language pathology, which a surgical trainee may lack. This study aimed to bridge the gap between surgical training and speech pathology, providing a comprehensive resource to enhance the understanding and management of VPD.

Impact of Gender-Affirming Surgery on Craniofacial Exposure for Plastic and Reconstructive Surgery Training: A Preliminary, Single-Institution Study

Objective: Current available plastic surgery positions in craniofacial surgery are not commensurate with the growing number of trained plastic surgery residents and fellows interested in the field. Despite this, there is growing demand for surgery in other areas of the craniofacial field, such as facial gender-affirming surgery (GAS), in which academic plastic surgery programs can increase resident and fellow case exposure. The present study sought to characterize the increase in craniofacial surgery exposure with the introduction of a GAS rotation among plastic surgery residents at one academic medical center. Methods: A single-center retrospective review of ten plastic surgery resident case logs between 2013 and 2021 was carried out. Case logs were evaluated for case frequency per year in craniofacial surgery and breast reconstruction surgery, which was used as a control. Case frequency was compared before and after the introduction of the GAS rotation in 2017. Results: Craniofacial surgery exposure increased from an average of 26 to 45 cases per resident per year after the introduction of a GAS rotation and overall increased from 17 to 29 cases per year. The average breast reconstruction caseload remained similar at the same time, from an average of 37 to 36 cases per year per resident. Conclusions: The introduction of a GAS rotation at one institution increased craniofacial surgery exposure for plastic surgery residents. Increasing craniofacial surgery exposure is crucial in the competitive landscape for job opportunities, further increasing resident exposure to the transgender and gender-diverse population, and expanding care for this patient population.

Impact of Policy Changes and Program Support on Family Planning Goals among Plastic Surgery Trainees.

In 2020, the American Board of Plastic Surgeons announced an update in the leave policy for plastic surgery trainees, extending personal leave to 12 weeks without delay in graduation. Simultaneously, the Accreditation Council for Graduate Medical Education announced their update in lactation policy. This study sought to understand the influence of the policy change on plastic surgery trainees' goals for family planning and lactation. An online 32-question survey was developed to evaluate plastic surgery trainees' perceptions of family planning and perceived program support in the United States. The survey was approved by the American Council of Academic Plastic Surgeons Research Committee and sent out to a total of 216 plastic surgery programs. One hundred thirty plastic surgery trainees completed the survey. Most respondents were women, between the ages of 30 and 34 years, and married. Forty-five (34.6%) respondents or their partners had experienced pregnancy or live birth during their training. More than 70% did not feel that they had adequate time for leave. Female trainees faced more barriers than men, including having a partner in training, concern for their pregnancy, and burdening their co-residents during leave. The majority stated that their decision to apply to plastic surgery residency was influenced by program support for family planning compared with policy changes. This survey highlighted that the new policies benefit trainees who consider starting a family during training. Despite this, there are still challenges that need to be addressed to help foster a fair environment for trainees to work and have a family.

Gender gap among plastic surgery residents: the Italian experience

Aim: Despite the significant increase in the proportion of graduating female physicians in recent decades, gender representation in surgical training remains imbalanced. The initial rise in female interest in plastic surgery has reached a plateau. Gender bias, affecting women’s confidence and opportunities, negatively impacts training and career prospects. This study aims to quantify and analyze disparities in surgical training opportunities, workplace treatment, and career advancement among male and female plastic surgery residents in Italy. Methods: Our study involved all Italian plastic surgery residents contacted between February and March 2024. A 21-item survey assessed professional, surgical, and personal aspects, focusing on gender gap differences. Responses were expressed in percentages and compared utilizing the Fisher Exact test. Results: A total of 551 surveys were distributed to Italian plastic surgery residents, with 46 responses each among women and men. Gender disparities persisted in workplace treatment, with more women reporting discrimination. Significant differences were identified in treatment inequality by hospital personnel and patients, the occurrence of inappropriate comments in the workplace, inquiries regarding work-life balance and career advancement opportunities, an augmented gender gap in surgical vs . clinical programs, and the perception of a negative impact of gender on surgical training. Conclusion: In conclusion, our study emphasizes the pervasive gender inequality in plastic surgery training, urging action against systemic biases hindering female surgeons’ progress. Gender equity efforts should combat discrimination, promote work-life balance, and foster inclusive training environments. Addressing these issues can create a field that empowers all surgeons to thrive.

UK Trainee Experience with WALANT - An Audit of 102 Cases.

Background: WALANT has gained much popularity in recent years, especially with COVID-19. However, a recent survey of the American Society for Surgery of the Hand membership (i.e. attendings/consultants) showed that only 17% were exposed to WALANT during residency or fellowship training. There is much interest in WALANT from trainees, but interpretation of the type and volume to be administered is highly varied. Methods: The aims of this study were (1) to survey a group of plastic surgery trainees in the UK about their knowledge of WALANT formulas, and (2) to compare trainee logbook records of WALANT procedures (if available) with published data from the UK. Results: All trainees were familiar with the 'standard' WALANT formula (1% lidocaine, 1:100,000 adrenaline ± 8.4% NaHCO3) described by Lalonde. However, because of local formularies, rather than 1:100,000 adrenaline, all used 1:200,000 adrenaline as it comes premixed in the UK. Other formulas used by UK trainees included 0.5% bupivacaine + 1:200,000 adrenaline, and mixing 1% lidocaine + 1:200,000 adrenaline with 1% lidocaine 1:1. In comparing available trainee WALANT records with published UK data, the average volume of WALANT used was 6.6 mls in the current study versus 12.9 mls for similar procedures (wound debridement and skin closure ± local flap, digital nerve repair, fingertip reconstruction, thenar injuries, phalangeal fracture and single digit extensor repair); specifically, for single digit flexor tendon repairs, this was 10 mls versus 16.3 mls. Conclusions: While the British Society for Surgery of the Hand (BSSH) have developed official guidance for the use of WALANT in the UK, it appears there remains much variation in interpretation and hence, application. Comparison of trainee logbook records of common hand surgery procedures suggests that most can be done with much less WALANT administered than previously reported, with safe and reproducible results. Level of Evidence: Level IV (Therapeutic).

The Burden, Challenges, and Prospects of Hand Surgery Practice in South Eastern Nigeria

Abstract Background: Hand injuries sometimes cause significant loss of function with psychological and functional consequences. The national status on dedicated specialised hand surgery units, hand surgery fellowship programmes, and outcome of operative hand surgery cases is generally lacking. Aims: To determine the current state of hand surgery practice in south eastern Nigeria and identify the major challenges to its practice and proffer realistic solutions. Methods: This was a prospective and cross-sectional study conducted amongst accredited hospitals for plastic surgery training in south eastern Nigeria amongst plastic surgery senior residents. Data were collected using a well-structured online questionnaire validated by a panel of investigators created as a Google form. Data analysis was carried out using Statistical package for Social Sciences by IBM, version 22. Ethical approval was obtained from the health, research, and ethical committee of the University of Enugu Teaching Hospital, Enugu, Nigeria. Results: There was a 70.59% response rate with 24 residents filling and submitting the questionnaire. Lack of fellowship training opportunities in hand surgery represents the most important challenge of hand surgery practice, followed by lack of appropriate facilities in government institutions in contrast to a lack of funding in private ones. Other major challenges include lack of adequate funding, lack of facilities, late presentation of cases, and lack of appropriate follow-up physiotherapy protocol. Availability of competent hand surgery specialists was significantly correlated with the frequency of hand surgery cases in the facilities (P = 0.000; χ2 = 20.400). Conclusion/Recommendation: The current state of hand surgery practice in south eastern Nigeria is not yet optimal. The creation of more hand fellowship trainings and courses bagged first place in recommended solutions by nearly half of the respondents. Provision of modern facilities, creation of dedicated hand surgical units, and better funding to the specialty were other suggestions.

The Value of Drawing Practice in Plastic Surgery Training.

No specialty has such close relationship with art as plastic surgery among medicine. Both are intensely creative processes that combine technology with utmost dexterity and now are undervalued in the medical education. Art is a reservoir that provides a surgeon with creativity and improved dexterity. It is beneficial for the surgeons to practice drawing, for it can bring passion and inspiration, enhance observation and imagination, improve dexterity and accuracy, and help keep a good relation with patients. In some way, plastic surgery is art and plastic surgeon is artist.

An Evaluation of the Presence of Diversity, Equity, and Inclusion Information on Plastic Surgery Residency Program Websites.

Increasing the diversity of plastic surgery trainees is an important step in providing optimal care for our increasingly diverse patient populations. Given that information presented on residency programs' websites can strongly influence applicants' decisions to apply to or rank a program, demonstrating a commitment to diversity, equity, and inclusion (DEI) on program websites may aid in recruiting applicants with URM background. Using 8 DEI-related criteria, we evaluated the websites of 103 plastic surgery residency programs for the presence of DEI-related content during the month of June 2022. Each program was evaluated by 2 individual graders. We analyzed the data with confirmatory factor analysis in R using the Lavaan package. On average, programs fulfilled 2.1 ± 1.6 of the metrics with a range of 0-7 fulfilled per program. Our model revealed that the criteria were a high-quality (P < 0.0001) measure of DEI-related metrics. There was a significant association between program size and presence of DEI-related criteria (linear 0.039; quadratic -0.005; both P < 0.01), such that mid-sized programs (16-18 residents) had the highest quality of DEI advertising compared to both small and large programs. Programs associated with a USNWR Top 20 Hospital were less likely to achieve high level of DEI-related criteria than other programs (P < 0.0001). Mid-sized programs had greater DEI quality on their websites, while smaller and larger programs similarly had poorer assessed quality. There is room for all programs to improve the presence of DEI-related material on their websites, especially related to care of transgender populations.

The Breast-Areola Reduction/Reconstruction Technique Addressing the Central Lumpectomy Defect in Ptotic Breasts.

For decades, oncoplastic techniques have been an emerging, yet underutilized approach to breast cancer surgery. Recent developments in breast oncology support the potential for the omission of radiation therapy in a subset of patients eligible for breast-conserving surgery, which makes immediate reconstruction available to a much larger demographic. Although existing oncoplastic methods have offered durable and cosmetically acceptable results in select cases, there remains significant room for improvement. This publication presents a novel option in oncoplastic reconstruction named Breast-Areola Reduction/Reconstruction (BARR) that utilizes the tenets of a superomedial pedicle breast reduction and a Wise-pattern closure to address asymmetry and deformity in treatment of central breast cancers. The BARR technique features principles that are foundational to plastic surgery training, which should augment the acquisition and delivery of oncoplastic surgery in the era of progress to come.

A Microsurgical Skills Curriculum to Develop Unconscious Competence.

The attainment of microsurgical competency is an important milestone for plastic surgery trainees. Technical skill and a practiced disposition are required to successfully perform microsurgical procedures. Microsurgical skills curricula may foster both proficiency with technical movements and facilitate performance with minimal cognitive burden while using the operating microscope. The microsurgical skills curriculum presented in this article focuses on three fundamental principles: intrinsic muscle strength, accuracy and precision of movement, and supervised practice. Progressive operative entrustment of trainees is earned through successful completion of deliberate microsurgical exercises rather than timed anastomosis trials. The overarching goal of this curriculum is to develop unconscious competence in microsurgery.

Diversity, Equity, and Inclusion in Plastic Surgery: Where Do We Stand? Highlighting Overlooked Issues in Efforts to Improve Representation

The lack of diversity among applicants successfully matching into integrated plastic surgery residency continues to be a topic of significant discussion, yet substantial improvements in representation remain elusive. This article aims to highlight the systemic barriers contributing to the decline in diverse plastic surgery trainees. This perspective summarizes current and existing challenges in improving recruitment efforts of underrepresented in medicine (URiM) trainees and those from socioeconomically disadvantaged backgrounds. While acknowledging current DEI initiatives, the authors point out those underappreciated modifiable and nonmodifiable obstacles that perpetuate the lack of equity and inclusivity in the match process. We emphasize the importance of continued commitment from program directors and chairs to these initiatives and its generational augmentative effects on achieving true and lasting diversity and equity.

Medical Student Exposure to Plastic Surgery and the Impact of a Home Training Program.

Contemporary medical education devotes little time to plastic surgery topics. This deficiency is potentially greater at institutions without a dedicated plastic surgery training program. Lack of exposure to plastic surgery results in many medical students developing limited awareness to the full scope of the field. As a result, these future physicians may be unaware of many conditions treated by the plastic surgeon, resulting in referrals being diverted to alternative specialist and furthering scope of practice creep. This study aims to assess medical students' exposure to plastic surgery and evaluate institutional-based differences in plastic surgery education by comparing medical schools with and without a plastic surgery training program. Surveys were distributed to medical students at 2 institutions in the same United States city: 1 with a plastic surgery training program (TP) and 1 with no training program (NTP). Surveys assessed students' clinical experiences, exposure to plastic surgery, and understanding of the scope of plastic surgery. The response rate was 24.3% (306 of 1261). Many students reported having "little" or "no" exposure to plastic surgery during preclinical (93.5%) and clinical (77.7%) phases. NTP students were more likely to report "no" exposure to plastic surgery during both the preclinical (P = 0.0145) and clinical (P = 0.045) years. Consequently, approximately half of all students felt uncomfortable knowing when to refer a patient (46.1%) or place an inpatient consult (51.1%) to a plastic surgeon.When presented with clinical scenarios, plastic surgery was selected by only 53.4% of students. Performance between institutions was similar (53.0% TP vs 53.5% NTP, P = 0.936), with greater accuracy on cosmetic vignettes compared with hand and peripheral nerve vignettes. There was a statistically significant difference in 4 subspecialty domains between students who had prior exposure to plastic surgery and those who did not (hand/peripheral nerve, P < 0.0001; craniofacial, P = 0.007; breast/cosmetic, P = 0.001; and reconstruction/burn, P < 0.0001). These findings add to the growing body of literature demonstrating that medical students have limited exposure to plastic surgery. Although limited in its scope, this study suggests that home TP status does not appear to overtly impact students' understanding. Increased exposure and overall surgical experience correlated with an increased understanding of the scope of plastic surgery.

Trends in Gender, Ethnicity and Less-Than-Full-Time Training among Reconstructive Plastic Surgery Registrars and Consultants between 2009 and 2020

ObjectiveThis study aimed to examine the trends in gender, ethnicity and less-than-full-time (LTFT) training in reconstructive plastic surgery from 2009 to 2020 in the UK by comparing them to overall surgical specialties. MethodsWe analysed NHS Digital workforce data from 2009 to 2020 by examining trends in gender, ethnicity and LTFT working among reconstructive plastic surgery consultants and registrars and comparing them to overall surgical specialties. Data were analysed using linear regression models. ResultsThe percentage of female reconstructive plastic surgery consultants and registrars increased significantly over the period, with reconstructive plastic surgery groups having higher percentages of females than overall surgical specialties. LTFT working trends varied, with declining trends among consultants and increasing trends among registrars. Ethnicity trends were complex, varying between different ethnic categories and between consultants and registrars, but showing an increase in diversity within the workforce. ConclusionThe demographics of reconstructive plastic surgeons in the UK became more diverse from 2009 to 2020 with trends indicating that this will continue in the future. However, there were significant variations among the different groups and levels of seniority, suggesting the need for targeted interventions to promote diversity and inclusivity in surgical specialties.