Sentiment Towards Gender Affirming Surgical Care Among Plastic Surgery, Urology, and Obstetrics and Gynecology Postgraduate Trainees.

ACC 

Providing gender-affirming care is a critical medical service that is rapidly evolving given the dynamic insurance and political landscape. There is limited information in the literature documenting an increase in willingness to provide care in the medical and surgical community. Plastic Surgery (PS), Urology, and Obstetrics/Gynecology (OB/GYN) are the disciplines most likely to perform gender-affirming surgeries (GAS). Anecdotally, these groups are most likely to view this population favorably. Targeting residents and fellows within these surgical residencies, we aimed to gauge the willingness to provide surgical care for this patient population in the US.

Plastic surgery, Urologic surgery, and OB/GYN trainees from all U.S. training programs were asked to complete a cross-sectional 26-question survey between August 2020 and January 2022. Respondents were queried regarding their demographic background. We focused on addressing transgender curricular exposure, knowledge of services offered at their institution, and comfort surrounding the training opportunities in transgender patient care. Additionally, respondents were queried on their desire or willingness to perform gender-affirming care or surgeries. Demographic data including personal gender identity and connection to the LGBTQ community was also collected.

164 responses across specialties were collected. Statistical analysis demonstrated distinct trends across specialties in exposure, comfort, gender, and region. Additionally, individual text-based responses from the survey were compiled. Our survey demonstrated consistency with prior studies on regional exposure to GAS but revealed interesting perspectives regarding the morality of providing this care. Namely, whether trainees have the option to opt in or opt out of surgical gender training despite the prevailing belief that these services are necessary.

Amongst all specialties, survey takers felt that residents should not have the option to opt out of curriculum specific to gender diverse patients (80.99%, 115/142) nor the option to opt out of caring for gender diverse (82.39%, 117/142). Similarly, most respondents to the survey do not have a moral/ethical objection to care for (90.85%, 129/142) nor to provide surgical care (82.39%, 117/142) for gender diverse patients. When looking at specialty specific responses, PS had the highest exposure to GAS. However, 20/68 plastic surgery respondents thought that residents should have the option to opt out of gender-affirming care, which was found to be significantly more than the other surgical specialties (p=0.013) with only 5 other respondents in OB/GYN or urology programs responding in favor of opting out. There was no statistical significance to respondents having moral/ethical objections to providing neither care or surgeries for gender diverse patients, despite the significance in PS residents in favor of opting out of services. OB/GYN had the overall lowest exposure to surgical cases with urology being exposed to the highest number of revision surgeries. Numerous other significant results were noted in our study.

Residency programs have made meaningful strides in offering more accessible and competent gender-affirming training. Differences in support exist among the included specialties. Plastic surgery for instance is most likely to teach GAS in their curricula but is more likely than their other specialties to opt out of training. This could be explained by preference among learners in subspecialty interests other than GAS. More interesting is that this finding does not seem to be a result of moral or ethical grounding. As most bottom surgery complications are urologic, it makes sense that revision surgeries are high in urologic training programs. Finally, the option to opt out of gender-affirming care also parallels the opt out option for abortion training in OB/GYN residencies but is not a standardized option amongst PS, urology, or OB/GYN training programs. This is the first survey of this kind to survey multiple surgical specialties providing gender-affirming surgical care and query resident sentiment and highlights the need for more questions to be asked about how to address GAS training in residency programs.

Gender Affirmation

Reconstructive

Plastic Surgery 2023