Nurture vs. Nature? PRS Residency Programs Influence on Career Specialization

Background: Where plastic surgery residents train can greatly impact their future careers. A look into residency curriculum or faculty specialization may reveal trends in residents' future subspecialty choices. Plastic surgeons may have entered residency intending to attain additional fellowship training in a specific subspecialty– nature, or their choice for future subspecialty may have been impacted by their experiences at their residency program– nurture. This study aims to use recent graduates' first job or fellowship type to identify if certain programs or faculty members shape trainees for specific careers or fellowship training. Methods: A retrospective study identified the number of graduates from integrated plastic and reconstructive surgery residency programs in the United States (2015-2022) with regard to their first job or fellowship type and their faculty member's subspecialty type. Data was collected from the official residency program's online website, and residency coordinators were contacted via email for any additional information needed. The data were categorized based on unique surgical specialties such as Aesthetic, Burn, Craniofacial, Gender Affirmation, Hand, Microsurgery, and Neuroplastic. For the analysis, the data were grouped into one of four categories: programs with faculty members of the specific subspecialty and graduates who pursued the same fellowship, programs with faculty members of the specific subspecialty and graduates who did not pursue the same fellowship, programs without faculty members of a specific subspecialty but had graduates who pursued the fellowship, and programs without faculty members of the specific subspecialty and graduates who did not pursue the same fellowship. Results: In total, 869 residents from 56 institutions were included in our study. There were 423 residents for aesthetic fellowship, 175 for microsurgery fellowship, 86 for craniofacial fellowship, nine residents for burn fellowship, 166 for hand fellowship, four for neuroplastic fellowship, and six for gender affirmation fellowship. The odds ratio with 95% confidence interval were calculated to determine if the exposure of a subspecialty faculty member increased the odds of residents pursuing fellowship training in the same specialty. The results include Aesthetic (OR 2.1, 95% CI: 0.08-51.1), Burn (OR 2.1, 95% CI: 0.37-11.5), Craniofacial (OR 0.8, 95% CI: 0.14-4.62), Gender Affirmation (OR 5.6, 95% CI: 0.58-53.9), Hand (OR 1.7, 95% CI: 0.06-45.5), Microsurgery (OR 0.52, 95% CI: 0.03-10.5), and Neuroplastic (OR 0.53, 95% CI: 0.07-4.11). For all subspecialties combined (OR 4.06, 95% CI: 2.46-6.72, p < 0.0001). Conclusion: While individual subspecialties had varying odds, with every category combined, faculty specialization in integrated plastic surgery residency programs was associated with increased graduates' chances of pursuing a given subspecialty, indicating a sense of nurturing on the part of residency programs and faculty.