3.1 Demographic information and needs assessment on aesthetic plastic surgeons
Demographic data of 290 aesthetic plastic surgeons completed the questionnaire survey, the responding rate was 81.5% ((290 out of 356)). 240 surgeons were practicing aesthetic plastic surgery after excluding those cosmetic dermatologists, and cosmetic doctors in traditional Chinese medicine.
Shown in Table 1, the distribution of gender, age groups, and years of practice, professional technical titles, and original working department was nearly the same among the 144 surgeons from public hospitals and 96 from private hospital. In general, over sixty percent of the surgeons were under 40 years of age, one third of the surgeons had less than three years of working experience with junior professional technical titles. Almost two thirds of surgeons’ original working departments were not aesthetic plastic surgery. The distribution of educational degree among doctors between hospitals was statistically different. There were more doctors with a graduate degree in public hospitals.
Table 1
Demographic data of aesthetic plastic surgeons
from public and private hospitals |
| Public hospital (N = 144) | Private hospital (N = 96) | P value |
Gender | | | 0.25 |
Male | 90 (62.5) | 52 (54.2) | |
Female | 54 (37.5) | 44 (45.8) | |
Age group (years) | | | 0.69 |
< 30 | 30 (20.8) | 21 (21.9) | |
30–40 | 70 (48.6) | 41 (42.7) | |
40–50 | 32 (22.2) | 22 (22.9) | |
> 50 | 12 (8.3) | 12 (12.5) | |
Educational degree | | | < 0.01 |
Associate degree or below | 6 (4.2) | 10 (10.4) | |
Bachelor | 72 (50) | 61 (63.5) | |
Graduate | 66 (45.8) | 25 (26) | |
Years of practice | | | 0.96 |
1–3 year | 48 (33.3) | 31 (32.3) | |
3–5 year | 19 (13.2) | 15 (15.6) | |
5–10 year | 35 (24.3) | 23 (24) | |
> 10 year | 42 (29.2) | 27 (28.1) | |
Professional technical title | | | 0.17 |
Senior | 45 (31.2) | 20 (20.8) | |
Junior | 59 (41) | 42 (43.8) | |
Primary | 40 (27.8) | 34 (35.4) | |
Original working department | | 0.62 |
Other specialty | 56 (38.9) | 32 (33.3) | |
Aesthetic plastic surgery | 54 (37.5) | 37 (38.5) | |
Other surgery | 34 (23.6) | 27 (28.1) | |
Values are presented as number (%). | | |
Table 2 summarized the current training status and study objectives for surgeons. Overall, there were some similarities between surgeons of public and private hospitals, half of the surgeons attended training less than three times with an affordable expense of 1000-5000RMB, surgeons in private hospitals were more likely to spend more than 10,000 RMB in training. The majority of them (almost 80%) had strong willingness to attend training to improve their practical skills, gain clinical experience, and learn latest technologies.
Table 2
Current training status and training objectives
| Public hospital (N = 144) | Private hospital (N = 96) | P value |
Numbers of training in a year | | | 0.60 |
1–3 | 74 (51.4) | 49 (51) | |
3–5 | 39 (27.1) | 26 (27.1) | |
> 5 | 29 (20.1) | 17 (17.7) | |
seldom | 2 (1.4) | 4 (4.2) | |
Training expense in a year (RMB) | | | 0.05 |
< 1000 | 29 (20.1) | 10 (10.4) | |
1000–5000 | 64 (44.4) | 49 (51) | |
5000–10000 | 33 (22.9) | 16 (16.7) | |
10000–20000 | 14 (9.7) | 13 (13.5) | |
> 20000 | 4 (2.8) | 8 (8.3) | |
Willingness on training | | | 0.88 |
very strong | 89 (61.8) | 57 (59.4) | |
strong | 19 (13.2) | 16 (16.7) | |
fairly | 35 (24.3) | 22 (22.9) | |
no | 1 (0.7) | 1 (1.0) | |
Study objectives | | | |
theory | 47 (32.6) | 20 (20.8) | 0.06 |
practical skills | 112 (77.8) | 74 (77.1) | 1.00 |
clinical experience | 89 (61.8) | 49 (51) | 0.13 |
communication skills | 34 (23.6) | 17 (17.7) | 0.35 |
aesthetic judgment | 24 (16.7) | 22 (22.9) | 0.30 |
team work | 19 (13.2) | 15 (15.6) | 0.73 |
scientific writing | 22 (15.3) | 12 (12.5) | 0.68 |
latest technology | 48 (33.3) | 38 (39.6) | 0.39 |
Values are presented as number (%). | | | |
Table 3 concluded the surgeons’ favorable training methods and reported obstacles. Further study in a tertiary hospital, short training course focusing in specific topic by corresponding experts, and operation demonstration were regarded as the top three favorable choices. The number one obstacle was “nobody can replace me at work”, however, training expenses was the second obstacle for doctors in public hospitals and the third one for doctors in private hospital, in converse, “I cannot learn the skills I want” was second obstacle and third one for doctors in private and public hospital respectively.
Table 3
Favorable methods and obstacles for training
| Public hospital (N = 144) | Private hospital (N = 96) | P value |
Favorable training methods | | | |
further study in tertiary hospital | 99 (68.8) | 49 (51) | 0.01 |
attend short focus training course by experts | 61 (42.4) | 43 (44.8) | 0.81 |
online computer courses | 28 (19.4) | 18 (18.8) | 1.00 |
online courses on smart phone | 54 (37.5) | 43 (44.8) | 0.32 |
attend conference | 54 (37.5) | 42 (43.8) | 0.40 |
operation demonstration | 64 (44.4) | 48 (50) | 0.48 |
Obstacles in training | | | |
I am not allowed by hospital | 41 (28.5) | 20 (20.8) | 0.24 |
nobody replaces me at work | 80 (55.6) | 59 (61.5) | 0.44 |
I am not allowed due to family reasons | 25 (17.4) | 9 (9.4) | 0.12 |
I cannot afford the training | 53 (36.8) | 29 (30.2) | 0.36 |
I cannot learn the skills I wanted | 46 (31.9) | 43 (44.8) | 0.06 |
Values are presented as number (%). | | | |
Table 4 summarized their interest in major surgical procedures and self-assessed knowledge gap. For surgeons in private hospitals, 69.2% of them intended to learn rhinoplasty, and eye plastic surgery. Fat transplant was their third interesting procedures, which coincided with their self-assessed knowledge gap. For surgeons working in public hospitals, their top three interesting surgical procedures were eye plastic surgery, rhinoplasty, and minimally invasive plastic surgery, in terms of knowledge gap, they believed that they had more knowledge gap in external genitalia, perineal surgery, rather than eye plastic surgery.
Table 4
Summary of major surgical procedures intended to study and self-assessed knowledge gap by aesthetic plastic surgeons
| Public hospital (N = 144) | Private hospital (N = 96) | P value |
Major surgical procedures | | | |
rhinoplasty | 49 (58.3) | 45 (69.2) | 0.232 |
eye plastic surgery | 62 (73.8) | 42 (64.6) | 0.302 |
fat transplant plastic surgery | 34 (40.5) | 32 (49.2) | 0.368 |
breast plastic surgery | 15 (17.9) | 19 (29.2) | 0.149 |
minimally invasive plastic surgery | 39 (46.4) | 16 (24.6) | 0.010 |
thread lifting | 18 (21.4) | 13 (20) | 0.992 |
Knowledge gap*, median (IQR) | | | |
gap in eye plastic surgery | 1 (0,2) | 2 (1,2) | 0.866 |
rhinoplasty | 2 (1,3) | 2 (0,2) | 0.770 |
ear plastic surgery | 1 (0,2) | 1 (1,2) | 0.897 |
facial wrinkles and contours | 1 (1,2) | 1 (1,2) | 0.648 |
lip plastic surgery | 1 (0,2) | 1 (1,2) | 0.288 |
hair transplant | 1 (0,2) | 1 (0,2) | 0.484 |
breast plastic surgery | 1 (0,2) | 1 (1,2) | 0.941 |
bariatric surgery and body shaping | 1 (0,2) | 1 (1,2) | 0.742 |
external genitalia, perineal surgery | 2 (0,2) | 1 (0,2) | 0.355 |
new technologies such as fat transplant, endoscope, and other minimally invasive plastic surgery | 2 (0,2) | 2 (0,2) | 0.593 |
Values are presented as number (%). *Knowledge gap, was calculated by the expected value minus the current assessed value, a five-point Likert scale |
3.2 Qualitative analysis on the current continuing professional education system for aesthetic plastic surgeons
Continuing medical education programs are under the management and organization of medical associations at municipal or provincial levels. Doctors in public hospitals are required to abstain a minimum credit by attending different continuing education programs. However, the doctors in private hospitals are not compulsory required to get the credits. In-depth interview revealed that most continuing professional education conferences were co-organized by public and private hospitals. As non-profit medical organizations, the department of aesthetic plastic surgery in most public hospitals were merged with burn surgery, therefore, they focused more on their social responsibility in repair and reconstructive surgery. Meanwhile, as a base to train medical students, public hospitals paid more attention on academic development and researches on basic and clinical technologies. By contrast, private aesthetic plastic hospitals were for-profit originations and laid more emphasis on improving customers’ experience. Since aesthetic plastic procedure were not covered by insurance schemes, customers were more likely to visit private hospitals for operations because of more comfortable environment and individualized services. These organizational differences between public hospitals and private hospitals led to different requirements of aesthetic plastic surgeons in their respective institutions, reflecting their needs difference in continuing professional education.