From the Division of Plastic Surgery, University of Nebraska Medical Center, Omaha, NE.
Creighton University School of Medicine, Omaha, NE.
Ann Plast Surg. 2024 Sep 1;93(3):378-383. doi: 10.1097/SAP.0000000000004039. Epub 2024 Jul 9.
Contemporary medical education devotes little time to plastic surgery topics. This deficiency is potentially greater at institutions without a dedicated plastic surgery training program. Lack of exposure to plastic surgery results in many medical students developing limited awareness to the full scope of the field. As a result, these future physicians may be unaware of many conditions treated by the plastic surgeon, resulting in referrals being diverted to alternative specialist and furthering scope of practice creep. This study aims to assess medical students' exposure to plastic surgery and evaluate institutional-based differences in plastic surgery education by comparing medical schools with and without a plastic surgery training program.
Surveys were distributed to medical students at 2 institutions in the same United States city: 1 with a plastic surgery training program (TP) and 1 with no training program (NTP). Surveys assessed students' clinical experiences, exposure to plastic surgery, and understanding of the scope of plastic surgery.
The response rate was 24.3% (306 of 1261). Many students reported having "little" or "no" exposure to plastic surgery during preclinical (93.5%) and clinical (77.7%) phases. NTP students were more likely to report "no" exposure to plastic surgery during both the preclinical ( P = 0.0145) and clinical ( P = 0.045) years. Consequently, approximately half of all students felt uncomfortable knowing when to refer a patient (46.1%) or place an inpatient consult (51.1%) to a plastic surgeon.When presented with clinical scenarios, plastic surgery was selected by only 53.4% of students. Performance between institutions was similar (53.0% TP vs 53.5% NTP, P = 0.936), with greater accuracy on cosmetic vignettes compared with hand and peripheral nerve vignettes. There was a statistically significant difference in 4 subspecialty domains between students who had prior exposure to plastic surgery and those who did not (hand/peripheral nerve, P < 0.0001; craniofacial, P = 0.007; breast/cosmetic, P = 0.001; and reconstruction/burn, P < 0.0001).
These findings add to the growing body of literature demonstrating that medical students have limited exposure to plastic surgery. Although limited in its scope, this study suggests that home TP status does not appear to overtly impact students' understanding. Increased exposure and overall surgical experience correlated with an increased understanding of the scope of plastic surgery.
当代医学教育在整形外科课题上投入的时间很少。对于没有专门的整形外科培训项目的机构来说，这种不足可能更大。缺乏对整形外科的接触导致许多医学生对该领域的全部范围只有有限的认识。结果，这些未来的医生可能不知道许多由整形外科医生治疗的疾病，导致转诊被转介给其他专科医生，并进一步扩大了实践范围。本研究旨在评估医学生接触整形外科的情况，并通过比较有和没有整形外科培训计划的医学院，评估机构基础上的整形外科教育差异。
在同一美国城市的 2 所机构向医学生分发了调查问卷：1 所为有整形外科培训计划的机构（TP），1 所为没有培训计划的机构（NTP）。调查问卷评估了学生的临床经验、接触整形外科的情况以及对整形外科范围的理解。
回复率为 24.3%（306/1261）。许多学生报告在临床前（93.5%）和临床（77.7%）阶段都只有“很少”或“没有”接触过整形外科。NTP 学生在临床前（P=0.0145）和临床（P=0.045）期间更有可能报告“没有”接触过整形外科。因此，大约一半的学生在知道何时将患者转介给整形外科医生（46.1%）或安排住院会诊（51.1%）时感到不舒服。当提出临床情况时，只有 53.4%的学生选择了整形外科。两所机构的表现相似（TP 为 53.0%，NTP 为 53.5%，P=0.936），在美容病例与手部和周围神经病例相比，准确性更高。在有或没有接受过整形外科培训的学生之间，有 4 个亚专业领域存在统计学上的显著差异（手部/周围神经，P<0.0001；颅面，P=0.007；乳房/美容，P=0.001；和重建/烧伤，P<0.0001）。
这些发现增加了越来越多的文献表明，医学生对整形外科的接触有限。尽管范围有限，但这项研究表明，家庭培训计划的地位似乎并没有明显影响学生的理解。增加接触和整体手术经验与对整形外科范围的理解增加相关。
