Understanding of medical students regarding the clinical scope of the plastic surgery specialty

Introduction: Plastic surgery is popularly known for its performance in body aesthetics. Besides, it includes burns, microsurgery, hand and craniomaxillofacial surgery. Due to the diversity of medical specialties, many of the procedures in which plastic surgeons are trained are also performed by other specialists, which may justify the population’s lack of knowledge regarding the rich plastic work. The objective is to understand the Brazilian medical students’ comprehension of the plastic surgery clinical scope. Methods: Cross-sectional study, applying an online questionnaire with Google Docs platform using the inclusion criteria of being a medical student and over eighteen years old. It consisted of twelve clinical cases sent to participants through social networks. At the end of 99 days after the link’s release, the questionnaire was closed, and the answers were counted with Windows Excel. Results: Sample composed of 423 participants, with a female majority and an average age of 22.23 years, with a higher prevalence of the third year of the academic clinical cycle. It was noticed that students are familiar with plastic surgeons’ actions in the aesthetic field, breast reconstruction after carcinoma, and reparative treatment of burns. Academics poorly indicated the treatment of fractures in the craniomaxillofacial complex and the palmar tendons’ laceration approach. Conclusion: Students have a good understanding of the role of plastic surgeons in the aesthetic field. ■ ABSTRACT


INTRODUCTION
Plastic surgery is popularly known for its performance in body aesthetics. Also, its area includes microsurgery, burn treatment, hand, and craniomaxillofacial surgery.
Due to the diversity of medical specialties, many of the procedures in which plastic surgeons are trained are also performed by other specialists, which may justify the population's lack of knowledge concerning the rich plastic performance. For example, we have rhinoplasty with correction of a deviated septum, a surgery that is also performed by otolaryngologists. Since the areas of operation of plastic surgery are little known by the general public and also by the medical public, there is a risk that plastic surgeons, qualified in dealing with a vast range of clinical-surgical problems, are forgotten and overlooked in cases that escape the aesthetic area, thus alienating competent professionals and overloading professionals from other specialties.

OBJECTIVES
Understand the comprehension that Brazilian medical students from different years and faculties have of the clinical scope and plastic surgery operation areas. In addition to the questions that addressed plastic surgery areas, other questions were elaborated on acute pancreatitis and abdomen trauma to divert biased responses.
From the analysis of clinical cases, it is clear that students are familiar with the action of plastic surgeons in the aesthetic field (as, for example, in the resolution of "facial aging," "reduction of breasts," and "flapping ears"). In the question that addressed facial aging, dermatology was the area most cited as apt for such an approach, with 53.7%. Plastic surgery and aesthetics occupied the second and third place with 38.3% and 7.32%, respectively. Plastic surgeons were the professionals mentioned by 372 (87.95%) students as trained professionals to perform otoplasty, followed by pediatric surgeons (5.43%) and otorhinolaryngologists (4.96%). As for the question on the theme of facial surgery, plastic surgery was mentioned by 349 (82.5%) of the participants. The dermatology area was remembered by 313 (74%) of the students as the most suitable medical specialty for applying botulinum toxin for facial rejuvenation.
In the question about the treatment of deviated septum and aesthetic correction of the nose, there was a predominance of otorhinolaryngologists (63.8%), followed by plastic surgeons (33.3%), the most suitable to approach the case.
As for the issue that addressed the topic of breast reconstruction after breast cancer, 373 (88.2%) of the participants indicated the plastic surgeon as a professional capable of performing the procedure. Mastology and oncology surgery were indicated by 37 (8.74%) and 13 (3.07%) of the students, respectively. In the question about basal cell carcinoma, there was a division of the answers regarding the medical specialties indicated for the treatment, being dermatology (46.8%), cancer surgery (37.1%) and plastic surgery (7.8%) as the most pointed out by the research participants. Regarding the evaluation of the participation of plastic surgery as an area also indicated for the treatment of fractures in the craniomaxillofacial complex, this was mentioned by 46 (10.9%) of the students, with the maxillofacial surgeon being the most remembered by 342 (80.8 %) of academics. As for the question that addressed the health professional most apt to intervene in cases of laceration of the palmar tendons, the orthopedist with 273 (64.5%) of the answers was the most mentioned by the participants. Then, general surgeons (15.1%) and plastic surgeons (11.1%) were mentioned. The evaluation of the participation of plastic surgery as an area indicated in the reparative treatment after burns was made through the question about great loss of soft tissues after an accident with high electrical tension. Students pointed out plastic surgeons as the most indicated by 260 participants (61.4%), followed by orthopedists with 23.4% and vascular surgeons with 7.8%. Relating the issues with themes that address the areas of plastic surgery that are not linked to the aesthetic field, such as the craniomaxillofacial area, and the cycle in which the participants were grouped, it was possible to observe that among the 294 students of the basic cycle only 8 (2 , 72%) mentioned plastic surgeons as indicated to intervene. Among the 203 students in the clinical cycle, 29 (14.3%) pointed out plastic surgery as a specialty able to approach the case and 9 (9.9%) of the total of 91 students at the boarding school mentioned plastic surgeons. Another area of plastic surgery with little knowledge about the possibility of action is microsurgery. In the present study, 29 (22.3%) of the basic cycle students indicated the plastic surgeon for the treatment of laceration of the palmar tendons, followed by 11.8% of the students of the clinical cycle and 3.3% of the students at the boarding school.

DISCUSSION
According to data from "Medical Demography 2018", there are 6,304 plastic surgeons in Brazil, and 2% of recent graduates have plastic surgery as their first medical option 1 . Data from the Sociedade Brasileira de Cirurgia Plástica (SBCP), Brazil disputes with the United States of America the first position