Gender-Affirmation Surgery Training in United States Academic Plastic Surgery Residency Programs

Purpose: Over 1.4 million American adults identify as transgender or nonbinary. Of these transgender persons, up to half will seek gender-affirmation surgery. The literature is void regarding the current state of gender-affirming surgical training provided to plastic surgery residents. This study reviews the quantity and type of transgender surgical education in American plastic surgery residency programs. Methods: We performed a cross-sectional analysis on all accredited independent and integrated plastic surgery residency programs. Information on program curricula was collected from official program websites and email or telephone interviews with program coordinators. Education was categorized into didactic, clinical, or elective. Programs were classified according to geography and affiliation with a “Leaders in LGBT Healthcare” center. Results: This study included 130 programs. While 58% of programs provided clinical training (n=75), significantly fewer had didactic teaching (n=50, 38%; p<0.003). One in five programs (n=15, 20%) that provided clinical training had a dedicated rotation. Programs affiliated with “Leaders in LGBT Healthcare” centers were significantly more likely to provide both didactic (n=33, n=17; p=0.031) and clinical training (n=48, n=27; p=0.006). Forty-two percent (n=54) of programs had no formal gender-affirmation surgery education and no scheduled elective time to acquire it. Conclusion: Despite the growing demand for gender-affirmation surgery, a large percentage of plastic surgery residency programs do not have didactic or clinical training and no elective means by which to acquire it. Institutional features, including “Leader in LGBT Healthcare Equality” status and geographic location, can significantly influence the type of gender transition education in residency.