Influence of the Teaching Hospital Environment on Plastic Surgery Residents' Academic Interest and Career Aspirations: Insights from France

Abstract

Background: Plastic surgery residency training in France presents unique challenges and opportunities, with a highly competitive environment and a growing demand for academic plastic surgeons. Understanding the factors influencing residents' career decisions is essential for optimizing training programs and fostering academic interest.

Methods: A cross-sectional study was conducted using a self-administered questionnaire comprising 14 questions distributed via RedCAP between January and June 2023. The study included all residents and young attendings in all 21 French University Hospital Centers nationwide, from year 1 to postgraduate year 2.

Results: Among 204 contacted participants, 106 responses were obtained. All responses were complete. First-year residents represented 9.4% of respondents, whereas residents in the "deepening" and "consolidation phases" represented 41.5% and 25.6%, respectively. Senior residents such as "junior doctors" and young attendings represented 25.5% of survey respondents. Although most residents expressed interest in private practice, mentorship from academic surgeons emerged as a significant influencer toward academic pursuits. Despite the prevalence of academic mentors (38% of identified mentors), a discrepancy was found between perceived academic orientation and actual research opportunities, indicating a need for improved awareness and exposure to academic possibilities during residency. Financial considerations, including salary differentials and job security, also seemed to play a substantial role in career decision-making.

Conclusions: Cultivating a deeper understanding of academic careers' multifaceted nature and enhancing the appeal of academic pursuits are essential for nurturing the next generation of academic plastic surgeons. It is hoped that this study will help enhance the appeal of academic vocations in plastic surgery residents.

Fig. 1.

Structure and duration of the plastic, reconstructive, and aesthetic residency program in France. DES: diplome d’etudes spécialisé (specialty degree); CCA: chef de clinique-assistant (assistant professor); R: residency year.

Fig. 2.

Demographics and profile of survey respondents. A, Two university centers were not represented (Limoges: no plastic surgery resident; Poitiers: no response). Paris was the center with the most representation, with 21.7%. B, Initiation: first year of plastic surgery residency; deepening: second–fourth years; consolidation: fifth and sixth years. Most of the respondents were young attending surgeons (after the sixth year).

Fig. 3.

Initial orientation and previous research experience. A, “Do you consider an academic career?” B, “Have you ever participated in writing a scientific article, in a clinical or a basic science study?” C, “If so, what feeling stands out from it?”

Fig. 4.

Subgroup analysis assessing the impact of seniority in residency on current career plans.

Fig. 5.

The academic environment as perceived by survey respondents. A, Presence of academic surgeons. B, Number of academic surgeons. C, Impact of academic surgeons on the resident’s surgical training. D, Overall academic orientation of the resident’s department. E, Identification of a mentor. F, Type of practice of the mentor. MCU, associate professor; PU, full professor; PH, attending surgeon (no academic duties/faculty position).

Fig. 6.

End of the survey: planned practice type and reasons in favor of or against considering an academic career.

Fig. 7.

Subgroup analysis to understand the influence of the mentor’s activity on career plans.