Are We Training Plastic Surgery Residents on the Management of Complications?

Background: In medical training, a crucial yet often ignored aspect is communication and processing of complications. This is a dynamic skill set that pervades across specialties. Beyond the knowledge base and technical skill to operatively manage complications, residents must learn how to tactfully communicate and emotionally process these events. A systematic review in 2024 on the competency framework for surgical training noted that soft skills, which includes communication, attitude, and handling adverse events, were largely missing from the studies’ analysis of education. As each specialty has its own unique patient populations, procedures and associated complications, each can be examined for characteristics and potential gaps in understanding of how to handle complications. Methods: We surveyed plastic surgery residents regarding their training on surgical complications and their perceived preparedness of management. Likert scale with scores from 0 to 5 (0 = extremely uncomfortable, 3 = somewhat comfortable, 5 = extremely comfortable) was used for questions on comfortability with handling a post-operative complication. Results: Forty plastic surgery residents completed the survey. Of these, 36 were years PGY1–PGY6 and 4 were fellows. Nearly all (39/40, 97.5%) reported awareness of complications associated with standard plastic surgery procedures. Most had received both formal (32/40, 80%) and informal (39/40, 97.5%) education on complications. Education on communicating post-complication events with patients and families was reported by 62.5% (25/40) formally and 72.5% (29/40) informally. Education on the psychosocial and professional implications of complications was less common, reported by 60% (24/40) formally and 62.5% (25/40) informally. Regarding comfort, residents rated their awareness of risks and ability to obtain informed consent highly (mean scores: 4.47 [SD 0.60] and 4.19 [SD 0.95], respectively). Comfort with discussing complications with patients and families and addressing psychosocial impacts was lower (mean scores: 3.83 [SD 1.00] and 3.39 [SD 0.87], respectively). When comparing comfort level between genders, the averages for male were higher in every category compared to their female counterparts (Table 2). There was a statistically significant difference between male and female comfort levels with obtaining consent and discussing complications with the patient and family (p = 0.024 and p = 0.019, respectively). Conclusion: Our data demonstrates strong educational constructs for plastic surgery residents to feel confident in their knowledge base and technical management of complications and their sequelae. We have identified gaps in formal training for management of complications as well as a gap in comfort based on resident gender. Future endeavors include creating a curriculum to best address these soft skills, such as communication and coping mechanisms, to establish a more holistic approach to residency education.