American Council of Academic Plastic Surgeons
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Is #GenderAffirmingSurgery Trending? An Analysis of Plastic Surgery Residency Instagram Content
Rose S. Maisner, BS; Kailash Kapadia, MD; Edward S. Lee, MD
Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, NJ

Background: Given rising numbers of transgender and gender-nonbinary patients (TGNB) undergoing gender affirming surgery, training in such procedures is crucial. However, the ACGME does not mandate its integration into plastic surgery residency curricula, require its cases logged, nor offer an accredited fellowship. Given increasing Instagram use by residencies to showcase their programs, we sought to analyze posts for gender affirming content
Methods: Integrated plastic surgery residency programs were identified from the ACAPS and FREIDA. Associated Instagram accounts were identified through Instagram and Google searches. Program factors, including geographic region, Doximity ranking by reputation, and years of accreditation, were recorded. All posts uploaded by May 9, 2021 were analyzed for gender affirming content in images and captions. Per post, LGBTQ-related hashtags were recorded. Mann-Whitney U and Median tests were used to compare content between programs (?=0.05)
Results: Seventy-six of 82 (92.7%) programs had Instagram accounts, totaling 8673 posts. Only 178 (2.1%) posts displayed gender affirming content, including educational sessions (29.2%), research (15.7%), resident interests (11.8%), pride/diversity (10.7%), operative cases (9.0%), posts to attract students or patients (8.4%), faculty spotlights (7.9%), LGBTQ-related news articles (6.2%), and patient testimonials (1.1%). Posts described gender affirming surgery overall (109), facial procedures (15), top surgery (20), bottom surgery (20), and body contouring (1). Posts utilized a median of 1 LGBTQ-related and 8 total hashtags. The most used hashtags were #transgender (81), #lgbtq (21), #transgendersurgery (16), #topsurgery (14), and #pride (14). Twenty-five (32.9%) accounts had no gender affirming content. Top-20 programs had significantly more followers (p < 0.001), total posts (p=0.011), and LGBTQ-related content (p= 0.033). Despite similar numbers of followers and total posts between programs by geographic region, there was a significant difference in LGBTQ-related content (p = 0.036), with Western (median 2.5) and Midwestern programs (1.5) having more
Conclusion: Despite the growing need for gender affirming surgeons and thus training, very little content on plastic surgery residency program Instagram accounts is LGBTQ-related. Further study is needed to evaluate whether this is solely secondary to scarce social media showcasing or indicates a larger issue of insufficient residency exposure.


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