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evaluative role with the patient, whether mental health professional or primary care provider. Two separate letters, or one letter signed by both (e.g., if practicing within the same clinic) may be sent. Each referral letter, however, is expected to cover the same topics in the areas outlined below. The recommended content of the referral letters for surgery is as follows: 1. The client’s general identifying characteristics; 2. Results of the client’s psychosocial assessment, including any diagnoses; 10 Qualified mental health professionals include certified and licensed: psychiatrists, clinical psychologists, psychiatric nurse practitioners, psychiatric physician assistants, psychotherapists/counselors, and social workers, or any health professional with behavioral health training and experience. Gender Reassignment Surgery Model NCD | 5 3. The duration of the mental health professional’s relationship with the client, including the type of evaluation and therapy or counseling to date; 4. An explanation that the criteria for surgery have been met, and a brief description of the clinical rationale for supporting the patient’s request for surgery; 5. A statement that informed consent has been obtained from the patient; 6. A statement that the treating professional is available for coordination of care and welcomes a phone call to establish this. III. Providers of Gender Reassignment Surgery Physicians who provide surgical treatments for Gender Dysphoria should have appropriate credentials and training for the procedures they provide. Commonly these surgeons are board certified gynecologists, general surgeons, plastic surgeons, otorhinolaryngologists, and urologists. Surgeons who perform genital surgeries should have specialized competence in genital reconstructive techniques as indicated by documented supervised training with a more experienced surgeon. Current Concepts in Gender-Affirming Surgery Postgraduate Training Alexander N. Khouri1 Caleb Haley2 Mark MacEachern3 Shane D. Morrison1 1 Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States 2Medical School, University of Michigan, Ann Arbor, MI, United States 3University of Michigan Taubman Health Sciences Library, Ann Arbor, MI, United States Indian J Plast Surg Address for correspondence Shane D. Morrison, MD, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340, United States (e-mail: shanedm@med.umich.edu). Keywords ► surgical education ► transgender persons ► gender-affirming surgery ► residency Abstract Background Recent advocacy efforts and expanded insurance coverage has increased health care utilization among transgender patients. Therefore, it is pivotal that surgical residents are properly trained to care for transgender patients in both clinical and surgical settings. Yet, no formal curriculum or training requirements exist for surgical residents. The aim of this systematic review is to understand the surgical trainee’s postgraduate education and training with respect to transgender health and gender-affirming surgeries (GAS). Methods A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant literature search was performed on December 04, 2020 in PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by two independent reviewers. Results Our literature search identified 186 unique publications, of which 14 surveys and one interventional study from various surgical specialties including plastic surgery, urology, otolaryngology, oral and maxillofacial surgery (OMS), dermatology, and obstetrics and gynecology (OBGYN) were included in this study. The majority of residents and program directors in surgical specialties believe education related to transgender health is important, and the current exposure in surgical training does not sufficiently prepare surgical residents to care for this marginalized population. Conclusion Current postgraduate surgical training in gender-affirming surgery is nonuniform across surgical specialty, geographical region, and individual program. Incorporating training modules and hands-on experiences into surgical trainee education will better prepare residents for the numerous clinical and surgical interactions with transgender patients. Further research is required to better understand how to best incorporate these experiences into existing surgical curriculums. received January 27, 2021 accepted March 17, 2021 DOI https://doi.org/ 10.1055/s-0042-1751021. ISSN 0970-0358. © 2022. Association of Plastic Surgeons of India. All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/ licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India THIEME Systematic Review Article published online: 2022-06-24 Introduction It is estimated that approximately 25 million people worldwide
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