Bridging the gap for aesthetic training amidst the Covid-19 pandemic.

Dear Sir,

Aesthetic surgery is a key component of the plastic surgery syllabus in the United Kingdom which covers a vast array of aesthetic procedures which are examined on both components of the intercollegiate Fellowship of the Royal College of Surgeons (FRCS) Plastic Surgery examination. Many techniques used in aesthetic surgery overlap with reconstructive techniques used in the National Health Service (NHS) and it is therefore vital that trainees have opportunities to enhance and develop skills in this area. ,

Both the Plastic surgery trainee association (PLASTA) and the British Association of Aesthetic Plastic Surgeons (BAAPS) play an active role in education and ensuring aesthetic training opportunities are provided at a national level. BAAPS have held regional aesthetic training days (RATDs) since 2014 to cover modules on the aesthetic syllabus, with some deaneries making it compulsory for trainees to attend. On a more local level, some UK deaneries incorporate an aesthetic rotation as part of their training programme. These deaneries should be commended on taking a proactive role in ensuring high quality aesthetic training is delivered and this should be a goal for all UK deaneries.

Unfortunately, the Covid-19 pandemic hit the aesthetic industry particularly hard. Both the American Society of Plastic Surgery (ASPS) and the International Society of Aesthetic Plastic Surgery (ISAPS) called a halt to all aesthetic procedures during the first wave of the pandemic. This had a direct knock-on effect for aesthetic training. This issue was exacerbated further when the UK government introduced the concept of “social distancing” and “lockdown” which led to the cancellation of RATDs and face-to-face educational courses.

“Out of adversity comes opportunity”

Benjamin Franklin

This lack of aesthetics training fuelled the enhancement of virtual learning platforms to meet the needs of plastic surgery trainees. Although virtual teaching sessions were already being delivered prior to the Covid-19 pandemic, the use of this platform rapidly accelerated on a global basis. PLASTA were successfully delivering educational webinars via Zoom® the previous year and plans were in place to collaborate with BAAPS to expand and incorporate aesthetic topics. When the WHO declared a global pandemic in March 2020, followed by the cessation of all aesthetic operations and cancellation of aesthetic training courses, the time was right to take aesthetic training to a new ‘virtual’ level, with greater reach than ever before and at no cost to the learners.

The collaboration between PLASTA and BAAPS led to the production of a virtual training series which took the place of the RATDs. The first series covered breast surgery and body contouring and was delivered in 3 parts in June 2020. Following the success of the first series and ongoing government restrictions a second 4-part series was delivered in October 2020. This covered Head and neck aesthetics, including; otoplasty, rhinoplasty, brow lift, upper and lower blepharoplasty. The third instalment was a 2-part series in February 2021 to complete head and neck aesthetic topics from the FRCS syllabus, including; face and neck lifts, facial lipomodelling and lip lift.

This virtual aesthetic training series was successfully received by all levels of plastic surgeons and trainees throughout the world with an average of 451 people attending each part of the first series. Only a third of learners were based in the UK and Ireland. This global reach is testament to the quality of speakers, the content, the method of delivery and a clear need for such high-quality teaching in aesthetic surgery across the world. This virtual platform also opened up these teaching opportunities to a wider range of training levels. Just over a third of attendees were plastic surgery registrars who are usually the only attendees at the RATDs. Surprisingly, there was a high rate of consultants (24%), junior doctors (24%) and medical students (5%) attending.

Feedback was significantly positive with an average score of 4.8/5 for the academic content across the first series. Relevance of the subject averaged 4.7 and organisation achieved scored 4.8. Written feedback was very supportive and positive with encouraging comments commending BAAPS and PLASTA for providing “very interesting and insightful educational seminars”. The enthusiasm from attendees led to the development of the subsequent series which was also highly attended.

Although these collaborative virtual aesthetic teaching sessions have been relevant and an effective means of learning in preparation for the FRCS Plast, they are not a substitute for hands on aesthetic experience and operating. They are merely a means of ‘bridging the gap’ until the aesthetic industry normalises in the wake of this pandemic. The Joint Committee for Surgical Training (JCST) and the Speciality Advisory Committee (SAC) need to ensure UK trainees are advocated for and highlight the need for the incorporation of aesthetic training into the recovery plans for the aesthetic industry to protect the future of our speciality.

Declaration of Competing Interest

None.