PREPPED: Plastic Surgery Research, Education, and Preparation Promoting Equity and Diversity

Abstract

Health disparities persist in plastic surgery, especially for people from racial or ethnic minorities or from lower socioeconomic backgrounds.1 Health care disparities and provider workforce diversity are intricately connected; providers from lower-income communities and ethnic minority backgrounds are significantly more likely to care for underserved communities.2 Patient–physician racial and gender concordance is associated with higher patient satisfaction, improved health care utilization, and superior patient compliance.3 It is essential to recruit individuals from racially or ethnically underrepresented in medicine (UIM) or low-income backgrounds to not only enhance equity overall but also to improve patients’ access to care and surgical outcomes. One of the bottlenecks for UIM medical students to enter plastic surgery is the increasing difficulty of matching into integrated plastic surgery residency programs. To bridge the gap in resources available to students from minority backgrounds and improve preparation for subinternships, the Plastic Surgery Research, Education, and Preparation Promoting Equity and Diversity (PREPPED) program was founded. The PREPPED program was the recipient of a Plastic Surgery Foundation Diversity and Inclusion grant, as well as funding from the American Council of Academic Plastic Surgeons, and contributions from ConnectMed International and the Garnes Society. PREPPED was a 2-day course hosted in San Diego, California, in 2022. (See Figure, Supplemental Digital Content 1, which shows the schedule of course components of PREPPED, https://links.lww.com/PRS/F935.) Students received a 40-question survey before and after the event. Forty students participated, of whom 72.7% identified as UIM, and 48.5% did not have a home integrated plastic surgery program (Table 1). Students reported significantly greater confidence, describing the qualities that lead to success on a subinternship and greater understanding of the plastic surgery residency application process, after the event (P < 0.001). Students were significantly more comfortable identifying resources in plastic surgery education and identifying at least three mentors in the field after the event (P < 0.001). Students showed significant improvement in the post-PREPPED assessment in all subspecialties (P < 0.05) except for the hand category, which trended toward improvement but was not significant (P = 0.10). Table 1. - Characteristics of Students Who Completed the PREPPED Course Characteristic No. (%) Gender Male 16 (48.5) Female 16 (48.5) Nonbinary 1 (3.0) Race White 10 (30.3) Black/African American 15 (45.5) Asian/Pacific Islander 4 (12.1) American Indian/Alaskan Native 1 (3.0) Multiracial 3 (9.1) Ethnicity Hispanic/Latinx 24 (72.7) Non-Hispanic 9 (27.3) Underrepresented in medicine status Underrepresented 24 (72.7) Not underrepresented 9 (27.3) Home program Yes, integrated plastic surgery program 17 (51.5) No integrated plastic surgery program 16 (48.5) Applying to plastic and reconstructive surgery residency this cycle Yes, integrated plastic surgery only 16 (48.5) Yes, dual applying 14 (42.4) No, not applying to plastic surgery this cycle 3 (9.1) Inequities observed in the physician workforce result from multiple factors: bias from evaluators, socioeconomic disadvantage, unequal access to resources, and inadequate availability of mentorship, among others.4,5 PREPPED is a concerted effort by several invested faculty and residents to assist a cohort of capable, highly motivated historically disadvantaged students interested in the field of plastic surgery. PREPPED represents the first national course for subinternship preparation for underrepresented students in plastic surgery (Figs. 1 and 2). At its core, PREPPED is a course meant to level the playing field for medical students who have not had equal access to resources or mentorship thus far to excel in their plastic surgery education. Alongside didactic knowledge and technical skills, the course sought to teach students the unspoken rules of how to stand out in a positive way on their audition rotations, which have been shown to be of increasing importance in achieving a successful match. The PREPPED program is a promising mechanism to improve recruitment of UIM students into plastic surgery. Further investigation as well as future PREPPED events will elucidate how this program may be effective in improving subinternship performance and match outcomes.Fig. 1.: Photograph from PREPPED showing participants and instructors participating in ear-molding exercises.Fig. 2.: Photograph from PREPPED showing participants and instructors participating in small group case-based learning.DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. This work was funded by Plastic Surgery Foundation Diversity and Inclusion Grant 2021–2022, the Garnes Society, the American Council of Academic Plastic Surgery, and ConnectMed International. PHOTOGRAPHIC CONSENT Participants provided written informed consent for the use of their images.