The Current State of Gender-Affirming Surgery Training in Plastic Surgery Residency Programs as Reported by Residency Program Directors

Abstract

Background: The purpose of this Web-based survey was to elucidate the current perspectives of plastic surgery residency program directors on training residents to perform gender-affirming surgery. Methods: Web-based surveys were distributed to 79 plastic surgery program directors. Demographic information and perspectives on training of gender-affirming surgery in plastic surgery residency were queried. Results: Of 79 distributed surveys, there were 43 responses (54 percent). Overall, program directors reported that their trainees were prepared to address plastic surgery–related transgender concerns (67 percent), and believe plastic surgeons are the most appropriate specialty referral for each type of gender-affirming surgery (top/chest, 98 percent; facial, 95 percent; and bottom/genital, 79 percent). Ninety-three percent of program directors noted that transgender surgery is becoming more accepted and/or practiced in their referral area, with 26 percent reporting a dedicated clinic experience. There was a mixed response on the need for additional fellowship training for gender-affirming surgery. Residents are exposed to significantly more bottom (p = 0.0018), top (p = 0.0013), and facial operations (p = 0.00005) if they rotate through a “gender” clinic. Conclusions: Of the queried program directors, the majority feel their residents are well-trained in gender-affirming surgery. However, residents have more clinical exposure in facial and top (chest) gender-affirming surgery as compared to bottom (genital) surgery. Although most program directors agree that plastic surgeons are the most important referral for top, bottom, and facial operations, there is less consensus over the role of fellowship training. Most program directors reported a desire to devote additional CME time to the topic in the coming years.

Gender-Affirming Surgeries

“…The number of training programs for GAS continues to increase but is severely low. 14 Studies in the future should combine other demographic variables including geographic location, insurance payer, socioeconomic status, and patient-reported outcomes.…”

“…Health care providers and surgical subspecialists should also have an increased knowledge and training surrounding GAS and transgender patients. The number of training programs for GAS continues to increase but is severely low 14 …”

Current Concepts in Gender-Affirming Surgery Postgraduate Training

“…A 3-year follow-up survey of 43 American plastic surgery program directors asserted that consistent education across residency programs may be improving. 20 Magoon et al found that a large majority of programs now devote educational time to transgender health and are planning on increasing these efforts in the coming years. 20 Programs now spend 3.5 hours annually on GAS curriculum, an increase of 1 hour per year from prior surveys and an indication that programs are committed to their plans to increase transgender health related education.…”

“… 20 Magoon et al found that a large majority of programs now devote educational time to transgender health and are planning on increasing these efforts in the coming years. 20 Programs now spend 3.5 hours annually on GAS curriculum, an increase of 1 hour per year from prior surveys and an indication that programs are committed to their plans to increase transgender health related education. 18 21 Although only 26% of programs report dedicated clinical experience with transgender patients, and the majority of that exposure exclusively dealt with chest/breast surgery, 67% of program directors felt that their residents were prepared to address transgender-related concerns.…”

Gender-Affirming Care in Plastic Surgery Training: Moving beyond Metrics of Exposure

“…In a survey of program directors, 67 percent described their trainees as prepared to address plastic surgery–related care for transgender and gender-diverse patients but reported only 28 percent of their residents had exposure to genital surgery and 56 percent had exposure to facial surgery. 2 In a national survey of plastic surgery residents, 64.6 percent of residents stated they had “[received] education or exposure to the care of transgender patients,” but there were significant differences in exposure by region. 3…”