Understanding the role of plastic and reconstructive surgery in a high-trauma setting: A multicenter study of academic and clinical exposure among Syrian medical students.

Abstract

Plastic and reconstructive surgery (PRS) is often perceived primarily as cosmetic, shaped by limited medical training exposure and public narratives. In Syria, ongoing conflict has caused high burdens of trauma, burns, and complex injuries, making awareness of PRS's full reconstructive scope critical for career choices, referrals, and patient care. We evaluated how teaching and clinical rotations influence medical students' perceptions of PRS. A multicenter cross-sectional study was conducted across three Damascus universities from August to October 2023. A total of 1555 students (years 1-6) completed a validated questionnaire adapted to the Syrian context, assessing demographics, specialty attribution across 24 clinical scenarios, and attitudes toward PRS. Descriptive statistics summarized responses, whereas the chi-square tests and logistic regression examined the associations between recognition of PRS roles and educational exposure. Students showed a strong cosmetic bias, often attributing esthetic cases to PRS while underrecognizing reconstructive roles such as nerve repair, hand trauma, and burn management. Clinical rotation experience improved recognition, with correct attribution in 79% of exposed students versus 61% without exposure. Logistic regression confirmed higher odds of accurate recognition after clinical years and with rotation experience, though some misattribution to other specialties reflected institutional practice patterns. Syrian medical students have limited understanding of PRS beyond esthetics. Clinical exposure improves awareness of reconstructive and trauma roles but remains insufficient. Targeted educational interventions and training non-PRS surgeons in key reconstructive skills are needed to optimize referrals, inform career choices, and ensure timely care in high-trauma settings.