Shaping Plastic Surgery Undergraduate Curriculum: Insights into Curriculum Preferences from International Consultants

Introduction

Plastic surgery is a complex and multi-faceted medical specialty that requires physicians to have a thorough understanding of embryology, anatomy, physiology, pathology, and surgical techniques. Therefore, medical students who plan to enter the field of plastic surgery require a comprehensive education to ensure safe and effective care for future patients.

However, only two studies of plastic surgery have addressed the undergraduate plastic surgery curriculum. The first study, which was conducted in 1989 in North America, no longer reflects the current state of plastic surgery education.¹ The second study, which was conducted in 2017, included 50 experts involved in plastic surgery training programs at university hospitals in Scandinavia.² Other studies have predominantly focused on post-graduate training of plastic surgery residents and delved into various crucial aspects of advanced training, including evidence-based practices, competency-based skills, operative skills, the educational curriculum provided to residents, simulation-based training, emotional intelligence, and the incorporation of virtual and augmented reality into training.^3-10 The integration of evidence-based practice into plastic surgery residency programs to ensure that the latest advancements and best practices are incorporated with surgical techniques has emerged as an important requirement.³ Furthermore, the emphasis on enhancing operative skills through comprehensive training programs, utilizing simulation methods to replicate real-life surgical scenarios, and fostering experiential learning is increasing.^7-8 Additionally, the incorporation of virtual and augmented reality technologies has been explored to allow new immersive and interactive learning experiences for aspiring plastic surgeons. 10

Meanwhile, the deficiency in exposure of plastic surgery faculty members results in a scarcity of career guidance, thus leaving students without readily available insights into this specialty.¹¹ Furthermore, the inclusion of plastic surgery in the undergraduate curriculum has decreased over time. In 1986, plastic surgery was included in the undergraduate curriculum of13 of 31 medical schools in the United Kingdom; however, in 2002, it was included in the undergraduate curriculum of only 2 of 34 medical schools in the United Kingdom (UK). This trend underscores the pressing demand for a revitalized approach to the undergraduate plastic surgery curriculum. Moreover, medical students have acknowledged the need for plastic surgery to be integrated into the undergraduate curriculum.

This study underscores the urgency of a comprehensive overhaul of plastic surgery education at the undergraduate level, emphasizing the importance of international collaboration with educational authorities to address this critical gap in medical education.¹²

Plastic surgery is recognized as an exceptionally competitive medical field. In the 2022 Main Residency Match, plastic surgery was the most sought-after specialty, boasting an applicant match rate of approximately 55%, with 207 of 340 applicants successfully matched. Notably, the match rate for senior physicians substantially decreased from 85.7% in 2018 to 62.7% in 2022 (a reduction of 23%) 13-15 Research on medical students’ attitudes toward integrating plastic surgery into their education has highlighted the importance of this specialty.^12,16 Furthermore, practitioners across a variety of medical specialties —such as dermatology, orthopedics, oncologic surgery, and emergency medicine— frequently encounter scenarios that require plastic surgery knowledge, thus making it imperative for medical students to have a foundational understanding of its core themes. This foundational knowledge is not only crucial for those who aim to specialize in plastic surgery but also vital to ensuring patient safety across specialties.^17,18

To our knowledge, this study marks a significant milestone as the first to explore the opinions of international plastic surgeons and transcend the boundaries of local and regional committees. During this research, we engaged with plastic surgery consultants from around the world and compiled unique insights necessary to lay the foundation for shaping a plastic surgery curriculum that is tailored to the needs of the medical community.

This study aimed to gather insights from at least 50 international plastic surgery consultants over a three-month period to identify and prioritize key components for an undergraduate plastic surgery curriculum, with the target sample size informed by previous literature and aiming to be equal to or greater than the largest sample reported in similar studies on the same topic. The findings are intended to provide educational organizations with actionable guidance for developing a curriculum that meets the evolving standards of medical institutions. By doing so, this study seeks to equip future healthcare professionals with essential plastic surgery knowledge, contributing to the global enhancement of undergraduate medical education in this specialty.

Methods

An international, cross-sectional, web-based survey of plastic surgery consultants was conducted using an online questionnaire distributed via social media platforms over a three-month period (January–March 2025) using convenience sampling. The purpose and introduction of the research were clearly explained at the beginning of the questionnaire to provide context and to enhance the understanding of the participants. Informed consent was obtained from all respondents prior to participation. Given the exploratory nature and global scope of this study, accurately calculating a sample size for board-certified plastic surgeons worldwide presented challenges. Precise population data on the total number of board-certified plastic surgeons was limited, as certification standards and record-keeping practices vary considerably across countries. To gather insights from a diverse range of educational contexts, we adopted a convenience sampling approach to encourage broad participation.

The inclusion criteria included board certified plastic surgeons with English proficiency to allow effective communication (because the survey was conducted in English). All non-board certified plastic surgeons or couldn’t speak or write the English language were excluded. Additionally, incomplete or incorrect responses were excluded from the study.

This study adhered to the principles outlined in the Declaration of Helsinki (World Medical Association, 2013) and the International Conference on Harmonization guidelines for Good Clinical Practice (ICH, 2016) and was approved by the Institutional Review Board (IRB) of Imam Mohammad Ibn Saud Islamic University (HAPO-01-R-0011; 393/2022). Informed consent was obtained from all participants.

A researcher-developed questionnaire was developed using an online questionnaire platform (Google Forms; Google, Mountain View, CA, USA) distributed via social media networks to provide broad access to plastic surgery consultants worldwide. This method ensured convenience and a diverse participant pool and facilitated the collection of valuable insights from international participants.

The questionnaire consisted of two sections. The first section comprised nine demographic questions to gather essential background information about the participants, such as their age, gender, years of experience, primary practice setting, and academic affiliation. Other relevant demographic information, such as sub-specialties, the primary country where the participants practiced, the country where plastic surgery board certification training was obtained, and educational leadership positions such as program director, academic supervisor, or other formal responsibilities in undergraduate or postgraduate surgical education, were also assessed. The inclusion of these demographic questions allowed for a comprehensive understanding of the participants, thus enabling a more accurate analysis of the study results.

The second section comprised four domains with multiple questions. The development of these domains involved a meticulous process that included a thorough review of the existing undergraduate and plastic surgery residency curricula internationally, textbooks recommended by international educational institutions for student training, as well as peer-reviewed literature relevant to undergraduate education, and the consideration of emerging topics in plastic surgery. The questionnaire content was reviewed by experts in the field during the design and pilot phases. The first domain explored the participants' perceptions of the relevance of various basic sciences to the plastic surgery curriculum. Respondents were asked to indicate the types of basic sciences they considered important in the field of plastic surgery. The second domain focused on participants’ perspectives on the importance of research to their academic pursuits. The third domain explored the importance of clinical exposure and the types of clinical exposure that are most important to the education of medical students who plan to enter the field of plastic surgery. Finally, the fourth domain of the questionnaire focused on participants’ preferences regarding the topics included in the curriculum.

The reliability of our questionnaire’s items was assessed through a pilot survey using Cronbach’s α by measuring the correlations between the questionnaire items. Cronbach’s α was 0.83 for questions with five answers (three items). Cronbach’s α was 0.93 for questions with three answers (six items). The average Cronbach’s α was 0.91 (nine items), indicating high reliability. This structured questionnaire aimed to capture comprehensive data regarding the participants’ preferences across various aspects of academics.

After the data collection period (3 months) was completed, the responses obtained from the participants were automatically recorded and stored on an online questionnaire platform (Google Forms; Google, Mountain View, CA, USA). Subsequently, data were exported to a Microsoft Excel spreadsheet (version 16.69.1; Microsoft, Redmond, WA, USA) for further analysis. This process facilitated data organization and preparation for statistical analyses.

The responses were organized, cleaned, and prepared for analysis. To ensure the validity of the responses collected via the questionnaire, participants were asked to confirm their careful consideration of each question by responding “yes” to a specific query designed to ascertain their attentiveness. This measure was implemented to ensure that the participants had thoroughly read and thoughtfully considered each item before responding, thereby enhancing the reliability of the data collected. This step was crucial to distinguishing between responses reflective of genuine engagement with the content of the questionnaire and those that may have been hastily or carelessly provided. Data were qualitatively analyzed using R Studio (version 4.1.3; Integrated Development Environment for R, Boston, MA, USA) to create summary tables and figures. Data are presented as numbers and percentages.

Results

A total of 85 responses were collected; of these 67 met the validity requirements and were included in the study. Most participants were male (80.6%), 31 to 40 years of age (52.24%), and had 6 to 10 years of experience in the field of plastic surgery (35.82%). More than 60% of the participants were general plastic surgeons (41.79%) or reconstructive microsurgeons (20.9%). Participants represented over 30 countries, with the highest representation from Saudi Arabia (n=15). Their plastic surgery board certification was obtained from a broad spectrum of educational institutions in 35 different countries. Moreover, 59.7% of respondents worked at an academic institution, and 50.75% had educational leadership positions in the field of plastic surgery. Additionally, more than half of the participants (53.73%) worked for the government and private sector. Details regarding the participants’ demographic data are presented (Table 1).

When participants were asked about the essential hands-on experience that should be included in the undergraduate plastic surgery curriculum, clinical exposure (88.06%) and the use of cadavers (79.1%) were the most frequent answers. In contrast, the use of animal models (61.19%) was the least frequent answer (Figure 1).

Most respondents indicated that they believe that hands-on experience (64.18%) and an emphasis on basic sciences (55.22%) are very important for undergraduate students. Moreover, 30 participants (44.77%) recommended that clinical exposure should comprise 50% to 75% of the curriculum. Regarding research, 47.76% of the respondents considered research very important; however, one respondent believed that research is not important to the curriculum (Table 2). The respondents most frequently selected anatomy, surgical techniques, and instrumentation as topics that they believed should be part of the undergraduate curriculum; however, biochemistry and immunology were the least frequently selected topics (Figure 2). The most frequently selected type of clinical experience was inpatient care, followed by experience in the operating room (Figure 3).

Additionally, participants were asked questions about 86 topics that were meticulously chosen in alignment with the content derived from plastic surgery textbooks and scholarly literature for potential inclusion in the undergraduate curriculum. The responses were subsequently categorized based on the participants’ academic affiliations. The 10 most widely accepted topics among academic and non-academic participants included wound healing and the reconstructive ladder, thermal injury, hand anatomy, suture technique, hand examination, acute burn management, suturing material, and basal cell carcinoma. Non-academic participants particularly favored pressure ulcers, breast anatomy, and local anesthesia as topics. Conversely, academic participants placed a strong emphasis on grafts and flaps, squamous cell carcinoma, melanoma, necrotizing soft tissue infections, and hand trauma. These distinctions underscored the varying importance within academic and non-academic communities, thus elucidating nuanced preferences that can guide curriculum development for undergraduate medical programs (Table 3, Supplementary Table).

The comparative analysis between academic and non-academic plastic surgery consultants demonstrated a high degree of concordance across most curriculum components, with the majority of topics showing no statistically significant differences. Core foundational areas—including suturing techniques, wound healing, reconstructive principles, and management of common conditions—were consistently prioritized by both groups, reflecting a shared consensus on essential undergraduate competencies. However, a limited number of topics demonstrated statistically significant differences. Notably, hand trauma (p = 0.012), ganglion (p = 0.025), and gynecomastia (p = 0.016) showed variation between academic and non-academic respondents, suggesting subtle differences in perceived importance that may relate to variations in clinical exposure, case mix, or teaching priorities. Additionally, several topics approached statistical significance, such as hemangioma (p = 0.050), high-pressure injection injuries (p = 0.065), hand infections (p = 0.055), and fingertip and nailbed injuries (p = 0.058), indicating potential trends toward differing emphasis that did not reach formal statistical thresholds. Overall, these findings suggest that while there is strong agreement on the core structure of an undergraduate plastic surgery curriculum, certain subspecialty areas may be variably emphasized depending on professional background, highlighting the importance of a balanced and inclusive curriculum that integrates perspectives from both academic and non-academic practitioners (Table 4).

Discussion

The results of this study have profound implications for curriculum development worldwide and offer valuable information that can be used to create a curriculum that transcends cultural and healthcare boundaries. Furthermore, healthcare practices and patients’ needs vary significantly across different countries; therefore, the findings in this study provide guidance for tailoring undergraduate plastic surgery education to suit the unique requirements of diverse settings.

The differences between the rankings of topics observed during this contemporary study and those of a study published in 1989 provide valuable insights into the shifting priorities within the field of plastic surgery.¹ In our study, both academic and non-academic participants ranked wound healing and the reconstructive ladder as the highest priority, indicating the enduring significance of foundational knowledge in the field. Thermal injury and hand anatomy also had high rankings, underscoring their continued relevance. Interestingly, grafts and flaps, squamous cell carcinoma, melanoma, and necrotizing soft tissue infections were highly ranked by academic participants, reflecting a growing emphasis on specialized and advanced subjects. Although important, these topics may not have had the same level of prominence in 1989, suggesting the evolution of the curriculum to meet the demands of contemporary plastic surgery practices. Furthermore, the 1989 study prioritized topics related to wound management, such as the management of clean and contaminated wound. Although the crucial aspects of plastic surgery remain relevant, these topics may have been integrated into broader discussions of wound healing and management in the current curriculum. This shift in the rankings of topics highlights the dynamic nature of medical education and the need to adapt the curriculum to align with evolving medical practices and technology. Additionally, this shift emphasizes the importance of ongoing research and assessments to ensure that the plastic surgery curriculum remains relevant and effectively prepares future practitioners.

The questionnaire data revealed intriguing differences in the priorities of academic and non-academic plastic surgery consultants in terms of the undergraduate curriculum. Both groups unanimously valued wound healing and the reconstructive ladder, indicating the shared recognition of their fundamental roles in plastic surgery education. However, academic consultants placed a greater emphasis on conditions that require substantial research and complex treatment modalities, such as squamous cell carcinoma, melanoma, and necrotizing soft tissue infections; all of these conditions were prioritized by 90% of respondents. This may reflect a research-oriented approach and a focus on comprehensive, advanced topics in the academic setting.

Conversely, non-academic consultants exhibited a slightly higher preference for local anesthesia and pressure ulcers, which may underscore the practical, hands-on nature of the skills required in clinical practice. Interestingly, breast anatomy was one of the 10 most widely accepted topics of non-academic participants, but not of academic participants, indicating a difference in the procedural focus that could possibly influence the undergraduate curriculum. These insights suggest that non-academics may prioritize topics that enhance clinical competency, whereas academics may favor a curriculum that supports a deeper understanding of pathophysiology. Understanding these distinctions is crucial to developing a plastic surgery curriculum that effectively fulfills the nuanced educational requirements of both academic and non-academic settings, thereby ensuring a comprehensive educational strategy that addresses the full spectrum of environments in the field of plastic surgery.

The insights gained from participants in this study provide a solid foundation for the development and revision of the undergraduate plastic surgery curriculum. Educational institutions can use these results to build their curriculum in the most efficient way and adapt to the current timeframe. Specific recommendations gleaned from this study, such as the emphasis on hands-on clinical exposure and the importance of basic sciences, can serve as actionable guidelines for curriculum designers. These insights underscore the importance of balancing theoretical knowledge with practical skills and cultivating a research-oriented approach among future practitioners. By considering these recommendations, educational institutions will be able to develop a more relevant, comprehensive, and approachable curriculum that can better serve students who wish to enter the ever-evolving fields of plastic surgery and healthcare. This effort represents a vital step toward ensuring that the curriculum aligns with the dynamic needs of the medical field.

The strong preference of the study participants for enhanced clinical exposure was a pivotal point of discussion during this study. This study highlights the significance of hands-on experience as a cornerstone of effective plastic surgery education, consistent with the findings of other studies of this field.^12,19 Therefore, educational institutions should consider practical strategies to increase clinical exposure provided by the curriculum. This could involve the creation of dedicated clinics where students can engage in supervised patient care, thereby allowing them to gain valuable insights into the intricacies of plastic surgery practices. Additionally, the incorporation of cadaver laboratories can offer a dynamic platform for students to hone their surgical skills and anatomical knowledge in controlled and immersive environments. These strategies not only align with the participants’ views but also provide tangible pathways to better prepare aspiring plastic surgeons for the multifaceted challenges of real-world clinical practice.

Because technology continues to evolve and reshape medical education, it has become increasingly important to consider how the plastic surgery curriculum can be adapted to prepare students to use of virtual and augmented reality tools. Only 5% of participants disagreed with the consensus that simulation laboratories should be integrated into the curriculum to enable hands-on training. The integration of these advanced technologies into the curriculum will offer a multitude of potential benefits, such as providing students with immersive and interactive learning experiences that closely simulate real surgical scenarios10,20,21, thereby enhancing their understanding of complex procedures and bolstering their confidence in the clinical setting. Despite these advantages, substantial investments in technology infrastructure and training for educators and students are still necessary. However, it is important to ensure that virtual and augmented reality tools are seamlessly incorporated into the existing curriculum without overshadowing essential hands-on experience.

This study has several notable strengths. First, to our knowledge, it is the first study to explore undergraduate plastic surgery curriculum preferences using an international sample of consultant plastic surgeons, providing a broader perspective beyond single-country or regional studies. Second, participants represented more than 30 countries and obtained board certification from 35 different countries, enhancing the diversity of viewpoints and the global relevance of the findings. Third, the study specifically surveyed consultant plastic surgeons, allowing curriculum recommendations to be informed by experienced specialists actively involved in clinical practice and education. Fourth, the questionnaire was developed through review of curricula, textbooks, and relevant literature, with expert review and pilot testing demonstrating high internal reliability (Cronbach’s α = 0.91). Fifth, the study examined a comprehensive range of 86 potential curriculum topics in addition to teaching methods, research, clinical exposure, and basic sciences, enabling a detailed assessment of undergraduate educational priorities. Sixth, the inclusion of both academic and non-academic consultants allowed comparative analysis between stakeholder groups, providing practical insights for balanced curriculum design. Finally, the findings offer actionable and contemporary guidance for institutions seeking to modernize undergraduate plastic surgery education by integrating theoretical knowledge with hands-on clinical competencies.

This study has several limitations. First, the use of a single-round questionnaire, rather than a Delphi-based iterative approach, may limit the ability to achieve consensus among experts. Second, recruitment through social media using convenience sampling introduces potential selection bias, as participants are more likely to be academically active or engaged in educational activities. Additionally, the lack of precise data on the total number of board-certified plastic surgeons worldwide precludes accurate estimation of the target population and response rate, which may affect the generalizability of the findings. Nevertheless, this approach facilitated access to a wide and diverse international pool of participants, enabling the inclusion of varied perspectives aligned with the study’s objective of informing plastic surgery curriculum development on a global scale. Finally, language constraints may have affected participation, as the survey was conducted in English, potentially limiting responses from non-English-speaking individuals. Despite these limitations, the results of this study are valuable to the creation of enhanced undergraduate plastic surgery education programs and the realization of curriculum development efforts. Although this study provides valuable insights into the perceptions of consultants and academics regarding the integration of technology, it underscores the need for further research in this dynamic field. Additional studies should further evaluate the practical implications of incorporating technology and its long-term impact on student learning and patient care to guide the evolution of plastic surgery education in the digital age.

Conclusion

Based on the results of this study, prioritizing hands-on clinical experience and exposure are recommended. These results offer actionable guidance that institutions can use to refine the curriculum. By balancing theoretical knowledge with practical skills and fostering a research-oriented approach, educational organizations can equip students for the ever-changing field of plastic surgery. Finally, because clinical exposure is important, institutions are encouraged to explore strategies, such as the establishment of dedicated clinics and cadaver laboratories to prepare students for real-world practice.

Ethics approval and consent to participate: This study adhered to the principles outlined in the Declaration of Helsinki and the International Conference on Harmonisation (ICH) guidelines for Good Clinical Practice (GCP) and was approved by the Institutional Review Board (IRB) of Imam Mohammad Ibn Saud Islamic University (HAPO-01-R-0011; 393/2022). Informed consent was obtained from all participants.

Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Disclaimer: None to declare.

Competing interests: The author declares no competing interests.

Funding Sources: None.

Authors' contributions: The author conceived and designed the study, conducted data collection, performed data interpretation, and developed the scientific content of the manuscript.

Acknowledgement: The author acknowledges the professional language editing service for assistance with grammar, spelling, and linguistic refinement of the manuscript. The author also acknowledges the professional statistical support service for assistance with data analysis performed under the direction of the authors. These contributors had no role in the study design, data collection, data interpretation, development of the scientific content, or the decision to submit the manuscript for publication.

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