Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, 1677e1681

How to improve plastic surgery knowledge, skills

and career interest in undergraduates in one day*
C.R. Davis a,*, J.M. ODonoghue b, J. McPhail c, A.R. Green c
a

St Thomas Hospital, London, SE1 7EH, UK

Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
c
Whiston Hospital, Merseyside, L35 5DR, UK
b

Received 13 March 2009; accepted 22 October 2009

KEYWORDS
Undergraduate;
Student;
Education;
Training;
Career;
Plastic surgery

Summary Introduction: Plastic surgery now occupies a negligible component of many undergraduate curricula. The British Association of Plastic, Reconstructive and Aesthetic Surgeons
Undergraduate Course aimed to introduce and improve students plastic surgery knowledge
and skills, as well as develop personal career interests. This research aims to quantify whether
this was achieved.
Methods: Students attending the one-day course were invited to complete a questionnaire
before and after the course. Questions were self-reflective and incorporated four key themes:
(1) plastic surgery knowledge; (2) awareness of the work of a plastic surgeon; (3) ability to
perform basic plastic surgical skills; (4) career interest in plastic surgery. Non-medical students
were given an identical questionnaire to quantify public perception of the work of a plastic
surgeon.
Results: 121 students attended from 17 universities across the UK, with 93 completing the
questionnaire (77% response rate). Paired analyses compared mean or median scores of the
students answers before and after the course. After completing the course, medical students
significantly improved in all four key themes (p < 0.01). 93 non-medical students completed
questionnaires. Medical students were significantly more accurate at identifying plastic
surgery procedures than non-medical students (P < 0.01), which was further strengthened
after completing the course (P < 0.001).
Conclusion: This study demonstrates the positive educational impact of a one-day plastic
surgery event for medical students and supports the need for plastic surgery education at
an undergraduate level.
2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by
Elsevier Ltd. All rights reserved.

Presented at the summer 2009 meeting of the British Association of Plastic, Reconstructive and Aesthetic Surgeons.
* Corresponding author. Tel.: 44 20 7188 7188.
E-mail address: chrisdavis959@hotmail.com (C.R. Davis).

1748-6815/$ - see front matter 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjps.2009.10.023

1678
The decline of plastic surgery education within the UK
undergraduate medical curriculum has been well documented.1-3 In the 1980s, 78% of medical schools formally
taught plastic surgery.1 By the 1990s, this figure fell to
21%.2 A recent UK poll reported only 13% of medical
students receive formal teaching in plastic surgery.3 If this
trend continues, doctors of tomorrow will have less exposure to the field of plastic surgery compared to their
predecessors. Of the medical schools worldwide that offer
plastic surgery, teaching is delivered via lectures,2,4,5
clinical attachments,2,4,5 computer-assisted learning packages5 and slide-shows.4 In many cases plastic surgery topics
are being taught but under the guise of different specialties.3 The perception of the work of a plastic surgeon is
therefore dependent on exposure to the speciality6 and
a decline in teaching may perpetuate misconceptions of the
work carried out by plastic surgeons.
Given the evolution in medical training and a trend
towards earlier specialisation,7 it is important that medical
students are exposed to all medical and surgical specialities
e including plastic surgery e in order to make informed
career decisions. The delivery of teaching not only educates
students into the technical nuances of plastic surgery, but
provides an inspirational platform to motivate students to
seek further opportunities within the speciality.5 Furthermore, interactions with consultants are the single most
important factor in influencing a student to pursue a surgical
career,8 possibly by acting as role-models to medical
students.9 Such positive influences are particularly powerful
in the early stages of medical school, with the majority of
students making speciality career decisions towards plastic
surgery in their third year of medical school.10
Given the inherent difficulties of changing a university
curriculum, a simple but effective solution to increase
plastic surgery exposure to all UK medical students is
required. The British Association of Plastic, Reconstructive
and Aesthetic Surgeons (BAPRAS) hosted a one-day national
course in order to educate, encourage and inspire medical
students to consider a career in plastic surgery. The aim of
this research is to quantify whether this one-day plastic
surgery course had a positive educational impact on
medical students knowledge, clinical skills and career
interest in plastic surgery.

Methods
The BAPRAS Undergraduate Course took place on 19
October 2008 at the Royal College of Surgeons of England.
Medical students across the UK were invited to register
their interest following email and poster advertisements in
each of the UK medical schools. Delegates were not
required to pay a course fee.
Teaching methods employed included a rotational
system of lectures by consultant plastic surgeons, surgical
skills training by specialist registrars using manikins
(Figure 1), video presentations, a guided tour of the plastic
surgery archive and a quiz with prizes. Lecture topics
included an introduction and history of the specialty as well
as presentations on hand surgery, breast reconstruction,
burns, lower limb trauma, skin cancer, sarcoma, paediatric
plastic surgery and aesthetic surgery.

C.R. Davis et al.

Figure 1

Images showing clinical skills teaching in progress

All students were invited to complete a questionnaire

before and after the course reflecting on four key themes:





Theme
Theme
Theme
Theme

1:
2:
3:
4:

Plastic surgery knowledge

Awareness of the work of a plastic surgeon
Ability to perform basic plastic surgery skills
Career interest in plastic surgery

Answers were recorded using a modified Likert scale and

numerically converted to scores out of ten. Data were
collated to express average scores (mean or median) before
and after completing the course. Normally distributed data
were expressed as mean values and standard error of the
mean (SEM) (Theme 1), whereas non-parametric data were
expressed as median values and standard deviation (SD)
(Themes 2, 3 and 4)
The attending medical students were also given a list of
plastic surgery procedures and asked to identify which
procedures might be carried out by a plastic surgeon both
before and after completing the course. Demographic data
and prior exposure to plastic surgery were also recorded
and students were asked to complete a supplementary
feedback form. To allow comparison of data, a control
group of non-medical students was invited to complete the
same questionnaire to identify procedures carried out by
a plastic surgeon. This control group was of a similar

How to improve plastic surgery knowledge

1679

educational and socio-demographic cohort, consisting of

non-medical students from the University of London and
University of Manchester.
The null hypothesis of this study stated that the course
would have no effect on knowledge, clinical skills and
career interest in plastic surgery. Significance was set at
P < 0.05. Statistical analyses compared mean or median
scores using paired t-tests or Wilcoxon matched pairs test
respectively, according to the distribution of data.

Table 2

Sources of previous plastic surgery experience

Environment Number of Proportion of Median Range

students all students (%) duration
Lectures
Theatre
Clinic
Elective

40
39
26
6

44
42
28
6.5

2h
15 h
10 h
2 weeks

1e17.5 h
1e350 h
2e100 h
6h e 8
weeks

Results
Discussion
283 students expressed an interest in the course, of which
the first 200 were offered a place. 121 students attended
from 17 universities in England, Scotland and Northern
Ireland (Table 1). 93 medical students returned their
questionnaires (77% response rate). The median age of the
students was 22 years, with a range from 19 to 39 years
(Table 1). 93 non-medical students from Universities of
London and Manchester completed the questionnaires
which acted as the control group for comparison.
67 students stated that they had previous exposure to
plastic surgery. The sources of experience for these
students are displayed in Table 2. In addition, five students
expressed an interest in carrying out an elective in plastic
surgery in the future.
After completing the course, medical students significantly improved in all four educational themes assessed
(P < 0.0001) (Table 3).
Furthermore, students ability to correctly identify
operations performed by a plastic surgeon significantly
improved after completing the course, with a mean
improvement of 37% (p < 0.01). Medical students awareness of the procedures performed by a plastic surgeon was
higher than non-medical students prior to the course
(P < 0.01). This finding was strengthened after completing
the course (P < 0.001) (Table 4).
Feedback from the students supported the mixture of
teaching styles provided during the day, with lectures being
the most popular followed by clinical skills and visiting the
archive. Every student said they would recommend the
course to their peers and 98% would attend again in future.
Invitations via email were the most successful means of
attracting students to attend.

Table 1
students

Sociodemographic data of attending medical

This is the first study to show quantifiable evidence that

a one-day undergraduate course significantly increases
plastic surgery knowledge, plastic surgical skills and career
interest in plastic surgery. Given the need for medical
students to make career decisions at an early stage, such
a course has the potential to positively influence the future
of many medical students. Undergraduate exposure is the
single most influential factor for subsequent career interest
in plastic surgery10 with the duration of speciality exposure
directly proportional to subsequent career intentions.11 It is
therefore imperative that medical student exposure to
plastic surgery continues to grow in order to attract the
brightest and best students to a career in this speciality.
This is especially important given the need to meet workforce projections.12
Selection into plastic surgery is also evolving, with the
possibility of increased attention to surgical skills as one of
the determinants of career progression.13 Trainees who
were successful in entering higher plastic surgery training
scored higher marks than unsuccessful candidates in the
assessment of surgical skills. 13 This further reinforces the
need to teach basic plastic surgery skills at an earlier stage
in order to maximise the quality of patient care, clinical
competencies and employability of surgical trainees.13

Table 3
Results of four key themes assessed before and
after the course (scores out of ten)
Theme Assessment

Before
After
Significance
Course
course
(p value)
(average (average
SD/SEM)
SD/SEM)

2.5 2.2

6.5 2.0

<0.0001

4.7 0.3

7.7 0.2

<0.0001

4.6 3.0

5.9 2.6

<0.0001

5.9 2.7

7.3 2.4

<0.0001

Number Percentage
Sex

Male
Female
University
London
Non-London
Year of medical school 2
3
4
5/6
BSc

74
47
31
60
9
28
22
26
4

61
39
34
66
10
31
24
31
4.4

Plastic surgery
knowledge
Awareness of
the work
of a plastic
surgeon
Ability to
perform
basic plastic
surgical skills
Career
interest
in plastic
surgery

SD Z Standard deviation; SEM Z Standard error of the mean

1680
Table 4

C.R. Davis et al.

Ability to recognise operations associated with plastic surgery

Operation /
surgical category
Microsurgery
Neuroma
Sarcoma
Amputation
Compartment syndrome
Free flaps
Melanoma excision
Limb replant
Trauma
Mastectomy
Breast enlargement
Facelift
Cleft palate repair
Burns
Skin grafts

Before course
(% correct)
25
37
61
59
41
80
77
83
86
84
95
96
97
100
99

Medical students
After course
Improvement
(% correct)
(relative difference, %)
96
58
80
77
53
96
91
96
98
94
99
100
99
100
98

Teaching undergraduate plastic surgery has potential

benefits to all future doctors and ultimately patients, irrespective of career intentions. Exposure to plastic surgery
may not lead to the development of a career interest in
plastic surgery. However, this is still an important reason to
encourage undergraduate teaching, as a negative decision
allows students to choose more suitable career paths.
Given the multidisciplinary nature of plastic surgery and
the abundant team working with other medical and surgical
specialities, it is important that non-plastic surgery colleagues
are aware of the work carried out by plastic surgeons. Referrals will therefore be more accurate, resulting in a more
efficient and higher quality of service delivered to patients.
This is reinforced by the significantly improved knowledge of
plastic surgery operations after completing the course (37%;
p < 0.01). These findings are supported by other educational
programmes that increased students ability to list five plastic
surgery operations from 15% to 100%.14
Previous evidence suggests that uninitiated general
practitioners and medical students are no better informed
than the general public about the type of operations performed by a plastic surgeon.15 However, this finding was not
supported in our study, which showed that medical students
were significantly more accurate than non-medical students
at identifying procedures performed by a plastic surgeon.
Recognition of aesthetic procedures was noticeably higher
than non-aesthetic/reconstructive procedures, particularly
amongst the non-medical students. Only by gaining firsthand experience in the specialty e even if just for one day e
will we increase the accuracy of the perception of the
modern plastic and reconstructive surgeon.
It is the authors intention with the continuing support of
BAPRAS to develop this programme into a twice-yearly
course. The courses will be rotated between London and
other the regions. Further information can be found on the
BAPRAS website.16
This study has quantifiably demonstrated the positive
educational impact a one-day plastic surgery course can

Non-medical students
Understanding
(% correct)

285
58
32
30
30
20
19
16
14
11
4.2
4.1
1.5
0
1.2

11
2
5
17
0
11
15
33
25
17
89
95
45
71
68

have on medical students, further reinforcing the importance of exposing medical students to the speciality. This
has implications for the future careers of individual medical
students, workforce planning within the speciality and for
the delivery of high quality care to our patients by the
plastic surgeons of the future.

Conflict of interest statement

None of the authors report any financial, ethical or personal
conflicts of interest with regards to this manuscript.

Authors contributions
CR Davis, Course planning, study design and statistical
analyses
JM ODonoghue, Chairman Education and Research
Subcommittee BAPRAS, Course convenor
J McPhail, Clinical Skills coordinator
AR Green, Immediate Past President BAPRAS

Acknowledgements
The authors would like to thank the BAPRAS secretariat for
their assistance, the finance subcommittee of BAPRAS for
helping to fund the course and the consultants and registrars who generously gave of their time to teach at the
course.

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