Gender Affirming Surgery During Canadian Plastic Surgery Residency: A Survey of Plastic and Reconstructive Surgery Residents' Experiences.

Introduction: Gender affirming surgery (GAS) is an umbrella term for procedures that can be a part of the transition process for transgender and nonbinary individuals. Plastic surgeons play an important role in gender affirming surgical care. Our purpose was to assess the GAS landscape in Plastic and Reconstructive Surgery (PRS) residency programs across Canada, including both the didactic and clinical context, along with assessing PRS residents on their perceived interest and competence relating to performing GAS. Methods: A survey was created based on existing literature relating to gender affirming care in surgical and medical postgraduate education. The survey was distributed to all PRS residents in Canada through their program director. Results were analysed using descriptive statistics. Results: Almost all residents surveyed agreed that transgender care is an important part of PRS. Despite this, little educational content regarding GAS was seen. The majority of individuals had never been exposed to any GAS clinically despite having at least one surgeon who performs GAS affiliated with their institution. For individuals who have had exposure, top surgery was the most common procedure seen. While few residents plan on pursuing a fellowship in GAS, some residents did comment they planned to offer top surgery or facial feminization as general plastic surgeons. Conclusion: The majority of PRS residents demonstrated a positive response towards the importance of GAS in PRS. As access to GAS in Canada remains limited, providing greater exposure to GAS in PRS residency may help in promoting willingness and competence to perform these procedures.