Abstract
Background
The importance of aesthetic surgery exposure for plastic and reconstructive trainees has been recently validated by the expansion of case requirements for aesthetic procedures from 50 to 150, as well as resident-driven desire for increased cosmetic exposure throughout training. We aim to systematically review the literature at a national level to report on overall trends in aesthetic surgery training within PRS residencies.
Methods
A literature search of PubMed, Embase, and Scopus identified all English articles published in the USA between 2000 and 2020, using a combination of “aesthetic surgery”, “cosmetic surgery”, “plastic surgery”, “residency and internship”, “education”, and “training.”
Results
Our initial search resulted in 415 articles. After review of inclusion and exclusion criteria, in addition to cross-referencing, 41 studies remained, including 15 studies discussing resident and/or program director surveys, eight studies discussing teaching methods, sixteen studies discussing dedicated resident clinics, four studies discussing cosmetic/aesthetic fellowships, three studies discussing cosmetic practice patterns, and eleven studies discussing patient outcomes.
Conclusion
Current literature demonstrates that there are gaps in aesthetic surgery training for PRS residents in the USA, including facial and neck surgeries and non-surgical interventions. Resident clinics have clear benefits for resident education, without sacrificing patient outcomes. Residency programs should consider the development of a resident cosmetic clinic and/or dedicated cosmetic center to increase surgical exposure and increase trainee comfort in providing this subset of procedures. Published literature is limited in consistency of methods of evaluation, and further in-depth analysis of case volume and diversity at training programs within the USA and internationally is indicated.
Level of Evidence III
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Protocol/Availability of Data
Study protocol and data extracted from included studies are available upon request.
Abbreviations
- ACGME:
-
Accreditation Council for Graduate Medical Education
- PRS:
-
Plastic and Reconstructive Surgery
- PRISMA:
-
Preferred Reporting Items for a Systematic Review and Meta-Analysis
- MGH:
-
Massachusetts General Hospital
- PSITE:
-
Plastic Surgery In-Service Training Exam
- M&M:
-
Morbidity and Mortality
- ASAPS:
-
American Society of Aesthetic Plastic Surgery
- AACS:
-
American Academy of Cosmetic Surgery
- AOA:
-
Alpha Omega Alpha
References
ASPS 2019 Statistics. https://www.plasticsurgery.org/documents/News/Statistics/2019/plastic-surgery-statistics-full-report-2019.pdf. Accessed 20 Nov 2020
Common Program Requirements. https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements. Accessed 25 Mar 2021
O’Neill R, Raj S, Davis MJ et al (2020) Aesthetic training in plastic surgery residency. Plast Reconstr Surg—Glob Open. https://doi.org/10.1097/GOX.0000000000002895
Neaman KC, Hill BC, Ebner B, Ford RD (2010) Plastic surgery chief resident clinics: the current state of affairs. Plast Reconstr Surg 126:626–633. https://doi.org/10.1097/PRS.0b013e3181df648c
Braza ME, Adams NS, Ford RD (2020) Perceptions of preparedness in plastic surgery residency training. Plast Reconstr Surg - Glob Open. https://doi.org/10.1097/GOX.0000000000003163
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan-a web and mobile app for systematic reviews. Syst Rev 5:210. https://doi.org/10.1186/s13643-016-0384-4
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605
Hashmi A, Khan FA, Herman F et al (2017) A survey of current state of training of plastic surgery residents. BMC Res Notes. https://doi.org/10.1186/s13104-017-2561-5
Kraft CT, Harake MS, Janis JE (2019) Longitudinal assessment of aesthetic plastic surgery training in the United States: the effect of increased ACGME case log minimum requirements. Aesthetic Surg J 39:NP76–NP82. https://doi.org/10.1093/asj/sjy164
Morrison CM, Rotemberg SC, Moreira-Gonzalez A, Zins JE (2008) A survey of cosmetic surgery training in plastic surgery programs in the united states. Plast Reconstr Surg 122:1570–1578. https://doi.org/10.1097/PRS.0b013e318188247b
Momeni A, Kim RY, Wan DC et al (2014) Aesthetic Surgery training during residency in the united states: a comparison of the integrated, combined, and independent training models. Plast Surg Int 2014:1–7. https://doi.org/10.1155/2014/281923
Oni G, Ahmad J, Zins JE, Kenkel JM (2011) Cosmetic surgery training in plastic surgery residency programs in the United States: How have we progressed in the last three years? Aesthetic Surg J 31:445–455. https://doi.org/10.1177/1090820X11404551
Ngaage LM, Kim CJ, Harris C et al (2020) Graduate perception of cosmetic surgery training in plastic surgery residency and fellowship programs. Arch Plast Surg 47:70–77. https://doi.org/10.5999/aps.2019.00409
Hashem AM, Waltzman JT, D’Souza GF et al (2017) Resident and program director perceptions of aesthetic training in plastic surgery residency: an update. Aesthetic Surg J 37:837–846. https://doi.org/10.1093/asj/sjw275
McNichols CHL, Diaconu S, Alfadil S et al (2017) Cosmetic surgery training in plastic surgery residency programs. Plast Reconstr Surg - Glob Open. https://doi.org/10.1097/GOX.0000000000001491
Walker NJ, Crantford JC, Rudolph MA, David LR (2018) Outcomes analysis of chief cosmetic clinic over 13 years. Ann Plast Surg 80:600–606. https://doi.org/10.1097/SAP.0000000000001443
Brandel MG, D’Souza GF, Reid CM et al (2017) Analysis of a resident aesthetic clinic: process for rhinoplasty, resident experience, and patient satisfaction. Annals of plastic surgery. Lippincott Williams and Wilkins, pp 175–179
Silvestre J, Taglienti AJ, Serletti JM, Chang B (2015) Analysis of cosmetic topics on the plastic surgery in-service training exam. Aesthetic Surg J 35:739–745. https://doi.org/10.1093/asj/sju151
May JW (2003) Aesthetic surgery 101: resident education in aesthetic surgery, the MGH experience. Annals of plastic surgery. Ann Plast Surg, Berlin, pp 561–566
Pu LLQ, Thornton BP, Vasconez HC (2006) The educational value of a resident aesthetic surgery clinic: a 10-year review. Aesthetic Surg J 26:41–44. https://doi.org/10.1016/j.asj.2005.10.004
David JA, Rifkin WJ, Saadeh PB, Sinno S (2018) Assessing the value of a multimedia-based aesthetic curriculum in plastic surgery residency: a single-center pilot study. Aesthetic Surg J 38:NP216–NP224. https://doi.org/10.1093/asj/sjy110
Besmens IS, Uyulmaz S, Giovanoli P, Lindenblatt N (2021) YouTube as a resource for surgical education with a focus on plastic surgery - a systematic review [published online ahead of print, 2021 Mar 10]. J Plast Surg Hand Surg. https://doi.org/10.1080/2000656X.2021.1884084
Khoo LS. In Response to: Plastic surgery and aesthetic medicine - specialties and specialists. 2015 May. the PFMA Journal. 2015.
Rinker B, Donnelly M, Vasconez HC (2008) Teaching patient selection in aesthetic surgery use of the standardized patient. Ann Plast Surg 61:127–131. https://doi.org/10.1097/SAP.0b013e31815b07b2
Agrawal N, Turner A, Grome L et al (2020) Use of simulation in plastic surgery training. Plast Reconstr Surg—Glob Open. https://doi.org/10.1097/GOX.0000000000002896
Kazan R, Viezel-Mathieu A, Cyr S et al (2018) The montreal augmentation mammaplasty operation (MAMO) simulator: an alternative method to train and assess competence in breast augmentation procedures. Aesthetic Surg J 38:835–849. https://doi.org/10.1093/asj/sjx267
Motakef S, Campwala I, Gupta S (2017) Establishing milestones for facial injectables in plastic surgery residency training: four-year follow-up. Aesthetic Surg J 37:NP140–NP141
Smith DM, Aston SJ, Cutting CB, Oliker A (2005) Applications of virtual reality in aesthetic surgery. Plast Reconstr Surg 116:898–904. https://doi.org/10.1097/01.prs.0000176901.37684.8a
Hultman CS, Wu C, Bentz ML et al (2015) Identification of best practices for resident aesthetic clinics in plastic surgery training. Plast Reconstr Surg—Glob Open 3:e370. https://doi.org/10.1097/01.gox.0000464864.49568.18
Neaman KC, Armstrong SD, Baca ME et al (2013) Outcomes of traditional cosmetic abdominoplasty in a community setting: a retrospective analysis of 1008 patients. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0b013e31827c6fc3
Ingargiola MJ, Molina Burbano F, Yao A et al (2018) Plastic surgery resident-run cosmetic clinics: a survey of current practices. Aesthetic Surg J 38:793–799. https://doi.org/10.1093/asj/sjy065
Shakir S, Kozak GM, Nathan SL et al (2020) The role of a resident aesthetic clinic in addressing the trainee autonomy gap. Aesthetic Surg J. https://doi.org/10.1093/asj/sjz324
White-Dzuro CG, Glassman GE, Lee ES et al (2020) Tools to increase resident aesthetic clinic volume. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-020-02013-5
Qureshi AA, Parikh RP, Myckatyn TM, Tenenbaum MM (2016) Resident cosmetic clinic: practice patterns, safety, and outcomes at an academic plastic surgery institution. Aesthetic Surg J 36:NP273–NP280. https://doi.org/10.1093/asj/sjw080
Qureshi AA, Parikh RP, Sharma K et al (2017) Nonsurgical facial rejuvenation: outcomes and safety of neuromodulator and soft-tissue filler procedures performed in a resident cosmetic clinic. Aesthetic Plast Surg 41:1177–1183. https://doi.org/10.1007/s00266-017-0892-1
Pyle JW, Angobaldo JO, Bryant AK et al (2010) Outcomes analysis of a resident cosmetic clinic. Ann Plast Surg 64:270–274. https://doi.org/10.1097/SAP.0b013e3181afa4e9
Weissler JM, Carney MJ, Yan C, Percec I (2017) The value of a resident aesthetic clinic: a 7-year institutional review and survey of the chief resident experience. Aesthetic Surg J 37:1188–1198. https://doi.org/10.1093/asj/sjx103
Handler E, Tavassoli J, Dhaliwal H et al (2015) A review of general cosmetic surgery training in fellowship programs offered by the American academy of cosmetic surgery. J Oral Maxillofac Surg 73:580–586. https://doi.org/10.1016/j.joms.2014.11.019
Maisner RS, Babu A, Ayyala HS, Ramanadham S (2020) Aesthetic surgery. Ann Plast Surg. https://doi.org/10.1097/SAP.0000000000002518
Egro FM, Saliu OT, Nahai F, Nguyen VT (2017) Aesthetic surgery fellowship selection criteria: a national fellowship director survey. Aesthetic Surg J 37:961–966. https://doi.org/10.1093/asj/sjx020
Brown CA, Nahai F, Miotto GC (2020) Program director survey of aesthetic plastic surgery fellowships in the united states current state-of-the-art. Ann Plast Surg 85:464–467
Egro FM, Beiriger J, Roy E, Nguyen VT (2020) The relationship of residency and fellowship sites to academic faculty and leadership positions. Ann Plast Surg 85:S114–S117. https://doi.org/10.1097/SAP.0000000000002336
Perdikis G, Eaves FF, Glassman GE et al (2020) Aesthetic surgery in plastic surgery academia. Aesthetic Surg J. https://doi.org/10.1093/asj/sjaa181
Cohen-Shohet R, Bloom J, Mast B (2020) Mastopexy: current trends in private practice and academic practice and the impact on resident training. Ann Plast Surg 84:S414–S416. https://doi.org/10.1097/SAP.0000000000002273
Rao VK, Schmid DB, Hanson SE, Bentz ML (2011) Establishing a multidisciplinary academic cosmetic center. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0b013e318222133a
Zweifler M, Glasberg SB (2000) An outcome-based study of aesthetic surgery in a clinic setting. Ann Plast Surg 44:355–360. https://doi.org/10.1097/00000637-200044040-00001
Ourian AJ, Doval AF, Zavlin D et al (2019) Evaluating patient outcomes in breast and abdominal cosmetic plastic surgery procedures involving residents. Aesthetic Surg J 39:572–578. https://doi.org/10.1093/asj/sjy329
Peterson EC, Ghosh TD, Qureshi AA et al (2019) Impact of residents on operative time in aesthetic surgery at an academic institution. Aesthetic Surg J Open Forum. https://doi.org/10.1093/asjof/ojz026
Carruthers KH, McMahan JD, Taylor A et al (2015) Patient attitudes toward resident participation in cosmetic vs reconstructive outpatient consultations. J Surg Educ 72:477–482. https://doi.org/10.1016/j.jsurg.2014.11.009
Iorio ML, Stolle E, Brown BJ et al (2012) Plastic surgery training: evaluating patient satisfaction with facial fillers in a resident clinic. Aesthetic Plast Surg 36:1361–1366. https://doi.org/10.1007/s00266-012-9973-3
Klassen AF, Cano SJ, Scott A et al (2010) Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plast Surg 26:303–309. https://doi.org/10.1055/s-0030-1262313
Pusic AL, Klassen AF, Scott AM, Cano SJ (2013) Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale. A new patient-reported outcome instrument for facial aesthetics patients. Clin Plast Surg 40:249–260
Cosmetic Surgery Certification. Royal College of Surgeons of England. Accessed Jul 11 2021 from: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/service-standards/cosmetic-surgery/certification/.
Cueva-Galárraga M, Cárdenas-Camarena L, Boquín M, Robles-Cervantes JA, Guerrerosantos J (2011) Aesthetic plastic surgery training at the Jalisco plastic and reconstructive surgery institute: a 20-year review. Plast Reconstr Surg 127(3):1346–1351. https://doi.org/10.1097/PRS.0b013e318205f317
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Morris, M.P., Toyoda, Y., Christopher, A.N. et al. A Systematic Review of Aesthetic Surgery Training Within Plastic Surgery Training Programs in the USA: An In-Depth Analysis and Practical Reference. Aesth Plast Surg 46, 513–523 (2022). https://doi.org/10.1007/s00266-021-02557-0
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DOI: https://doi.org/10.1007/s00266-021-02557-0