Assessing gender-affirming surgery training in plastic surgery sub-internships: Insights into the current landscape

Interest in gender-affirming surgery (GAS) is growing in plastic and reconstructive surgery (PRS), yet GAS exposure during PRS sub-internships remains underemphasized. This study assessed GAS exposure during these rotations via a cross-sectional survey to applicants to a single institution's 2024 integrated residency program, examining demographics and exposure differences by region, program size, and type. Of 295 applicants, 73 (25%) responded. GAS exposure occurred in 78% of reported sub-internships (120/154). Students at medium-sized programs had higher odds of GAS exposure than those at small programs (odds ratio [OR] = 14.3, p = 0.026). Compared to Southern programs, students in the Midwest had higher clinic exposure (OR = 9.85, p = 0.050), and those in the West had greater facial GAS exposure (OR = 5.13, p = 0.048). Ninety percent of respondents believed GAS exposure is at least moderately important for sub-interns. While GAS exposure is increasing, regional and program disparities persist. Clearer expectations could help students align their rotations with educational goals and better prepare them for residency.