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BACKGROUND: As the demand for gender affirmation grows, teaching gender-affirming surgery (GAS) in plastic and reconstructive surgery (PRS) programs has become increasingly important. Residency applicants interested in GAS often use program web sites to explore potential training opportunities. Our study aimed to quantify the GAS training opportunities promoted on residency program web sites and determine the characteristics of programs likely to promote GAS training. METHODS: An assessment of 88 integrated PRS residency programs' web sites was conducted between 2021 and 2022. Plastic and reconstructive surgery residency and institutional webpages were queried for geographical location, training opportunities in GAS through residency or fellowship, and the number of faculty performing GAS. Descriptive statistics and multivariable regressions were used to describe and identify factors associated with increased GAS residency training opportunities. RESULTS: Twenty-six percent of PRS residencies mentioned training opportunities for GAS on their web sites. Gender-affirming surgery fellowships were offered at 7% of institutions, and an additional 7% were available via adjunct academic programs. Programs with faculty practicing GAS were 54% more likely to mention GAS on their residency page (odds ratio, 1.54; 95% confidence interval, 1.14-2.21; P = 0.009). CONCLUSIONS: Few PRS residency programs mention GAS on their web sites. As GAS becomes a more robust component of plastic surgery, appropriate information about the extent of GAS training should be available for applicants. Determining how local, state, and federal policies impact programs' abilities to highlight GAS should be investigated in future studies.
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Internado y Residencia , Cirugía de Reasignación de Sexo , Cirugía Plástica , Humanos , Cirugía Plástica/educación , Educación de Postgrado en Medicina , EscolaridadRESUMEN
INTRODUCTION: Advances in operative management, minimally invasive procedures, and physical therapy have allowed for dramatic improvements in functional and cosmetic outcomes in patients with facial paralysis. Our goal was to evaluate the current trends and practice patterns in the diagnosis and management of facial paralysis by provider demographics. MATERIALS AND METHODS: An electronic questionnaire was distributed to members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Practice patterns in the diagnosis and treatment were compared by level of training (fellowship-trained facial plastic and reconstructive surgeon versus non-fellowship trained), practice type (academic and private), practice length, patient volume, and presence of a dedicated facial nerve clinic. The bivariate associations of the outcome variables and the stratification factors were analyzed using 2-way contingency tables and Fisher's exact tests. RESULTS: The survey was sent to 1129 members of the AAFPRS. The response rate was 11.7% (n=132). Most respondents were fellowship-trained surgeons (79%) in the academic setting (55%), and most have been in practice for more than 10 years (53%). Practice setting and patient volume were the factors most associated with significant variations in management, including the use of facial paralysis grading scales, photography/videography, patient-reported outcome metrics, as well as differences in both noninvasive and surgical management. CONCLUSION: Based on the present study, several physician demographic factors may play a role in choosing which diagnostic and treatment options are employed for facial paralysis, with practice setting and patient volume appearing to be the 2 variables associated with the most significant differences.
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Parálisis Facial , Cirujanos , Cirugía Plástica , Parálisis Facial/diagnóstico , Parálisis Facial/cirugía , Becas , Humanos , Pautas de la Práctica en Medicina , Cirugía Plástica/educación , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Although there is limited evidence for regulating the use of prophylactic antibiotics in reduction mammaplasty, many plastic surgeons prescribe them, even in the postoperative period. This study aimed to conduct a national survey to investigate the antibiotic prophylaxis protocols followed by Brazilian plastic surgeons in reduction mammaplasty. METHODS: An anonymous survey comprising 19 questions was sent to all 4864 active members of the Brazilian Society of Plastic Surgery (SBCP). The surgeons electronically received the invitation to participate in the survey and the link to fill out the electronic form. RESULTS: In total, 859 surgeons (17.7%) responded. Most respondents (77.8%) were men and aged 35-55 years (61.5%); 58.6% of them had 10-29 years of specialty training. Only a minor proportion of the respondents (0.5%) reported not prescribing antibiotics at any time (95% confidence interval [CI]: 0.0-0.9), 9.9% (95% CI: 7.9-11.9) prescribed them only preoperatively, and 14.6% (95% CI: 12.2-16.9) prescribed continued antibiotic use for 24 h. The majority of the respondents (75.1%; 95% CI: 72.1-77.9) prescribed antibiotics for additional days after discharge. There were significant associations between antibiotic prescription and the surgeons' age group (p = 0.015), time since graduation (p < 0.001), experience in the specialty practice (p = 0.003), SBCP membership (p < 0.001), and surgical site infection rates (p = 0.011). CONCLUSION: Most responding plastic surgeons affirmed that they prescribed prophylactic antibiotics for more than 24 h in reduction mammaplasty cases. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Mamoplastia , Cirugía Plástica , Masculino , Femenino , Humanos , Profilaxis Antibiótica , Mamoplastia/métodos , Cirugía Plástica/educación , Brasil , Antibacterianos/uso terapéuticoRESUMEN
ABSTRACT: An increasing number of plastic and reconstructive surgery (PRS) units have transitioned from divisions to departments in recent years. This study aimed to identify quantifiable differences that may reflect challenges and benefits associated with each type of unit. We conducted a cross-sectional analysis of publicly-available data on characteristics of academic medical institutions housing PRS units, faculty size of surgical units within these institutions, and academic environments of PRS units themselves. Univariate analysis compared PRS divisions versus departments. Matched-paired testing compared PRS units versus other intra-institutional surgical departments. Compared to PRS divisions (nâ=â64), departments (nâ=â22) are at institutions with more surgical departments overall (Pâ=â0.0071), particularly departments that are traditionally divisions within the department of surgery (ie urology). Compared to PRS divisions, PRS departments have faculty size that more closely resembles other intra-institutional surgical departments, especially for full-time surgical faculty and faculty in areas of clinical overlap with other departments like hand surgery. Plastic and reconstructive surgery departments differ from PRS divisions by certain academic measures, including offering more clinical fellowships (Pâ=â0.005), running more basic science laboratories (Pâ=â0.033), supporting more nonclinical research faculty (Pâ=â0.0417), and training residents who produce more publications during residency (Pâ=â0.002). Institutions with PRS divisions may be less favorable environments for surgical divisions to become departments, but other recently-transitioned divisions could provide blueprints for PRS to follow suit. Bolstering full-time surgical faculty numbers and faculty in areas of clinical overlap could be useful for PRS divisions seeking departmental status. Transitioning to department may yield objective academic benefits for PRS units.
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Internado y Residencia , Procedimientos de Cirugía Plástica , Cirugía Plástica , Estudios Transversales , Docentes Médicos , Becas , Humanos , Cirugía Plástica/educación , Estados UnidosAsunto(s)
Educación a Distancia/métodos , Educación de Pregrado en Medicina/métodos , Cirugía Plástica/educación , Adulto , Competencia Clínica/estadística & datos numéricos , Curriculum , Educación a Distancia/estadística & datos numéricos , Educación de Pregrado en Medicina/estadística & datos numéricos , Docentes Médicos/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Satisfacción Personal , Estudiantes de Medicina/estadística & datos numéricos , Cirugía Plástica/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricosAsunto(s)
Investigación Biomédica/organización & administración , Becas/organización & administración , Equidad de Género/estadística & datos numéricos , Internado y Residencia/organización & administración , Cirugía Plástica/educación , Investigación Biomédica/economía , Investigación Biomédica/estadística & datos numéricos , Bases de Datos Factuales , Becas/economía , Becas/estadística & datos numéricos , Femenino , Humanos , Internado y Residencia/economía , Internado y Residencia/estadística & datos numéricos , Masculino , Cirugía Plástica/economía , Encuestas y Cuestionarios/estadística & datos numéricosRESUMEN
BACKGROUND: The competitive nature of an academic plastic surgery career has contributed to an increase in sub-specialization. The aim of this study is to assess the benefits of subspecialty fellowship training to pursue a career in academic plastic surgery. METHODS: A cross-sectional study was conducted of all current academic plastic surgeons (APSs) participating in Accreditation Council for Graduate Medical Education-certified residency programs. Online faculty website listings were used to collect their demographics, training and practice characteristics, academic rank and leadership positions, and research productivity. RESULTS: A total of 927 APSs met the inclusion criteria, of which 70.2% had undergone fellowship training, with an overall significant increase in fellowship-trained surgeons within the last 10 years (odds ratio [OR], 1.66; P = 0.0005). Hand training was the most common fellowship (35.6%), followed by craniofacial (32.0%) and microsurgery (28.1%). Fellowship training was more prevalent among younger (48.7 vs 53.5 years, P < 0.0001), White (67.8%), and non-White (77.4%, P = 0.0058) APSs who had received either integrated (67.1%) or independent (81.8%, P < 0.0001) plastic surgery training and are currently working in a department (OR, 1.44; P = 0.028). Fellowship training was shown to influence academic rank (associate professor: OR, 1.68 [P = 0.0073]; full professor: OR, 0.58 [P = 0.0008]), leadership position (fellowship director OR, 10.09; P < 0.0001) and research productivity (publications: 26 vs 16.5; P = 0.0009). In addition, fellowship attainment did not correlate with the size of the employing academic program, population of the city of practice, or being a residency director or chair. CONCLUSION: The majority of APSs have undergone fellowship training, and there is very strong evidence supporting its impact in current entry and advancement in academic plastic surgery.
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Internado y Residencia , Cirugía Plástica , Estudios Transversales , Educación de Postgrado en Medicina , Becas , Humanos , Cirugía Plástica/educación , Estados UnidosRESUMEN
BACKGROUND: The lack of underrepresented in medicine (UIM) physicians in academic plastic surgery is emerging as a critical issue. Lack of diversity has a negative effect on patient care and on the culture of our health care system. This study reports the current status of ethnically UIM physicians in the plastic surgery pipeline, starting from the medical student level and progressing to national leadership positions. METHODS: The Electronic Residency Applications Service, National Resident Matching Program, Association of American Medical Colleges, and professional Web sites for journals and national societies were accessed for racial demographic information from 2008 to 2019. RESULTS: Over the past decade, there has been no change or a slight decrease in representation of Blacks among plastic surgery residency applicants, trainees, and academic faculty, at half or less than expected, compared with US Census data. The first point of drop-off occurs at the resident (3.8% of integrated and 5.6% of independent residents) to faculty level (<2.8%). Two percent of program directors and department heads/division chiefs are Black. The next point of drop-off occurs at the national level: there has never been a Black president of American Society of Plastic Surgeons or Plastic Surgery Foundation, and there are no Black editors-in-chiefs of major plastic surgery journals.Following LatinX American surgeons down the pipeline over the past decade, there has been no change or a decrease in representation among plastic surgery residency applicants, resident physicians, and academic faculty, at one-third or less than expected, compared with US Census data. The first point of drop-off occurs at the faculty (4.8%) to local leadership level (0% of program directors and department heads/division chiefs) where there is no representation of LatinX. Once this drop-off occurs, there is no recovery at the national leadership level. CONCLUSIONS: In order for our profession to reflect our nation's demographics, academic plastic surgery is in need of a paradigm shift now. Attrition of UIM physicians in plastic surgery begins at medical school graduation and persists through surgical training, faculty appointments, and attainment of leadership positions. Creative and innovative commitment to diversity and inclusion is necessary.
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Internado y Residencia , Cirujanos , Cirugía Plástica , Docentes Médicos , Humanos , Liderazgo , Facultades de Medicina , Cirugía Plástica/educación , Estados UnidosRESUMEN
BACKGROUND: Conducting research during specialty training provides an opportunity to develop critical thinking and leadership skills along with a better understanding of the scientific literature. However, trainees often find it difficult to undertake research, in the context of labor-intensive surgical training. The aim of this study is to evaluate the research output and limitations of plastic surgery residents in different countries. METHODS: An international cross-sectional study involving plastic surgery trainees and recent postgraduates from Brazil, Chile, Germany, and the United Kingdom was conducted. A survey inquiring into academic productivity, limitations to conducting research, and working-hours patterns was distributed among eligible participants. RESULTS: From September to December 2019, 106 surveys were retrieved. Most respondents declared having participated in at least 1 project that resulted in a presentation or publication during their training (90.6% in national presentations, 68% international presentations, 67% in national publications, and 66% international publications). Having completed a previous research fellowship was associated with a statistically higher academic output (P < 0.05). Seventy-nine percent of respondents felt that their participation in research activities would have been greater if limiting factors had been addressed, including lack of time (72.5%) and insufficient supervision and mentoring (55%). CONCLUSIONS: Optimizing plastic surgery trainees' participation in scientific research is beneficial both for residents and their mentors. Research fellowships can provide an opportunity for academically oriented trainees to further develop their research skills. Protected time and adequate mentoring can help not only to increase residents' research output, but also to recruit the next generation of academic plastic surgeons.
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Internado y Residencia , Cirugía Plástica , Estudios Transversales , Becas , Humanos , Mentores , Cirugía Plástica/educación , Encuestas y CuestionariosRESUMEN
BACKGROUND: Linton A. Whitaker is a pioneer of craniofacial surgery. He served as chief of plastic surgery at the Children's Hospital of Philadelphia and University of Pennsylvania and director of the craniofacial training program. Herein, the authors reflect on his legacy by studying the accomplishments of his trainees. METHODS: Dr Whitaker's trainees who completed (a) craniofacial fellowship training while he was director of the program or (b) residency training while he was chief were identified. Curricula vitae were reviewed. Variables analyzed included geographic locations, practice types, academic leadership positions, scholarly work, and bibliometric data. RESULTS: Between 1980 and 2011, 34 surgeons completed craniofacial fellowship training under Dr Whitaker, and 11 completed plastic surgery training under his chairmanship and subsequent craniofacial fellowship. The majority had active craniofacial practices after training (83.3%) and practice in an academic setting (78.0%). Most settled in the northeast (31.1%) and south (31.1%) but across 24 states nationally. Overall, the mean ± SD number of publications was 76 ± 81 (range, 2-339); book chapters, 23 ± 29 (0-135); H-index, 18 ± 12 (1-45); and grants, 13 ± 16 (0-66). Of those who pursued academia, 53.1% were promoted to full professor, 46.9% had a program director role, 75.0% directed a craniofacial program, and 53.1% achieved the rank of chief/chair. CONCLUSIONS: Equally important to Dr Whitaker's clinical contributions in plastic and craniofacial surgery is the development and success of his trainees who will undoubtedly continue the legacy of training the next generation of craniofacial surgeon leaders.
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Internado y Residencia , Cirujanos , Cirugía Plástica , Niño , Becas , Humanos , Masculino , Philadelphia , Cirugía Plástica/educaciónRESUMEN
BACKGROUND: Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide. METHODS: Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models. RESULTS: A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%. CONCLUSIONS: This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Procedimientos de Cirugía Plástica , Entrenamiento Simulado , Cirugía Plástica , Educación de Postgrado en Medicina , Estética , Humanos , Cirugía Plástica/educaciónAsunto(s)
COVID-19 , Educación , Procedimientos Quirúrgicos Electivos , Procedimientos de Cirugía Plástica , Cirugía Plástica/educación , Heridas y Lesiones , Centros Médicos Académicos/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/organización & administración , Educación/organización & administración , Educación/tendencias , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Internado y Residencia , Masculino , México/epidemiología , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Estudios Retrospectivos , SARS-CoV-2 , Heridas y Lesiones/epidemiología , Heridas y Lesiones/cirugíaAsunto(s)
Centros Médicos Académicos/organización & administración , Departamentos de Hospitales/tendencias , Internado y Residencia/tendencias , Procedimientos de Cirugía Plástica/educación , Cirugía Plástica/tendencias , Centros Médicos Académicos/historia , Centros Médicos Académicos/estadística & datos numéricos , Centros Médicos Académicos/tendencias , Docentes/estadística & datos numéricos , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Departamentos de Hospitales/historia , Departamentos de Hospitales/organización & administración , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Internado y Residencia/historia , Internado y Residencia/estadística & datos numéricos , Masculino , Grupos Minoritarios/estadística & datos numéricos , Otolaringología/estadística & datos numéricos , Otolaringología/tendencias , Ejecutivos Médicos/historia , Ejecutivos Médicos/estadística & datos numéricos , Ejecutivos Médicos/tendencias , Cirugía Plástica/educación , Cirugía Plástica/historia , Cirugía Plástica/estadística & datos numéricosRESUMEN
BACKGROUND: The impact of residency training on academic productivity and a career in academic plastic surgery remains uncertain. Previous literature has explored the influence of training institutions on academic careers in surgery. The aims of the study were to assess research productivity during plastic surgery residency training and to illustrate how differences in training programs impact resident research productivity. METHODS: Academic plastic surgery faculty that graduated in the past 10 years were identified through an Internet search of all Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs. Research productivity was compared based on h-index, number, and quality of peer-reviewed articles published during residency. RESULTS: Three hundred seventy-five academic plastic surgeons were identified and produced 2487 publications during residency. The 10 most productive training institutions were Johns Hopkins, Georgetown, University of Michigan, Stanford, University of California Los Angeles, Northwestern, Harvard, New York University, University of Pennsylvania, and Baylor. Academic productivity was higher among integrated residents (integrated = 8.68 publications, independent = 5.49 publications, P < 0.0001). The number of publications positively correlated to faculty size (r = 0.167, P = 0.0013), National Institute of Health (NIH) funding (r = 0.249, P < 0.0001), residency graduation year (r = 0.211, P < 0.0001), and negatively correlated with Doximity ranking (r = -0.294, P < 0.0001). H-index was positively correlated with number of publications (r = 0.622, P < 0.0001), faculty size (r = 0.295, P < 0.0001), and NIH funding (r = 0.256, P < 0.0001) and negatively correlated with Doximity ranking (r = -0.405, P < 0.0001) and residency graduation year (r = -0.163, P < 0.0001). CONCLUSIONS: Our study has found that there is an elite cohort of programs that are the most productive research institutions. Resident research productivity is higher among integrated residents, recent graduates, and programs that are larger in size, with a higher Doximity ranking and NIH funding. This study can guide medical students and future applicants who are interested in a career in academic plastic surgery in the selection of programs that match their career aspirations.
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Investigación Biomédica , Internado y Residencia , Cirugía Plástica , Selección de Profesión , Educación de Postgrado en Medicina , Eficiencia , Humanos , New York , Cirugía Plástica/educaciónRESUMEN
BACKGROUND: The number of adults with master's, professional, and doctoral degrees has doubled since 2000. The relevance of advanced degrees in plastic surgery has not been explored. METHODS: Faculty, residents, and recent alumni with advanced degrees from the United States plastic surgery training programs were identified. Degrees were analyzed based on geography, program/hospital rankings, department versus division status, gender, leadership/editorial roles, private versus academic practice, subspecialization training, academic productivity/H-indices, and National Institutes of Health funding. RESULTS: A total of 986 faculties, 1001 residents, and 761 alumni credentials from 95 training programs were reviewed: 9.3% of faculties, 7.1% of residents, and 6.3% of alumni have advanced degrees, majority being men (71%). Residency programs ranked top 10 by Doximity or affiliated with a top 10 medical school/hospital have more faculty/residents/alumni with advanced degrees (Pâ<â0.01). Faculty holding PhDs are less likely fellowship trained (52.5% versus 74.0%, Pâ=â0.034). Master's in Business Administration (MBA) is associated with chair/chief status (30.0% versus 8.57%, Pâ=â0.01) or other major academic title (eg, Dean, Director) (70.0% versus 37.14%, Pâ=â0.01). No significant associations exist between degree type and professor status, research productivity, academic versus private practice, or subspecialization (eg, craniofacial surgery). CONCLUSION: The majority of plastic surgeons with advanced degrees have PhDs, although there is an increasing trend of other research degrees (eg, Master's in Public Health) in current trainees. MBA is associated with chair/chief status or other major academic title. Reasons for obtaining an advanced degree and impact on career deserve further attention.