Evaluation of plastic surgery resident aesthetic clinic websites.

BACKGROUND: The purpose of the present study was to evaluate the website pages of integrated plastic and reconstructive surgery resident aesthetic clinics in the United States.
METHODS: Website pages dedicated to resident aesthetic clinics in all integrated plastic and reconstructive surgery residency programs (n = 79) were accessed between October and November 2019 and evaluated across several criteria, including: number of pages, procedures offered, faculty participation, respective prices, patient photographs, patient testimonials, contact information, and specific recruitment incentives.
RESULTS: Seventy-nine integrated and 54 independent residency programs were identified, 31 of which had both an integrated and an independent residency program for a total of 102 distinct programs. Out of these, only 11 programs (10.8%) had a webpage dedicated to their resident aesthetic clinic (Figure 1). Twelve other programs (13.7%) that did not have a dedicated webpage mentioned a resident aesthetic clinic elsewhere on their residency program website. For each of the eleven programs with space for the resident aesthetic clinic, there was exactly one dedicated webpage. None of the programs with dedicated webpages included photographs of before and after cases, nor procedures performed, nor a listing of resident aesthetic clinic prices. Three of the dedicated webpages included information about faculty participation. Out of the 24 ASAPS endorsed aesthetic fellowship programs, 6 (25%) had a webpage dedicated to the fellow aesthetic clinic. Four of these webpages were comprised of a single webpage, while one program had 6 webpages and one program had 8 webpages. Only one program's webpage included before and after pictures. Four programs (16.7%) included information about faculty participation on the webpage. Five out of the 6 programs had a procedure list on the webpage. DISCUSSION: Resident aesthetic clinic websites are an important tool in recruiting patients as well as medical students. Addressing the lack and quality of such websites may improve recruitment of patients and students to plastic and reconstructive surgery residency programs. As a primary source of information for potential future residents and patients, plastic and reconstructive surgery programs need to maximize the content and utility of their websites.

Introduction

Education in aesthetic surgery is an important component of plastic and reconstructive surgery residency training. The recently increased minimum aesthetic surgery requirements set by the Plastic Surgery Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) highlight the importance of aesthetic surgery training for plastic surgery residents. Unlike other key subspecialties, such as general reconstruction, pediatric cleft and craniofacial surgery, microsurgery, and hand surgery, aesthetic surgery involves relatively healthy patients requesting improvement in their appearance. Many residency training programs thus offer residents an opportunity to run their own resident aesthetic clinic to help recruit patients and enhance their aesthetic surgery education. For medical students interested in a career in aesthetic surgery, information about a given program's resident aesthetic clinic is an important consideration during the residency application and ranking process. Students applying to plastic and reconstructive surgery residency programs will frequently use the Internet as a resource to gather such information. Therefore, it is important for residency programs to produce and maintain an informative and comprehensive website.

The authors sought to evaluate the websites of integrated plastic and reconstructive surgery resident aesthetic clinics in the United States.

Methods

A comprehensive list of integrated and independent plastic and reconstructive surgery residency programs was obtained from the ACGME. Additionally, a list of aesthetic fellowships endorsed by the American Society of Aesthetic Plastic Surgery (ASAPS) was obtained from their website. Each of the programs’ websites was then searched for webpages dedicated to resident aesthetic clinics between October and November 2019. If a dedicated webpage(s) was identified, it was evaluated for content, including number of pages, procedures offered, faculty participation, respective prices, patient photographs, patient testimonials, contact information and specific recruitment incentives.

Results

Seventy-nine integrated and 54 independent plastic and reconstructive surgery residency programs were identified, 31 of which had both an integrated and an independent residency program for a total of 102 distinct programs. Out of these, only 11 programs (10.8%) had a webpage dedicated to their resident aesthetic clinic (Figure 1). Twelve other programs (13.7%) that did not have a dedicated webpage mentioned a resident aesthetic clinic elsewhere on their residency program website. For each of the eleven programs with space for the resident aesthetic clinic, there was exactly one dedicated webpage. None of the programs with dedicated webpages included photographs of before and after cases, nor procedures performed, nor a listing of resident aesthetic clinic prices. Three of the dedicated webpages included information about faculty participation (Figure 1).

Figure 1

Aesthetic website presence among residency programs.

Out of the 24 ASAPS endorsed aesthetic fellowship programs, 6 (25%) had a webpage dedicated to the fellow aesthetic clinic. Four of these webpages were comprised of a single webpage, while one program had 6 webpages and one program had 8 webpages. Only one program's webpage included before and after pictures. Four programs (16.7%) included information about faculty participation on the webpage. Five out of the 6 programs had a procedure list on the webpage (Figure 2).

Figure 2

Aesthetic website presence among fellowship programs.

Discussion

The presence of residency program websites is becoming more frequent and prior studies have documented their importance to potential residency applicants.1, 2, 3, 4 Our Division recently examined specific aspects of plastic and reconstructive resident aesthetic clinics. A survey of 35 questions was distributed to 70 plastic surgery resident program directors in the United States to delineate clinic structure, procedures and services offered, financial cost to the patient, and satisfaction and educational benefit derived from the experience. Thirty-two of the respondents (63%) reported having a dedicated resident aesthetic surgery clinic at their institution. The most common procedures performed were abdominoplasty, breast augmentation, and liposuction. Most clinics offered neuromodulators and injectable fillers. The most common billing method used was a 50% discount on surgeon fee, with the patient being responsible for the entirety of hospital and anesthesia fees. The authors found that such clinics are an effective training method for the development of both aesthetic surgical technique and resident autonomy.

Another study evaluating the content of plastic and reconstructive surgery residency program websites found that there is a lack of information provided about programs’ current residents, contact information, time spent on general surgery, operative logs, research requirements and output, responsibility progression, night float, call system, benefits, facility information, graduate fellowships, job placement and visa information. They did not take into account the presence of a resident aesthetic clinic as one of the important factors included on the website. The authors believe that with the importance of aesthetic training during residency, the presence of information on resident aesthetic clinic on a program's website is beneficial to both prospective residency applicants and prospective patients.

Furthermore, the importance of a strong online presence for aesthetic plastic surgeons is well documented in the literature. Walden et al. found that 52% of patients undergoing aesthetic breast augmentation cited their plastic surgeon's website as having greatly influenced their decision when choosing the surgeon. When asked what the first thing they look for on a plastic surgeon's website is, before and after photographs and procedure prices were among the top 5 answers on a survey of patients undergoing aesthetic plastic surgery. An ideal website should provide the potential patient with a visual representation of the residents’ previous work in the form of before and after photographs.

Information listing the procedures provided by the resident aesthetic clinic is useful to prospective residents and patients and should be included on the website. Based on the resident/fellow's needs/interests, the procedure list can function to highlight certain procedures that need to be driven. For example, residents often get more experience in breast and body contouring as well as injectables as opposed to rhinoplasty and facial rejuvenation. As such, the website can serve as a tool to personalize the types of procedures residents want to recruit patients for. Patient testimonials can be provided in concordance with ethical advertising guidelines set forth by the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, while there may also be a link to outside sources of testimonials on RealSelf.com, Google Reviews, etc. Most resident/fellow aesthetic clinics provide services at a discounted price. Noting that the prices are discounted should be sufficient and supersede the need to list actual prices on the website, which may become problematic.

Equally as important as the website's content is its accessibility. During the data collection portion of this study, the authors noted that of the few programs that did have dedicated webpages, these webpages were often difficult to find. A resident aesthetic clinic webpage should be linked to the residency program website and possibly to sites on the hospital side that simply address conditions treated. The majority of the programs were only linked to the residency program website, potentially missing an opportunity to recruit patients.

The importance of a strong resident aesthetic clinic webpage for plastic and reconstructive surgery residency programs is twofold. First, it is an important tool in recruiting medical students to the residency program. Second, it serves as an important resource of information and recruitment tool for potential patients. A 2018 audit of aesthetic surgery in United States academic programs found that 7 of the 11 programs with a dedicated aesthetic webpage responded that aesthetic surgery is overall slightly revenue positive within their department/division (Perdikis et al., 2020 Submitted). One of the 7 programs responded that it is revenue neutral and one program that it is slightly revenue negative. 86% (n = 6) responded that they feel their residents get an overall adequate exposure and experience in aesthetic surgery.

Resident aesthetic clinic websites are an important tool in recruiting patients as well as medical students. An ideal residency program website should include a dedicated webpage for the resident aesthetic clinic. The dedicated site should include information clearly describing the nature of the clinic and the faculty supervision. Before and after photographs, procedures offered, and relevant information about the clinic itself are also important. Clinic pricing is not as critical. Addressing the lack and quality of such websites may improve recruitment of patients and students to plastic and reconstructive surgery residency programs.

Financial disclosures

The authors have no financial relationships to disclose.

Declaration of Competing Interest

The authors have no financial relationships or conflicts of interest to disclose.