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INSPIRE: Inclusivity in plastic surgery - Insights, recommendations, & education. A national cross-sectional study
Garikai Kungwengwe1, Umar Rehman2, Simon Filson3
1Imperial College Healthcare NHS Trust, London, UK.
Background:
Plastic surgery is a highly competitive surgical speciality in the United Kingdom. Barriers to entry disproportionately affect ethnic minority candidates. Limited mentorship, unequal access to research opportunities, and systemic biases contribute to differential attainment and hinder career progression.
Methods:
A national cross-sectional survey was conducted amongst UK medical students and pre-specialty doctors to explore perceptions of mentorship, access to research, and clinical exposure in plastic surgery. A 20-item questionnaire was distributed via social media and institutional networks. Binary, multinomial, and ordinal logistic regression were used to identify predictors of plastic surgery interest and career progression.
Results:
Among 2528 respondents, 20.5% (n = 517) expressed interest in plastic surgery, with comparable interest between men (26.4%) and women (21.4%). Completing a plastic surgery rotation more than doubled interest (adj.OR 2.11, 95% CI 1.55-2.86, p < 0.001), and research involvement nearly quadrupled interest (adj.OR 3.95, 95% CI 2.70-5.78, p < 0.001). Mentorship significantly increased research engagement (adj.RRR 9.20, 95% CI 6.31-13.40, p < 0.001). Despite comparable interest, men were more likely than women to progress to speciality training (OR 1.70, 95% CI 1.24-2.35, p < 0.001). Ethnic minority candidates had lower progression rates (OR 0.43, 95% CI 0.31-0.61, p < 0.001). Mentorship reduced perceptions of racial (adj.OR 0.84, p = 0.048) and gender bias (adj.OR 0.78, p = 0.010).
Conclusions:
Structured mentorship is strongly associated with increased research involvement, speciality readiness, and confidence among aspiring plastic surgeons. Its protective effect against racial and gender bias underscores the need for targeted mentorship to promote diversity and equity in plastic surgery training.
