A Survey of US Plastic Surgery Residents Report Inadequate Training in Gender Affirmation Surgery

Goals/Purpose: The demand for gender affirmation surgeries (GASs) in the US has increased up to 155% yearly. Dedicated training is critical to provide adequate care to these patients. Prior studies have highlighted general deficiencies in GAS training during Plastic Surgery (PS) residency, but have not investigated the type/quantity of GAS training, the residents’ self-rated preparedness in performing GAS, or the reasons underlying these deficiencies. The purpose of our study was to address this gap, and we hypothesized that despite being exposed to GAS, most PS residents feel inadequately trained due to geographical differences in case volume and/or the lack of dedicated faculty.

Methods/Technique: An anonymous, online survey was conducted to PS residents to get an in-depth and updated analysis on training in GAS. Questions included type and quantity of formal education in GAS, hands-on exposure to each GAS non-surgical/surgical procedure, resident self-rated preparedness to perform GAS after residency, and reasons underlying possible deficiencies in training.

Results/Complications: The survey had a 14.5% response rate (168/1,160 US PS residents). Hands-on exposure is reported by 83.3% of respondents. Female-to-male mastectomy is the most common procedure respondents are exposed to (90.7%): 18% of residents were exposed to >15 cases. Metoidioplasty is the least common procedure by exposure (12.9%): only 5% of residents were exposed to >15 cases. The majority of residents (64.6%) feel adequately trained to perform Female-to-Male mastectomies; however, 53.4-79.7% of them do not feel adequately trained to perform other GASs. Residents in the West are exposed to significantly more GASs compared to those in the South. Lack of patient volume and interested and/or trained faculty are identified as areas that need the most improvement. About one-third of residents (34.3%) report no dedicated faculty surgeon or any formal transgender clinic in their program. Two-thirds of residents (66.9%) believe a dedicated fellowship is important to perform GASs after residency.

Conclusion: While most PS residents have some training in GAS, the majority do not feel adequately trained in most procedures. Higher patient volumes, trained faculty, and dedicated fellowships are identified as main options to improve training.