Gender-affirming Surgery in Plastic Surgery Training: Gaps in Institutional and National Training
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Gender-affirming surgery (GAS) has become more prevalent in recent years and studies report between 0.39% and 2.7% of the United States identifying as transgender or gender non-binary (TGNB).1 Studies have demonstrated that education for plastic surgery trainees on TGNB health is lacking, as evidenced by 1 hour per year of didactic education by most estimates. National studies have even suggested disparities between types of gender-affirming procedures with reports of more trainee exposure to “top” surgery than genital reconstruction or facial procedures. Caring for the TGNB population warrants a multidisciplinary approach that encompasses a variety of surgical and medical subspecialties, with plastic surgery being at the forefront of most procedures. Unfortunately, due to limited exposure to the myriad of gender-affirming procedures, there is a prevalent sense of discomfort among many plastic surgery providers. In order to enhance our understanding regarding plastic surgery provider’s comfort levels in caring for this population, we aimed to study overall trends in GAS training, provider comfort, and ability to perform specific GAS procedures at a high-volume academic institution. METHODS: All current residents, clinical fellows, and faculty in the Division of Plastic and Reconstructive Surgery at our institution were asked to complete an anonymous survey. RESULTS: An estimated 54 subjects were polled, of which 30 (56%) responded. Subjects included 12 faculty members and 18 trainees. All subjects responded that training in GAS is “somewhat” or “very important.” In total, 47% of subjects believe that they had adequate surgical exposure to top surgeries during training compared with 3% and 7% for genital and facial surgeries, respectively. Trainees reported significantly more exposure to top surgeries during training than faculty (P = 0.001). Providers felt most comfortable performing top surgeries, and felt least comfortable performing either genital or facial surgery. Trainee comfort with providing top surgery increased with years in training (P = 0.0126), while no difference in comfort was seen for genital or facial procedures (both P > 0.05). An estimated 68% of subjects selected a low volume of surgical instruction as the reason for their comfort levels. To improve their GAS education, 83% suggested increased surgical exposure, 50% suggested more clinic exposure, and 33% suggested more didactic education. CONCLUSIONS: Significant disparities exist in resident familiarity, education, and operative comfort depending on the specific type of gender-affirming procedure. Although providers generally feel comfortable performing top surgeries, surgical instruction appears to be lacking with regard to genital and facial procedures. These data supplement previous national data to further suggest that plastic surgery training programs need to develop necessary infrastructure that will allow for the participation of trainees in genital and facial gender-affirming procedures. Addressing the lack of surgical exposure and improving didactic curriculums in gender-affirming surgery will not only aid in providing trainees with a more holistic GAS education, including interdisciplinary work with other specialties, but will also provide better healthcare for this underserved patient population. REFERENCE: 1. Nolan IT et al. Current state of transgender medical education in the united states and canada: update to a scoping review. J Med Educ Curric Dev. 2020;7:2382120520934813. doi:10.1177/2382120520934813
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4286913231