Medical Student Exposure to Plastic Surgery and the Impact of a Home Training Program.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic?

PURPOSE OF REVIEW: This article aims to summarize some recent trends in occupational allergic contact dermatitis (ACD), including dermatitis related to pandemic-level personal protective equipment in healthcare workers, hazards patients may experience when working from home, and occupational perspectives on the recent American Contact Dermatitis Society (ACDS) allergens of the year and ACDS Core Allergen Series updates. RECENT FINDINGS: Recent ACDS Allergens of the Year may be particularly relevant to healthcare workers, including isobornyl acrylate, which is present in glucose sensors and propylene glycol present in hand cleansers and disinfectants. Lavender, limonene, and linalool, all of which are new additions to the ACDS Core Allergen Series, have been reported as causes for occupational ACD in massage therapists and aromatherapists. Isothiazolinone allergy continues to rise in both consumer and occupational settings. Finally, the COVID-19 pandemic has resulted in a wave of occupational ACD in healthcare workers to personal protective equipment, and revealed new potential allergens for individuals working from home. Occupational allergic contact dermatitis continues to exert a significant occupational disease burden. Remaining aware of the current trends in allergens may allow for earlier recognition, diagnosis, and treatment, subsequently helping our patients to work in healthier and safer environments.

Patient Outcomes and Satisfaction After Mohs Micrographic Surgery in Patients With Nonmelanoma Skin Cancer.

BACKGROUND: Quality in medicine is increasingly being measured through patient-reported outcome measures. Given the rising incidence and costs for nonmelanoma skin cancer (NMSC) treatment, it is imperative to define quality measures specific to dermatologic surgery. OBJECTIVE: This study aims to evaluate patient-reported outcomes and satisfaction with Mohs micrographic surgery (MMS) together with patient and tumor factors to better define their use in developing treatment strategies and quality measures. METHODS AND MATERIALS: A prospective study was conducted among 226 patients undergoing MMS for treatment of NMSC. Patient demographics, quality of life, functional status, satisfaction, and prognostic factors were gathered. Postoperative outcomes were measured at 1 month and included patient-reported problems and provider-reported complications. Relationships between patient factors and outcomes were evaluated through statistical analysis. RESULTS: Average patient satisfaction in the domain of general satisfaction of the Patient Satisfaction Questionnaire-18 was 4.34 of 5. General patient satisfaction did not differ across age, final defect size, sex, or prognostic scores. At 1-month postoperatively, 97 percent of patients expressed willingness to undergo future MMS if indicated. CONCLUSION: Patients are generally satisfied with MMS for treatment of NMSC. Specific patient factors that may affect satisfaction include smoking status and anticoagulation use.

Influenced: Exploring the Effect of Social Media on Medical Students' Perceptions of Plastic Surgery.

Background: Medical students rarely receive dedicated education in plastic surgery, exposing them to influence from the internet or television programming that is frequently skewed toward cosmetic procedures. Additionally, social media posts from board-certified plastic surgeons make up a small portion of available content. These biased representations may impact students' perceptions, narrowing the scope of referrals and limiting career exploration. Methods: Medical students at two academic medical centers were surveyed. Blinded data were collected on exposure to plastic surgery, social media usage, observed content, and perceptions of the specialty. Students' understanding of plastic surgery was evaluated using clinical scenarios. Results: The response rate was 24.3%. Social media and television were the primary contributors to understanding of plastic surgery in 51.6% of students, especially for those who had not completed a surgical clerkship (P < 0.026). Students most frequently viewed plastic surgery content posted by influencers (28.1%), followed by board-certified plastic surgeons (24.1%), patients (21.2%), and nonplastic surgeon physicians (19.7%). Posts relating to cosmetic procedures (44.3%) were viewed most frequently. Students who followed board-certified plastic surgeons performed better when answering clinical vignettes (64.8% versus 50.9%). Conclusions: Social media and television play a significant role in medical students' perceptions of plastic surgery. Students are also more likely to see posts from influencers than board-certified plastic surgeons, furthering potential bias. Quality content from board-certified surgeons and professional societies may improve scope of practice creep and student interest.

Comparing the safety and effectiveness of different liposuction techniques for lipedema.

INTRODUCTION: Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema. METHODS: Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. RESULTS: A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). CONCLUSION: Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment.