Plastic Surgery Resident Manual
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Plastic Surgery Resident Manual Presentation Transcript

  • 1. A MANUAL FOR PLASTICSURGERY RESIDENTS 2008 - 2009
  • 2. WHAT THE SURGEON OUGHT TO BE"The conditions necessary for the surgeon are four: First, he should belearned; second, he should be an expert; third, he must be ingenious; andfourth, he should be able to adapt himself.It is required for the First that the Surgeon should not know only theprinciples of Surgery, but also those of medicine in theory and practice;for the Second, that he should have seen others operate; for the Third,that he should be ingenious, of good judgment and memory to recognizeconditions; and for the Fourth, that he be adaptable and able toaccommodate himself to circumstances.Let the surgeon be bold in all sure things, and fearful in dangerousthings; let him avoid all faulty treatments and practices. He ought to begracious to the sick, considerate to his associates, cautious in hisprognostications. Let him be modest, dignified, gentle, pitiful, andmerciful; not covetous nor an extortionist of money; but rather let hisaward be according to his work, to the means of the patient, to thequality of the issue, and to his own dignity." Guy de Chauliat, 1300-1370 Ars Chirugica THE PHYSICIAN"No greater opportunity, responsibility or obligation can fall the lot of ahuman being than to become a physician. In the care of suffering heneeds technical skill, scientific knowledge and human understanding.He who uses these with courage, with humility and with wisdom willprovide a unique service for his fellowman and will build an enduringedifice of character within himself. The physician could ask of hisdestiny no more than this; he should be content with no less." Tinsley R. Harrison, M.D. Principles of Internal Medicine 1950 2
  • 3. CONTENTSFACULTY......................................................................................6 2008-2009 Tulane/LSU Plastic Surgery Residency ContactInformation...................................................................................12THE RESIDENCY IN PLASTIC SURGERY............................14COGNITIVE SKILLS.................................................................17GOALS AND OBJECTIVES......................................................20Residency Goals and Objectives: First Year...............................47Goals and Objectives: Second Year............................................48TULANE ROTATION OBJECTIVES.......................................50OCHSNER ROTATION OBJECTIVES....................................50CHILDRENS ROTATION OBJECTIVES................................51EAST JEFFERSON: HAND ROTATION OBJECTIVES.......52OUR LADY OF THE LAKE REGIONAL MEDICAL CENTERROATION OBJECTIVES............................................................52TOURO: PRIVATE PRACTICE ROTATION OBJECTIVES. 53THE EMERGENCY DEPARTMENT.......................................54CONSULTATIONS.....................................................................54OPERATING ROOM..................................................................55OPERATIVE CONSENT............................................................56Resident Expectations.................................................................58Evaluation....................................................................................65Plastic & Reconstructive Surgery Procedural Evaluation........66 3
  • 4. DIDACTIC COMPONENT........................................................68CONFERENCES ........................................................................69PLASTIC SURGERY OPERATIVE LOG (PSOL)...................75RESEARCH PROJECTS............................................................76ACGME: Definition of surgeon..................................................79SCHEDULING REQUIREMENTS...........................................84DISASTER PLAN.......................................................................84DAYS OFF..................................................................................85VACATION TIME......................................................................85Meetings ......................................................................................85Sick Leave....................................................................................85Benefits........................................................................................86Institutional Policies: please review the following website........87ABPS REQUIREMENTS...........................................................89FOREWARDWelcome! The Faculty is pleased that you have chosen to continue youreducation in Plastic Surgery with us. Few departments offer the educa-tional and clinical opportunities that are available here. The overallclinical and academic strength of the University is the foundation of ourprogram. 4
  • 5. This manual has been written for your benefit and it will give you aninsight into the philosophy of our plastic surgical training program. Itoutlines certain suggestions to help you in your educational process andit also lists certain requirements that we ask of our residents.The faculty joins me in emphasizing to you the necessity to assume, asearly in your training as possible, certain critical behavior patterns whichare typical of successful surgeons. These are embodied, in brief form inthe passage from Guy de Chauliac, which is reproduced on the frontinside cover of this manual. Inherent in the professional behavior of thesurgeon is the commitment to provide first-class, continuous care for his/her patient. This means that whenever you are not available to care foryour patient you will be certain that the level of care provided by yoursubstitute is identical in intensity to the care that you would providepersonally. The patient and his family should be aware of any change inthe personnel responsible for their care, even for a brief interval.The conceptual foundation is the belief of the faculty that the programshould be flexible enough to meet the needs of the trainees in theprogram. You are allowed to review your evaluations and hopefully givefeed back to us so that we may continually improve the residency. Youare required to meet with the Program Director at least once eachquarter.You should be aware that the ultimate responsibility for your educationrests with you. This faculty places a great deal of emphasis onacademic and research activities. Any of the faculty will be happy toassist you in meeting these requirements.Once again, the Faculty welcomes you to the Tulane Plastic SurgeryResidency and we look forward to fostering your growth during yoursurgical training. R. EDWARD NEWSOME, M.D. 5
  • 6. Program Director and ChiefFACULTYEdward Newsome, MDProgram Director and ChiefAssistant Dean GMEDivision of Plastic SurgeryPlastics: Temple UniversityAmerican Board of Plastic Surgery, 2000Rick I. Ahmad, MDPrivate PracticeFellowship: The Indiana Hand Center, Indianapolis, IN Hand Surgery FellowshipAmerican Board of Orthopaedic SurgeryCertificate of Added Qualification in Hand SurgeryChristopher R. Babycos, MDDepartment of Surgery, Ochsner ClinicPlastics: Tulane UniversityFellow in Craniofacial Surgery: Australian Craniofacial Unit, Adelaide, Australia 6
  • 7. American Board of Plastic Surgery, 1998Benjamin J. Boudreaux, MDDivision of Plastic SurgeryPlastics: Cleveland Clinic FoundationResidency: University of Tennessee Hlth. Sciences Ctr. – Memphis, TNErnie Chiu, MDChief of Plastic Surgery; University HospitalDirector of Plastic Surgery ResearchPlastics: NYUPost-Doctoral Research Fellow: NYUMicrosurgery/Breast Reconstructive Fellow: Memorial-Sloan Kettering Cancer Center New York, NYAmerican Board of Plastic Surgery, 2005Abigail Chaffin, MDAssistant Clinical Professor of SurgeryDivision of Plastic SurgeryPlastics: Tulane UniversityResidency: Wayne State University – Detroit, MIJohn Church, MDPrivate PracticePlastic Fellowship: Tulane UniversityAmerican Board of Plastic and Reconstructive Surgeons, 1977Louisiana Society of Plastic and Reconstructive SurgeonsCalvin Johnson, Jr., MDFaculty – Aesthetic: TouroAmerican Board of Plastic SurgeryAmerican Academy of Facial Plastic and Reconstructive Surgery, 1989American Board of Otolaryngology-Head and Neck Surgery, 1974William P. Coleman, III, MDPrivate PracticeDermatology Residency: TulaneAmerican Board of Dermatology, 1978 7
  • 8. American Board of Cosmetic Surgery, 1985Gustavo Colon, MDDirector of Aesthetic SurgeryPlastics: Tulane UniversityAmerican Board of Plastic Surgery, 1973Director of American Society of Plastic Surgeons 1999-2006Former President of the Aesthetic SocietyCharles L. Dupin, MDClinical Professor of Plastic SurgeryProgram Director and ChiefLSU Division of Plastic SurgeryPlastics: Lenox Hill Hospital, NYAmerican Board of Plastic Surgery, 1979Frank J. Dellacroce, MDPrivate PracticeOtolaryngology/Head and Neck Surgery Residency, University of TexasHealth Sciences Center at HoustonPlastics: LSU Health Science Center at New Orleans American Board ofOtolaryngology/Head and Neck SurgeryAmerican Board of Plastic SurgeonsJonathan L. Kaplan, MDTraining Director: Our Lady of the Lake Regional Medical CenterPlastics: Cleveland Clinic FoundationAmerican Board of Plastic SurgeryLucius Doucet, MDChief Plastic: Our Lady of the Lake Regional Medical CenterPlastics: UC-DavisAmerican Board of Plastic SurgeryJuan R. Escobar, MDPrivate PracticePlastics: Maricopa Medical Center, Mayo Clinic Scottsdale and Tulane University 8
  • 9. Eric George, MDPrivate PracticePlastics: Grand Rapids, MichiganHand Fellowship: Phoenix Integrated Mayo ClinicAmerican Board of Plastic Surgery, 1997Certification of added qualifications in Surgery of the HandDavid Jansen, MDPrivate PracticePlastics: Baylor College of MedicineAmerican Board of Plastic Surgery, 1995Kamran Khoobehi, MDAssistant Clinical Professor of SurgeryDivision of Plastic SurgeryPlastics: LSU School of Medicine-New OrleansAmerican Board of Plastic Surgery, 2000Alan Lewis, MDTulane University Department of DermatologyDermatology Residency: Baylor, Houston, TXFellowship: Dermatologic Surgery and Cutaneous Oncology Dermatologic Surgicenter, Philadelphia, PAJohn Lindsey, MDPrivate PracticePlastics: UT Southwestern Medical Center, Dallas, TXFellowship, Hand and Microsurgery: UT Southwestern Medical Center, Dallas, TXAmerican Board of Plastic Surgery, 1996Added qualifications Surgery of the Hand, ABS 1996Cynthia Mizgala, MDPrivate PracticePlastics: Plastic Surgery Associates, PA Woodbridge Cosmetic Surgery Hospital 9
  • 10. Scarborough General HospitalPlastic Surgery: Fellow of the Royal College of Surgeons (Canada), 1991Michael Moses, MDPrivate PracticeChief, Division of Plastic Surgery Touro InfirmaryDirector, Craniofacial Clinic Children’s HospitalPlastics: Massachusetts General Hospital, Boston, MAFellow in Craniofacial Surgery: Children’s Hospital and Brigham and Women’s Hospital, Boston, MAAmerican Board of Plastic Surgery, 1985Michael R. Robichaux, Jr., MDPrivate PracticeResidency: Alton Ochsner Medical Foundation, New Orleans, LA Orthopaedic SurgeryAmerican Board of Orthopaedic Surgery: HandStephen E. Metzinger, MDPrivate PracticePlastics: American Academy of Facial Plastic and Reconstructive Surgery, Preceptor: G. McCollough, Birmingham, ALFellowship: Craniomaxillofacial Surgery/Microvascular Surgery, University of Maryland Medical Center, Baltimore, MarylandAmerican Board of OtolaryngologyAmerican Board of Facial Plastic and Reconstructive SurgeryAmerican Board of Plastic SurgeryHugo St. Hilaire MD, DDSAssistant Professor of Clinical SurgeryPlastics: LSU Health Sciences Center at New OrleansFellowship: Johns Hopkins OMF, 2008Anthony Stephens, MDClinical Assistant Professor – Plastic SurgeryPlastics: LSU Health Sciences Center at New OrleansAmerican Board of Plastic Surgery, 2001 10
  • 11. Harold Stokes, MDClinical Professor of Plastic Surgery and Orthopaedic SurgeryLSU Department of Orthopaedic SurgeryOrthopaedic Surgery: Henry Ford Hospital, Detroit, MIHand Fellowship: R. Guy Pulvertaft, Derby, EnglandAmerican Board of Orthopaedic Surgery, 1974Added Qualifications in Surgery of the Hand, 1989, 1996Scott K. Sullivan, MDPrivate PracticePlastics: LSU Health Sciences Center at New OrleansAmerican Board of Plastic SurgeonsJohn Williams, MDPrivate PracticePlastics: The New York Hospital-Cornell Medical CenterAmerican Board of Plastic Surgeons, 1984M. Whit Wise, MDAssistant Professor of Plastic SurgeryLSU Division of Plastic SurgeryPlastics: Cleveland Clinic FoundationAmerican Board of Plastic Surgery, 2004 11
  • 12. 2008-2009 Tulane/LSU Plastic Surgery Residency Contact Information 06/12/08Name Contact Number Pager Number Email AddressRESIDENTSPerry Liu 504-343-2264 (c) 504-861-2822 (h) 504-213-1619 perryhliu@gmail.comAzul Jaffer 413-841-3903 (c&h) 504-213-1599 azulmd@hotmail.comClifton Cannon (1st yr.) 912-547-1091 (c) 504-267-7748 (h) 504-213-0176 Cliff_cannon@yahoo.comJennifer Chan (1st yr.) 505-463-3131 (c&h) 504-213-0172 Jennifer_chan@yahoo.comMary J. Wright (09-10) mjwright@tulane.eduThomas T. Sands (09-10) sandstrey@yahoo.comJonathan Weiler 504-931-4088 Jweiler86@gmail.comAlireza Sadeghi 646-460-3741 DSSADEGHI@yahoo.comKiran Narra (LSU- 1st yr.) 504-423-3409 kpolav@yahoo.comRyan Wong (LSU- 1st yr.) 504-423-3446 ryeguy77@gmail.comAndrew Freel (09-10) afreel@lsuhsc.eduFACULTYEdward Newsome 504-988-5500 (o) enewsome@cox.net(Debra) 504-450-1589 dfelix@tulane.edu 504-988-3740 (f)Charlie Dupin 504-258-1119 (c) cldupinmd@gmail.com(Connie) 504-349-6460 (o) connie-wbps@hotmail.comErnie Chiu 504-988-5500 (o) 504-501-0888 eschiu@gmail.com 504-301-3388 (h) 504-388-3213 (c)Abby Chaffin 313-492-0098 (c&h) 504-213-0596 achaffin@tulane.eduJyoti Arya 303-319-3654 504-538-9496 aryaj@mac.comHugo St. Hilaire 917-655-2726 504-423-3523 hugost1@gmail.comKamran Khoobehi 504-779-5538 (o) khoobehi@aol.com 504-779-5399 (f)Whit Wise 504-722-3188 (c) 888-307-1003 mwise@lsuhsc.edu(Sedette) 504-568-2721 (o)Chris Babycos 985-778-8583 (c) 504-538-8821 cbabycos@ochsner.org 12
  • 13. (Helen Roussel) 504-842-3950 (o) hroussel@ochsner.orgDavid Jansen 504-231-6353 (c) djansenmd@hotmail.com(Debbie) 504-455-1000 (o) drjansen@drdavidjansen.com Debbie@drdavidjansen.comFACULTYGus Colon 504-452-6828 (c) gacolon@cox.net(Cecilia) 504-219-0042 (h) gacolon@bellsouth.net 504-888-4297 (o) 504-456-2502 (f)John Church 504-895-4561 jmchurch@bellsouth.net(Rose or Cathy) CQ107@bellsouth.netJuan Escobar 504-349-6330 (o) jescobarmd@hotmail.com(Debra) 504-477-4596 (p) 504-458-8399 (c)Michael Moses 504-669-8558 (c) michael@drmoses.com 504-895-7200 (o) Jean@drmoses.comJohn Williams 225-281-2816 dr_williams@ascsurgery.comJohn Lindsey 504-885-4508 (0) jlindseyplassurg@aol.com(Robin) 504-885-4715 (f) drjlindsey@aol.comStephen Metzinger 504-459-3517 (o) metzingermd@cox.net(Michelle) 504-495-2381 (c) 504-522-7819 (h)Hal Stokes 832-260-6673 (c) hstokes@aol.com 504-454-2191Eric George (Pattie) 504-378-1818 (o) handfixer@aol.com 504-378-1837 (f)Charlie Clasen cclasen@bellsouth.netJonathan Kaplan 504-669-3222 jkapla@hotmail.comDonald Faust 504-899-1000 (o) dcfaustmd@yahoo.comScott Sullivan 504-352-0341 (c) scsullimd@aol.comFrank DellaCroce 504-220-5942 (c) fjdmd@cox.netMichelle Cooper 985-646-2227 (p) michele@michelecoopermd.comHamid Massiha 504-455-9441 (o) massihamd@aol.com 504-885-5063 (f)Thomas Guillot 225-769-2955 (o) tomguillotmd@aol.comLucius Doucet 225-769-2955 (o) drdoucet@cox.net 13
  • 14. Cynthia Mizgala 504-885-4515 (o) Jackie@awomanplasticsurgeon.com 504-554-2881 (c) 504-865-0859 (h) Jon Boraski 504-349-6460 (o) jboraski@cox.net William Murillo (+57) 315 559 39 90 (c) williamurillo@hotmail.com Kenneth Dieffenbach 504-891-5801 (o) Kdieffenba@aol.com 504-895-0011 (f) Elliott Black 504-883-8900 (o) elliottblack@gmail.com Summer Black 504-883-8900 (o) summerblack@gmail.com (Anna) 504-274-8545 (c) doctorblack@gmail.com Anthony Stephens 225-767-7575 (o) anthony@doctorstephens.com Bob Allen boballen@diepflap.com Bill Coleman 504-251-6189 (c) wcoleman@pol.net 504-455-2572 (h) 504-455-3180 (o) Alan Lewis 504-220-7011 alewis@tulane.edu FACULTY Calvin Johnson 504-895-7642 (o) lori@drcalvinjohnson.com Thomas Moulthrop 504-895-7642 (o) thment@aol.com 504-975-6991 (c) Rick Ahmad 225-921-5379 (c) riahmad@bellsouth.net (Kathy) 225-408-7937 (o) kathy@brortho.comTHE RESIDENCY IN PLASTIC SURGERYCLINICAL EXPERIENCEThe clinical experience available during your training will bedesigned to give you an in-depth education in the care of patients 14
  • 15. that fall under the broad definition of plastic surgery. Theresident will rotate through eight institutions with the main corecomponent being Tulane and Ochsner.1. Tulane University Hospitals and ClinicIn 1834, seven physicians banded together to form the MedicalCollege of Louisiana, which today is Tulane University HealthSciences Center. At that time there were only fourteen medicalschools in the United States and none west of the AlleghenyMountains. It closed during the Civil War, but during the last 100years, has come to be known as one of the leading medicalschools in the nation. Prior to Hurricane Katrina the Hospitalincluded a 300-bed tertiary care facility staffed by the faculty ofthe medical school. Tulane University Hospital and Clinic and theTulane University School of Medicine are components of theTulane University Health Sciences Center. The facility is rapidlyrebuilding and has resumed operations. Seventy-two medicalspecialties are recognized in the Medical Center. At Tulane, theplastic surgery resident will be offered the entire breadth of ourspecialty and be given graded responsibility under direct facultysupervision.2. Ochsner Foundation HospitalIncludes a 442-bed tertiary care hospital dedicated to patientcare, education and research. Ochsner Foundation Hospital andClinic was founded under the leadership of Dr. Alton Ochsner,Sr., former Professor and Chairman of the Department ofSurgery, Tulane University School of Medicine and severalTulane Faculty. Since its origin the Ochsner Hospital and Clinichas had congruent interests and cooperative programs withTulane. Ochsner Foundation Hospital and Clinic has a 15
  • 16. distinguished history of excellence and teaching and provideshighly tertiary services as well as primary surgical care. A closerelationship exists between the Department of Surgery atOchsner and the Department of Surgery at Tulane. For nearly 60years Ochsner has cared for residents in the greater NewOrleans communities. The Ochsner main campus, which includesthe hospital and clinic, are located in Jefferson Parish, butOchsner Clinic Foundation (OCF) has 27 clinics throughout theregion.3. Touro InfirmaryFounded in 1852, Touro Infirmary is New Orleans onlycommunity based, not-for-profit faith-based hospital.For more than 150 years, Touro has been in the vanguard ofmedical excellence. As one of New Orleans most enduringmonuments, Touro Infirmary stands for stability with modernfacilities utilizing the latest technology. Touro is known for itsquality and excellence.In 1923, Touro was one of only fifteen hospitals in the countryapproved to use insulin to treat diabetes. Today, thousands ofpeople from our community take advantage of our free diabetesscreenings and education seminars.4. East Jefferson HospitalOn February 14, 1971, the hospital opened its doors with 250beds and 250 physicians. Today, East Jefferson General Hospitalhas 450 beds and a medical staff of nearly 900. With over 3,000team members, the hospital is one of the largest employers in theparish.East Jefferson General has grown over the past three decades tobecome a medical landmark with the addition of medical office 16
  • 17. buildings, the Yenni Pavilion for outpatient cancer treatment, andthe Domino Pavilion, which houses Same Day Surgery,outpatient laboratory and outpatient radiology services. Mostrecently, the Wellness Center, a 38,000 square foot, state-of-the-art fitness facility, was added to the hospitals main campus.5. Our Lady of the Lake Regional Medical CenterOur Lady of the Lake Regional Medical Center is the dominantinstitution in healthcare in the Greater Baton Rouge area. It isalso the largest private medical center in Louisiana, with 763licensed beds. Opened in 1923, the Lake has grown from itsmodest beginning to a major player in healthcare, with anoutreach spanning geographical and political boundaries. In agiven year, Our Lady of the Lake treats approximately 25,000patients in the hospital, and serves about 350,000 personsthrough outpatient locations with the assistance of almost 900physicians and 3,000 staff members.Established in 1923 by the Franciscan Missionaries of Our Lady,the Lake continues to set the standard for quality patient care.COGNITIVE SKILLSEducation in surgery is designed to simultaneously developcognitive knowledge, judgment, technical ability and teachingskills. The practice of surgery requires the application of clinicaldata and technical skills to cure disease. Surgical judgment isthat combination of knowledge, confidence, ability, andcompassion that leads to the successful practice of our specialty. 17
  • 18. The cognitive basis of plastic surgery is summarized and devel-oped in a body of literature pertinent to the specialty. Mastery ofthis resource is a necessary task. The resident will be expectedto study the literature of our specialty diligently and apply theinformation therein to the problems of his patients. As theresident moves toward senior responsibility a greater breadth anddepth of knowledge is required, such they will be required toknow how to perform operations that they have never seen andwill be required to teach students and junior residents thediscipline necessary to search the literature.Evaluating the literature is a difficult skill acquired only throughpractice. This skill will be taught by example of the Faculty. Dr.John Gibbon, inventor of the extracorporeal pump-oxygenator,accurately made the following observation: "Unless he has a real understanding of what constitutes a valid measurement, he will be buffe- ted on the seas of surgical opinion. He will either change his ideas with every new article he reads, a slave to the authority of the printed word, or he will cling to the opinions of those surgeons with the greatest reputations in their field. How pathetic it is to hear a young surgeon parroting some authority without bothering to examine the evi- dence on which such an opinion is based! The pleasures and rewards of exercising critical judgment contribute to the self assurance and self reliance which assuredly are valuable attributes of a surgeon." John Gibbon, M.D. 18
  • 19. Annals of Surgery 142:321, 1955The following suggestions are offered: 1) During the first year use a standard textbook and periodical. Read the textbook from cover to cover over a 12-month period. A second standard text should be read during your second year. Suggested Textbooks: a. Grabb and Smith’s: Plastic Surgery b. Achauer: Plastic Surgery Indications, Operations and Outcomes c. Mathes: Plastic Surgery d. Grabbs: Encyclopedia of Flaps Suggested Periodicals: e. Lippincott: Plastic and Reconstructive Surgery and Annals of Plastic Surgery f. Selected Readings in Plastic Surgery g. Clinics in Plastic Surgery 2) Selected Readings in Plastic Surgery is required reading and will be studied in the core curriculum conference. 3) The residents should subscribe to the following journal: Plastic and Reconstructive Surgery (PRS). The Annals of Plastic Surgery along with PRS will be reviewed as the content for Journal Club. 4) Atlases are not a substitute for availing yourself of the opportunity to see every operation possible. The alert resident should be able to learn from every operation whether he/she functions as the surgeon, first assistant, 19
  • 20. second assistant or observer. Take advantage of participating in all available cases. 5) The library in the Plastic Surgery Division is for your use; however please do not remove any material from the office. The development of judgment requires an inquiring mind. Yourmost frequent question to yourself, the faculty and colleaguesshould be "Why”.GOALS AND OBJECTIVESThe basic science and clinical skills objectives are listedindividually below. The objectives will be emphasized on certainrotations; however it will be important for the resident to be ableto integrate these broad topics into an effective comprehensivepatient treatment and care. Regarding technical skills, theresident is expected to master the less complex proceduresbefore proceeding to the more complex. Furthermore, he/she isexpected to first assist until he/she understands the principlesand methods, at which time the resident becomes the operatingsurgeon with faculty supervision, and eventually moves toteaching others. 20
  • 21. Tulane Plastic Surgery Residency Training Objectives- Core CompetenciesGOALS AND TRAINING OBJECTIVESThe Tulane Plastic Surgery Residency will stress: 1) Ethical, appropriate, specific and effective treatment, independent thinking, life long learning and improvement. 2) After completion of training the resident will have broad training in plastic surgery giving him a solid foundation on which to provide competent patient care.Education in surgery is designed to simultaneously develop cognitiveknowledge, judgment, technical ability and teaching skills. The practice ofsurgery requires the application of clinical data and technical skills to curedisease. Surgical judgment is that combination of knowledge, confidence,ability, and compassion that leads to the successful practice of our specialty.The basic science and clinical skills objectives are listed individually below.The objectives will be emphasized on certain rotations; however it will beimportant for the resident to be able to integrate these broad topics into aneffective comprehensive patient treatment and care. Regarding technicalskills, the resident is expected to master the less complex procedures beforeproceeding to the more complex. Furthermore, he/she is expected to firstassist until he/she understands the principles and methods, at which time theresident becomes the operating surgeon with faculty supervision, andeventually moves to teaching others.The following resident has demonstrated cognitive knowledge, technicalability and sound surgical judgment in meeting the goals and trainingobjectives in the required plastic surgical residency rotations. He/she has actedin a professional manner and can now be considered to have completed theTulane University Plastic Surgery Residency. Resident Program Director’s Signature 21
  • 22. PROFESSIONALISMRequired Professionalism of Patient Care during each Plastic Surgery Rotation.Goal:Upon completion of this rotation the Plastic Surgical Resident will understandcommitment to professional responsibilities, adherence to ethical practices andsensitivity to diverse patient populations. He/she will present himself in arespectful, professional, honest and congenial manner in all interaction withpatients, colleagues, other health care professionals and ancillary staff.Terminal Performance Objective:The Surgical Resident will be able to demonstrate a commitment to theirprofessional responsibilities, adherence to ethical principles and sensitivity todiverse patient populations as judged against applicable standards of patientcare.Enabling Objectives:Condition: Upon completion of this rotation the Surgical Resident will: 1) Demonstrate a commitment to professional responsibilities 2) Perform patient care in an ethical manner 3) Display sensitivity to the needs of a diverse patient population 4) Demonstrate the principles of the highest standard of patient care 5) Demonstrate commitment to continuity of patient care 6) Demonstrate sensitivity to patient age, gender and cultureStandard: As judged against applicable standards for the Medical Professional. Resident Program Director’s Signature 22
  • 23. INTERPERSONAL AND COMMUNICATION SKILLSRequired Interpersonal and Communication Skills of Patient Care during each PlasticSurgery RotationGoal:Upon completion of this rotation the Surgical Resident will be able to communicate ina collaborative model with patients, patient’s families and members of the health careteam relevant and important information.Terminal Performance Objective:The Plastic Surgical Resident will be able to demonstrate effective communicationwith members of the health care team, counsel and educate the patient, patient’s familyand health care team and accurately document all patient care information as judgedagainst applicable standards of patient care.Enabling Objectives:Condition: Upon completion of this rotation the Surgical Resident will: 1) Discuss the patient’s medical condition, progress and outcome with the patient and patient’s family (if requested) to assure complete understanding 2) Team with the patient, their family and other health care providers to optimize the patient’s recovery 3) Demonstrate effective communication with other health care professionals 4) Demonstrate education of the patient’s family 5) Demonstrate counsel of the patient’s family 6) Document all steps in patient care 7) Document patient education and counseling 8) Document development of patient care plan 9) Demonstrate ability to obtain informed consent, including the components of condition, proposed treatment, alternative treatment, complications, risk, benefits, outcomes of treatment and alternatives 10) Demonstrate maintenance of patient confidentiality in communication with family, friends and other health care workers 11) Demonstrate integration and understanding in how Professionalism and Communication are critical and essential in overall optimal patient care and equally crucial in risk management and therefore effective Systems Based Practice.Standard: As judged against applicable standards of Physician-Patient interaction. Resident Program Director’s Signature 23
  • 24. PRACTICED BASED LEARNING AND IMPROVEMENTRequired Practice Based Learning and Improvement of Patient Care duringeach Plastic Surgery rotation.Goal:Upon completion of this rotation the Surgical Resident will understand the roleof Practice-Based Learning and Improvement in the management of theirpatients and as a life-long process for optimal health care.Terminal Performance Objective:The Plastic Surgical Resident using an individual critique of their patient carepractice outcomes will be able to demonstrate methods of improvement inpatient care through the recognition and practice of lifelong learning skills inthe surgical field as judged against applicable standards of patient care.Enabling Objectives:Condition: Upon completion of this rotation the Surgical Resident will: 1) Evaluate patient care through a personal QA program 2) Appraise scientific evidence as to correctness of data 3) Appraise scientific evidence as to applicability in patient care 4) Assimilate new scientific knowledge to improve the care of one’s own patient 5) Evaluate methods of acquiring scientific knowledge to improve the care of one’s own patient based on changing standardsStandard: As judged against applicable standards of physician knowledge,skill improvement and quality improvement. Resident Program Director’s Signature SYSTEMS BASED PRACTICE 24
  • 25. Required Systems Based Practice of Patient Care during each Plastic Surgery Rotation.Upon completion of the each rotation the Plastic Surgical Resident will meet thefollowing GOALS: 1) Understand and discuss how the Plastic Surgeon is a vital component to support ALL specialties 2) Understand how the Plastic Surgeon is BEST utilized in the context of maximizing results and minimizing expenditures 3) Understand specific examples of efficient and inefficient resource allocation and how this impacts the total health care systemTerminal Performance Objective:The Surgical Resident will be able to demonstrate an awareness of the health caresystem, respond to the larger context of the health care system and manage health caresystem resources to provide optimal care as judged against applicable standards ofpatient care.Enabling Objectives:Condition: Upon completion of this rotation the Surgical Resident will: 1) Define cost-effective patient care 2) Describe how to meld together both high-quality and cost-effective care methods in providing health care 3) Demonstrate risk benefit analysis in day-to-day patient care 4) Describe the appropriate use of specialists in health care 5) Describe the use of non-physician health care team members in daily care of the patient 6) Demonstrate the role of the individual physician in the development of the overall health care system at the local, state, national and international level 7) Describe the importance of using the political process to enhance the medical health care systemStandard: As judged against applicable standards of medical practice. Resident Program Director’s Signature 25
  • 26. ROTATIONAL COMPETENCIES Resident Name:AestheticsBasic Sciences / Medical Knowledge Objectives 1) The resident will be familiar with concepts of beauty and aesthetic principles of the facial structures. 2) He/she can recognize the varying effects of aging and sun exposure on the facial skin and structures. 3) He/she can recognize the various aesthetic deformities of the ear and appreciates the principles and techniques of surgical correction. 4) He/she will be familiar with aesthetic and functional problems of the eyelid including blepharochalasis and ptosis and knows the treatment techniques for these problems, complications and their prevention. 5) He/she will understand the principles and techniques of aesthetic rhinoplasty 6) He/she will recognize the differences in approach between primary and secondary rhinoplasty. 7) He/she will be familiar with diagnostic and therapeutic techniques in the management of nasal airway obstruction. 8) He/she will understand the implication of Bariatric SurgeryClinical / Surgical Skills Objectives 1) The resident will be familiar with techniques of rhytidectomy, suction lipectomy, brow lift, blepharoplasty and other methods for treatment of the aging face and body. 2) He/she will understand the complications of facial aesthetic surgery, their prevention and treatment. 3) He/she will perform surgical therapy for patients with aging face including rhytidectomy, brow lift, blepharoplasty and understand open and endoscopic techniques. 4) He/she will treat patients with mammary hypoplasia including both acute management and the care of patients with late problems (such as capsular 26
  • 27. contracture). 5) He/she will evaluate and treat patients with mammary ptosis. 6) The resident will also treat patients with aesthetic deformity of the abdomen, trunk and lower extremity and performs abdominoplasty, panniculectomy, and abdominal suction lipectomy. 7) He/she will evaluate patients with nasal deformities and perform rhinoplasty and septal surgery. 8) He/she understands the evaluation of patients with aesthetic problems of the ear and performs otoplasty. 9) He/she will perform aesthetic procedures on patients with massive weight loss.ROTATIONAL COMPETENCIES Resident Name:Anesthesia and Critical CareBasic Sciences / Medical Knowledge Objectives 1) The resident will demonstrates knowledge of common agents for local anesthesia (esters and amides), regional anesthesia and general anesthesia (intravenous agents, inhalation agents, muscle relaxants, antiemetics, etc). 2) He/she will know the principles and the techniques for administration of local anesthesia and understand the pharmacology and safe utilization of agents in "conscious sedation."Clinical / Surgical Skills Objectives 1) The resident will participate in the decision as to which technique of anesthesia should be used on his patients. 2) He/she will utilize the techniques of local anesthesia and carry out emergency management of burn and trauma patients. 3) He/she will manage all plastic surgical patients postoperatively. 27
  • 28. ROTATIONAL COMPETENCIES Resident Name:Benign and Malignant Skin LesionsBasic Sciences / Medical Knowledge Objectives 1) The resident will understand the natural history of benign lesions and the pathophysiology of malignant lesions. 2) He/she will comprehend histologic grading and clinical staging systems currently in use for the malignant and premalignant skin tumors. 3) He/she will understand the lymphatic drainage pattern of the head and neck structures and its relationship to the management of malignant tumors. 4) He/she will know the methods for diagnosis and the options for treatment of squamous cell carcinoma of the head and neck, basal cell carcinoma and malignant melanoma.Clinical / Surgical Skills Objectives 1) The resident will be familiar with the clinical presentation of benign and malignant cutaneous lesions and generalized skin disorders. 2) He/she will be able to provisionally evaluate both simple and complex cutaneous lesions and proceed with diagnostic steps necessary to secure a definitive diagnosis. 3) The resident will formulate a definitive treatment plan for the particular lesion in question choosing a surgical or nonsurgical treatment modality, which best suits the lesion (based on size, anatomical location and physical condition of the patient). 4) He/she will be familiar with other treatment modalities including (but not limited to) x-ray therapy, Mohs micrographic surgery, cryotherapy, laser therapy and topical chemotherapy. 28
  • 29. 5) The resident will be able to explain in a comprehensible but simplified manner, to the patient, the nature of the lesion, its extent, treatment options and long-term results. 6) He/she will formulate a definitive treatment plan for regional or distant spread of malignant cutaneous tumors. 7) The resident will performs all invasive diagnostic studies including (but not limited to): direct incisional and excisional biopsy, needle biopsy, punch biopsy; recognizes under which circumstances each should be used. 8) He/she can execute extirpative surgery of a variety of benign and malignant cutaneous lesions and associated locoregional disease, choosing the optimal surgical incision or excision for the particular region to be treated. 9) He/she also will be able to execute complex procedures for the reconstruction of surgically created wounds (including skin grafts, local or distant flaps, or free tissue transfer) resulting from skin tumor extirpation.ROTATIONAL COMPETENCIES Resident Name:Hand ObjectivesBasic Sciences / Medical Knowledge Objectives 1) The resident will know, in detail, the anatomy of the muscles, tendons, and ligaments of the hand and upper extremity. 2) He/she will understand the anatomy of the vascular tree and major nerves of the upper extremity including relationships to the surrounding structures. 3) He/she also will understand the functional anatomy of the upper extremity including the cutaneous cover. 4) The resident will be familiar with the spectrum of congenital abnormalities of the upper extremity. 5) He/she will understand the principles of diagnosis and treatment of upper extremity tumors. 6) He/she will know the clinical techniques for physical examination of the hand. 7) He/she will know the techniques for operative and nonoperative management of traumatic injuries of the upper extremity, their indications and contraindications, and their potential complications and treatment thereof. 8) He/she will demonstrate knowledge of the nerve compression and entrapment syndromes of the upper extremity and understand the basic principles of their treatment. 9) He/she will be familiar with the pathologic anatomy and physiology of upper extremity joint contractures and Dupuytren’s disease.Clinical / Surgical Skills Objectives 1) The resident will perform physical examination of the hand and upper 29
  • 30. extremity in both normal and pathologic states. 2) He/she will obtain and interpret radiographs and other diagnostic images for evaluation of traumatic, congenital and degenerative problems of the hand and upper extremity. 3) The resident will debride and close wounds acute and chronic of the upper extremity. 4) He/she will evaluate and manage nerve, tendon, fingertip and bony injuries. 5) He/she will diagnose, evaluate and treats upper extremity infections. 6) He/she will perform skin grafting and flap closure of soft tissue defects of the upper extremity. 7) The resident will direct rehabilitation of upper extremity trauma following surgical treatment. 8) He/she will know and practice the principles of immobilization and splinting.ROTATIONAL COMPETENCIES Resident Name:Burns and TraumaBasic Sciences / Medical Knowledge Objectives 1) The resident will understand normal skin anatomy, circulation and how it is impacted by injury. 2) He/she will also understand the physiologic changes, which occur with thermal or traumatic injury. 3) He/she understands the relationship between duration of exposure and temperature and the specific changes which occur in the zone of coagulation, stasis, and hyperemia. 4) He/she understands the pathophysiology and treatment of inhalation injuries and carbon monoxide poisoning. 5) He/she also understands the pathophysiologic changes unique to chemical burns. 6) The resident will understand the pharmacology and utilization of topical antibacterial agents, analgesics and antibiotics in the treatment of burns.Clinical / Surgical Skills Objectives 1) He/she will recognizes the Rule of Nines, the use of more detailed body surface charts, and the difference in relative body surface area comparing children to adults. 2) He/she knows the parameters, which define major, moderate and minor 30
  • 31. burns. 3) He/she understands the various factors, in addition to body surface area, which affect prognosis of a patient with a thermal injury. 4) He/she understands the principles and techniques of fluid resuscitation. 5) He/she will recognize injuries and sequelae associated with electrical injuries. 6) He/she will understand principles pertinent to burn rehabilitation and reconstruction including aesthetic units of the face, tissue expansion, hair transplantation and hand splinting.ROTATIONAL COMPETENCIES Resident Name:Mohs Chemosurgery/DermatologyBasic Sciences / Medical Knowledge Objectives 1) The resident will appreciate the basic physiology of the aging process of the skin and will understand the basic physiologic processes of sun exposure on the skin. 2) He/she will understand the role of lasers in the management of various skin lesions and conditions. 3) He/she will understand the natural growth history of skin cancers and the value of Mohs Chemosurgery.Clinical / Surgical Skills Objectives 31
  • 32. 1) He/she will recognize common inflammatory disorders of the skin such as impetigo, cellulitis, lymphangitis, hidradenitis suppurativa, and will be familiar with medical management and surgical treatment of inflammatory disorders of the skin. 2) The resident will demonstrate knowledge of common generalized dermatologic disorders such as: psoriasis, seborrheic dermatitis, acne, and benign skin lesions such as nevi and seborrheic keratoses. 3) He/she will recognize common skin malignancies and formulate plan to include staging, extirpation and reconstruction. 4) He/she will become familiar with the pathologic interpretation of common skin malignancies. He/she will understand the process of Mohs surgery.ROTATIONAL COMPETENCIES Resident Name:Congenital/EmbryologyBasic Sciences / Medical Knowledge Objectives 1) He/she will know the anatomy of the facial bones, their ostia and bony relationships, and embryology. 2) He/she will be familiar with the general principles of embryology of the head and neck, with special reference to the development of the facial structures including lip, palate and ear. 3) He/she will demonstrates intimate knowledge of the common congenital disorders of the head and neck including cleft lip and 32
  • 33. palate, craniofacial syndromes, vascular malformations, auricular abnormalities.Clinical / Surgical Skills Objectives 1) He/she will understand the basic principles of the surgical and nonsurgical management of common congenital disorders of the head and neck. 2) The resident will participate in the surgical planning for patients with common congenital disorders of the head and neck including cleft lip and palate and craniosynostosis. 3) He/she will perform primary and secondary surgery on patients with common congenital disorders of the head and neck, chest, trunk and extremities.ROTATIONAL COMPETENCIES Resident Name:Facial Trauma 1) Basic Sciences / Medical Knowledge Objectives 2) The resident will know the priorities involved in treating patients with multiple trauma, the timing of treatment of head and neck injuries, and the indications for endotracheal intubation and tracheostomy in such patients. 3) He/she knows an orderly, systematic approach to the physical examination of patients with facial trauma. 4) He/she will understand the indications for specific diagnostic studies including conventional radiography, Panorex films, computer-assisted tomography, three-dimensional CT scan imaging, and magnetic resonance imaging. 5) He/she appreciates the mechanical properties of the facial skeleton and patterns of injury associated with facial trauma including associated cervical and cranial trauma. 6) The resident understands the management of open facial injuries including: 33
  • 34. anesthesia, local wound care, principles of debridement, and biologic features, which distinguish facial injuries from those in other locations. 7) He/she will understands the concepts of primary bone healing, malunion, nonunion and osteomyelitis. 8) He/she will recognize the indications for operative treatment of facial fractures. 9) He/she will know the advantages and disadvantages of various techniques for treatment of facial fractures including nonoperative treatment, closed reduction, mandibulomaxillary fixation, open reduction with and without fixation, wire fixation, compressive and non-compressive fixation, intraoral splints, external fixation (including halo and biphasic techniques) and bone grafting.Clinical / Surgical Skills Objectives 1) The resident will treat patients with minor and major soft tissue injuries of the face including injuries to the facial nerve, lacrimal apparatus and parotid gland. 2) He/she will diagnose and treats patients with closed and open fractures of the facial skeleton. 3) He/she will operate on patients with fractures of the facial skeleton and performs closed reductions, open reductions, internal fixations, and bone grafting. 4) The resident will manage patients postoperatively after surgical treatment of facial fractures. 5) Specifically the resident will understand treatment of maxillary, mandibular, orbital, nasoethmoidal, frontal, zygoma and zygomatic arch fractures; the potential complications of such treatment (including malposition, deformity, malocclusion, etc); the management of these complications.Resident Name:Flaps and GraftsBasic Sciences / Medical Knowledge Objectives 1) The resident understands the physiology of flaps and grafts, is thoroughly familiar with surgery in all types of flaps and grafts, and can design and utilizes flaps effectively for reconstruction in the full spectrum of plastic surgical practice. 2) He/she will understand the terminology of flap movement, composition and vascular supply. 3) The resident will recognize the physiology of normal flaps, ischemic flaps, and the "delay" phenomenon. 34
  • 35. 4) He/she will understand the specific physiology of split and full thickness skin grafts, dermal grafts, cartilage grafts, bone grafts, tendon grafts, nerve grafts, fascial grafts, and composite grafts.Clinical / Surgical Skills Objectives 1) The resident will knows specific grafting techniques including the operation of various types of dermatomes, management of graft donor sites, and care of graft recipient sites. 2) He/she will understand the principles and applications of special grafting techniques including dermabrasion, xenografts, cadaver grafts, skin matrix and synthetic or chemically manipulated materials. 3) He/she shall perform operations incorporating the full spectrum of flaps and grafts including skin grafts, local flaps, fascial and musculocutaneous flaps, free tissue transfers, bone grafts, composite grafts. The resident will treat patients who have complications of flaps and grafts including skin graft loss, flap necrosis, wound dehiscence and wound infection.ROTATIONAL COMPETENCIES Resident Name:Functional ProblemsBasic Sciences / Medical Knowledge Objectives 1) The resident will knows the basic physiology of the aging process of the skin and will understands the basic physiologic processes of sun exposure on the skin. 35
  • 36. 2) He/she demonstrates knowledge of common generalized dermatologic disorders such as: scleroderma, dermatomyositis, and lupus erythematosus.Clinical / Surgical Skills Objectives 1) He/she is familiar with basic principles of medical treatment of generalized skin disorders and can recognizes common inflammatory disorders of the skin such as impetigo, cellulitis, lymphangitis, hidradenitis suppurativa, necrotizing fasciitis and is familiar with medical management and surgical treatment of inflammatory disorders of the skin.ROTATIONAL COMPETENCIES Resident Name:Head and Neck ReconstructionBasic Sciences / Medical Knowledge Objectives 1) The resident will knows the anatomy of the skull including suture lines, foramina, and structures exiting foramina; is familiar with the anatomy and functions of the cranial nerves. 2) He/she will know the anatomy of the facial bones, their ostia and bony relationships, and embryology. 36
  • 37. 3) He/she has special knowledge of the vascular structures of the skull, head and neck. 4) He/she understands the anatomy of the eye including normal dimensions, bony structures, the eyelids, the extraocular muscles, the innervation of the eye and adnexal structures, the vascular supply, and the lacrimal apparatus. 5) He/she understands the anatomy of the ear including common measurements of the ear, relationships of the ear to other structures, and the vascular and sensory supply. 6) The resident will know the anatomy of the nose and septum including bones and cartilages, nerve and vascular supply and he will be familiar with the physiology of the nose with particular reference to air flow and airway obstruction. 7) He/she will know the anatomy of the oropharynx including muscular structures, lymphatic drainage, and contiguous neurovascular structures and he will be familiar with the physiology of the oropharynx including palatal function, speech, and swallowing. 8) He/she knows the anatomy and function of facial structures including facial muscles, facial layers and salivary glands. 9) He/she will know the lymphatic drainage pattern of the head and neck structures and its relationship to the management of malignant tumors. 10)He/she understands the methods for diagnosis and the options for treatment of squamous cell carcinoma of the head and neck (particularly the oropharynx), basal cell carcinoma and malignant melanoma. 11)He/she will understand the methods for diagnosis and the options for treatment of benign and malignant processes of the salivary glands.Clinical / Surgical Skills Objectives 1) The resident will be able to evaluate and treat patients with benign and malignant conditions of the head and neck. 2) He/she will appreciate a non-operative and operative plan depending on the patient’s diagnosis, age and condition. 3) He/she will understand the reconstructive ladder and can make an applicable operative plan. 4) He/she will understand the principles and techniques available for appearance restoration and understand the specific reconstructive needs of special tissues such as oral mucosa, nasal lining, etc. 5) He/she will utilize flaps, grafts, tissue expansion, free flaps and/or alloplastic insertions for head and neck reconstruction. 6) He/she will perform reconstruction of specific head and neck structures such as eyelid, lips, nose, oropharynx, ear, mandible, scalp and skull.ROTATIONAL COMPETENCIES Resident Name:Implants and BiomaterialsBasic Sciences / Medical Knowledge Objectives 37
  • 38. 1) At the end of the unit, the resident is familiar with the biology of the various implant materials including bone, cartilage, and alloplasts. 2) He will know the local wound factors which influence bone graft survival and recognizes the biologic differences between vascularized and non-vascularized bone grafts. 3) The resident will understand the influence of perichondrium and on the warping of cartilage grafts. 4) He/she will recognize the various types of breast implants and the factors involved in implant choice including surfaced content characteristics and is aware of the issues regarding silicone and is able to discuss these with a patient. 5) He/she understands the effects of breast implant surface characteristics on formation of capsular contracture and recognizes the various injectable materials for subcutaneous filling and the principles of their use.Clinical / Surgical Skills Objectives 1) The resident will performs surgical procedures using solid and injectable implant materials. 2) He/she will understand the procedures for carving autografts and alloplastic implants.ROTATIONAL COMPETENCIES Resident Name:Lower Extremity ReconstructionBasic Sciences / Medical Knowledge Objectives 38
  • 39. 1) The resident will know the vascular, muscular, neural, and osseous anatomy of the lower extremity. 2) He/she will understand the various muscular and vascular anatomies of specific flaps including tensor fascia lata, vastus lateralis, rectus femoris, sartorius, gastrocnemius, gracilis, and biceps femoris flaps. 3) The resident will understand the concept of fasciocutaneous flaps and can design them on the distal lower extremity. 4) He/she will know the cutaneous margins and vascular anatomy of foot flaps including medical plantar, lateral plantar, V-Y plantar, and dorsalis pedis- based flaps. 5) He/she will understand the physiology of arterial insufficiency, venous hypertension, and diabetes as they pertain to the lower extremity. 6) He/she will understand the indications for and timing of closure of soft tissue traumatic defects of the lower extremity. 7) He will have a thorough knowledge of coverage techniques (including skin grafts, local skin flaps, distant flaps, musculocutaneous flaps, and free flaps) for soft tissue and bony closure of the lower extremity. 8) He/she will understand the management of infectious processes (including osteomyelitis) related to traumatic injuries of the lower extremity. 9) He/she will know the etiology and treatment of lymphedema (including nonoperative and operative measures).Clinical / Surgical Skills Objectives 1) The resident will undertake perioperative management and surgical treatment of patients with major acute and chronic injuries of the lower extremities requiring reconstruction and resurfacing. 2) He/she will evaluate and treats patients with lower extremity trauma and ulceration of a variety of etiologic origins.ROTATIONAL COMPETENCIES Resident Name:Medicolegal and Psychiatric Aspects of Plastic Surgery 39
  • 40. Basic Sciences / Medical Knowledge Objectives 1) The Resident will understand the medical and legal perspectives of the contractural agreement between a physician and his/her patient. 2) He/she understands the concepts of informed consent and implied guarantee and understands the role of the medical record as a legal document. 3) He/she knows the impact a physical deformity can have on patients and their families. 4) The resident utilizes various techniques to explore the motivations of patients seeking cosmetic surgery, and how to distinguish acceptable, unacceptable, and pathological motivations. 5) The resident will obtain informed consent from all patients and effectively documents the consent agreement. 6) He/she will evaluate patients for aesthetic surgery from a physical and psychological perspective. 7) He/she contributes effectively and accurately to the medical record of both inpatients and outpatients. 8) He/she will treat patients with physical deformity and explores the psychological aspects of their care.ROTATIONAL COMPETENCIES Resident Name: 40
  • 41. MicrosurgeryBasic Sciences / Medical Knowledge Objectives 1) The resident is familiar with the principles of microsurgery and recognizes the mechanisms and consequences of the no-reflow phenomenon; knows how to treat a failing flap. 2) He/she will understand the technologic, pharmacologic and physiologic principles of postoperative monitoring of free flaps. 3) He/she will know the basic physiology of nerve injury (axonotmesis, neurotmesis, neuropraxia, Wallerian degeneration) and of nerve healing.Clinical / Surgical Skills Objectives 1) The resident will have mastered the basic microsurgery techniques including micro-neural repair and microsurgical anastomosis. 2) He/she will become familiar with the use of the operating microscope and understand the indications for, the contraindication to, and the techniques for accomplishing replantation of amputated parts. 3) He/she shall be familiar with the tissue composition of free flaps and know the anatomy for harvesting the most common free flaps. 4) He/she also will be able to recognize the indications for harvesting various flaps and matching specific donor sites to specific recipient site needs and manage the long-term aspects, including donor site problems, of patients who have undergone free tissue transfers. 41
  • 42. ROTATIONAL COMPETENCIES Resident Name:Practice ManagementBasic Sciences / Medical Knowledge Objectives 1) The resident will understand how to interview and evaluate the patient, especially the aesthetic surgery candidate. 2) He/she will know the coding of diagnoses by the ICD-9 system and the coding of procedures by the CPT system. 3) He/she will understand ethical principles as they relate to billing and coding. 4) He/she understands how to take and catalogue standardized medical photographs. 5) He/she will be thoroughly familiar with the principles of risk management. 6) The resident will participate in outpatient management including both a clinic experience in which the resident has independent responsibility and observation of faculty managing private patients including the initial consultation and management of complications. 42
  • 43. ROTATIONAL COMPETENCIES Resident Name:Special TechniquesBasic Sciences / Medical Knowledge Objectives 1) The resident will understand the principles of a variety of special techniques in plastic surgery including: liposuction, tissue expansion, laser treatments, chemical peel and dermabrasion. 2) He/she will know the different injection techniques, fluid and suction limits and safety precautions for liposuction. 3) He/she will understand the physiology of cavitation. 4) The student will know the physiologic principles of tissue expansion and understand the various techniques for expansion. 5) The resident will comprehend the physiologic principles of dermabrasion, chemical peel and laser resurfacing and recognize the differences between these techniques and the indications for one method over another.Clinical / Surgical Skills Objectives 1) He/she will understand the common techniques and the instrumentation of suction lipectomy. He will know the indications for and contraindications to suction lipectomy. 2) He/she will be familiar with the principles of preoperative assessment and recognize the limitations of liposuction. 3) He/she can perform preoperative, intraoperative and postoperative management of the patient undergoing suction lipectomy and will be familiar with the complications of liposuction and their management. 4) He/she will know the principles of management of patients undergoing tissue expansion; recognizes the complications of tissue expansion and is competent in their treatment. 5) He/she is familiar with the instrumentation and techniques for dermabrasion and laser resurfacing. 6) He/she will be competent in the principles of pre and postoperative management of patients undergoing facial resurfacing and can recognize the complications of the technique and their management. 43
  • 44. ROTATIONAL COMPETENCIES Resident Name:Trunk and Breast ReconstructionBasic Sciences / Medical Knowledge Objectives 1) The resident will demonstrate knowledge of the musculature; blood supply, lymphatic drainage and innervation of the trunk, abdominal wall and breast. 2) He/she will understand the glandular structure and function of the breasts and appreciate the hormonal influence on breast development and function. 3) He/she will recognize differences in breast structure and function in adolescence, the reproductive years, pregnancy, lactation and menopause. 4) He/she will understand the basic principles and techniques of the surgical treatment of common developmental breast anomalies including amastia, Poland’s syndrome, asymmetry, ectopic mammary tissue, virginal hypertrophy, gynecomastia, etc. 5) He/she will be familiar with chest wall embryology and anatomy as applied to developmental chest wall deformities. 6) He/she will recognize the physiologic consequences of developmental chest wall defects and understand the biologic behavior, histologic characteristics and clinical manifestations of malignancies of the breast. 7) He/she will be familiar with plastic surgical options for management of the opposite breast after mastectomy for carcinoma and the principles of long-term management of patients with breast carcinoma. 8) He/she will have a thorough knowledge of breast reconstruction including autologous tissue and the use of prosthetic devices. 9) He/she will understand the etiology of gynecomastia and is familiar with the various surgical options for treatment. 10)He/she will understand the basic principles of medical and surgical management of common acute traumatic trunk and breast injuries including sternal wounds. 11)He/she will understand the etiology and nonsurgical management of pressure sores (including preventive measures). 12)He/she will have a detailed knowledge of surgical aspects of pressure sore reconstruction. 44
  • 45. Clinical / Surgical Skills Objectives 1) The resident will evaluate and treats patients with congenital and post-surgical breast deformities. 2) He/she will perform breast reconstruction with various techniques, such as implants, tissue expanders and flaps. 3) He/she will perform nipple and areolar reconstruction. 4) The resident will evaluate and treats patients with pressure sores and formulate a reconstructive plan for patients with pressure sores. 5) He/she will evaluate patients with mammary hypertrophy, marks and operates upon them, and performs postoperative care. T 6) He/she resident will formulate a care plan for patients with both malignant and infectious chest wall pathology.ROTATIONAL COMPETENCIES Resident Name: 45
  • 46. Wound CareBasic Sciences / Medical Knowledge Objectives 1) The resident will understand the physiology and biochemistry of normal and abnormal wound healing. 2) He/she will also become familiar with the pharmacologic agents and other non-surgical methods for treatment of abnormal healing of skin and subcutaneous tissue. 3) He/she shall become familiar with the role of nutrition has in the wound healing process and understands the pathologic processes involved in keloid formation and the methods available to treat keloids.Clinical / Surgical Skills Objectives 1) The resident will be able to assess any wound and be able to formulate an optimal treatment plan. 2) He/she will become competent in the management of dressings, splints and other devices and techniques utilized in wound management. 3) He/she will understand when surgical debridement is necessary and the correct use of pharmacologic wound manipulating agents. 4) He/she will treat complex wound problems such as dehiscence, delayed healing, multiple traumatic wounds and evaluate patients with scar problems and revise scars to achieve maximum functional and aesthetic benefit. 5) He/she shall become skilled in the application, planning and surgical performance of techniques to alter scar (such as Z-plasty, W-plasty) and recognize the various lines of the skin (such as Relaxed Skin Tension Lines) and their importance in placement of incisions for maximum aesthetic benefit. 46
  • 47. Residency Goals and Objectives: First YearBy the end of the first year the resident will bec ompet ent in: 1) Communicating effectively with resident staff, faculty, nursing and others such that patients with emergent needs may be safely transferred from off campus or on campus to the environment appropriate to their specific need within the Tulane and Other Rotation Institutional Systems. (IPC, P and SBP*) 2) Obtaining consultation from appropriate services for elective cases of patients on campus. (SBP) 3) Utilizing the appropriate information systems on and off campus to provide excellent patient care and to facilitate his/her further education. (IPC and P) 4) Delivering a comprehensive one hour didactic conference on a selected topic. (M, IPC) 5) Evaluating his own educational progress through regular recording and review of cases performed and by meeting with faculty and the Program Director and communicating those needs to the faculty and the Program Director. (PC and PBLI) 6) Communicating with patients and families a treatment plan including appropriate informed consent for operation. Describing that treatment plan clearly to other physicians and recording it in textural and other forms. (IPC, P and M) 7) Leading a team consisting of plastic surgeons, general surgeons, nurses, PA’s, medical students and others to perform excellent patient care. (PC, SBP, M, IPC and P) 47
  • 48. 8) Obtaining the knowledge and technical skills to perform procedures and solve patient care problems and perform operative procedures encountered in specific rotations. (PC, PBLI and M) 9) Performing microsurgical vascular anastomosis and neural repair on a laboratory animal. (PBLI and M) * Competencies: PC = Patient Care, M = Medical Knowledge, SBP = Systems Based Practice, PBLI = Practice Based Learning and Improvement, IPC = Interpersonal and Communication SkillsGoals and Objectives: Second Year By the end of training t he resident will be compet ent in: 1) Communicating effectively with resident staff, faculty, nursing and others such that patients with emergent needs may be safely transferred from off campus or on campus to the environment appropriate to their specific need within the Tulane and Other Rotation Institutional Systems. (IPC, P and SBP*) 2) Obtaining consultation from appropriate services for elective cases of patients on campus. (SBP) 3) Utilizing the appropriate information systems on and off campus to provide excellent patient care and to facilitate his/her further education. (IPC and P) 4) Delivering a comprehensive one hour didactic conference on a selected topic. (M, IPC) 5) Evaluating his own educational progress through 48
  • 49. regular recording and review of cases performed and by meeting with faculty and the Program Director and communicating those needs to the faculty and the Program Director. (PC and PBLI)6) Communicating with patients and families a treatment plan including appropriate informed consent for operation. Describing that treatment plan clearly to other physicians and recording it in textural and other forms. (IPC, P and M)7) Leading a team consisting of plastic surgeons, general surgeons, nurses, PA’s, medical students and others to perform excellent patient care in an independent and comprehensive manner. (PC, SBP, M, IPC and P)8) Obtaining the knowledge and technical skills to independently perform procedures and solve patient care problems and perform operative procedures encountered in all the specific rotations. (PC, PBLI and M)9) Performing microsurgical vascular anastomosis and neural repair on a laboratory animal. (PBLI and M)10) Assessing aesthetic patients for their suitability for operation and choosing an appropriate operative or non-operative approach. (PC, M, P and IPC)11) Describing patient care actions in CPT language in an accurate and ethical fashion. (IPC and SBP)12) Writing a medical paper (case report, chapter, etc) for possible publication. (M and IPC)13) Accurately assessing the performance of first year residents, rotating residents from other services and medical students. (IPC, P)14) Evaluating the accuracy, validity and usefulness of a publication or presentation on plastic surgery. (M and PBLI) 49
  • 50. * Competencies: PC = Patient Care, M = Medical Knowledge, SBP = Systems Based Practice, PBLI = Practice Based Learning and Improvement, IPC = Interpersonal and Communication SkillsTULANE ROTATION OBJECTIVESDr Newsome will oversee this rotation. The following categorieswill be emphasized: • Wound Care • Flaps and Grafts • Microsurgery • Implants and Biomaterials • Special Techniques • Functional Problems • Reconstruction of Head and Neck • Reconstruction of Trunk and Breast • Reconstruction of Lower Extremity • Congenital • Mohs • Benign and Malignant Skin LesionsThe resident will rotate at Tulane University for three months thefirst year and three months the second year with graduateresponsibility.OCHSNER ROTATION OBJECTIVESDr. Babycos will oversee this rotation. The following categorieswill be emphasized: 50
  • 51. • Wound Care • Flaps and Grafts • Reconstruction of Trunk and Breast • Facial Trauma • Microsurgery • Aesthetic • Congenital • Benign and Malignant Skin LesionsThe resident will rotate at Ochsner for three months the first yearand three months the second year with graduate responsibility.CHILDRENS ROTATION OBJECTIVESDr. Moses will oversee this rotation and the following categorieswill be emphasized: • Congenital • Embryology • Flaps and Grafts • Facial Trauma • MicrosurgeryAttention will be given to the care of patients at Children’sHospital. This rotation will afford the resident concentratedexposure to the breadth of pediatric plastic surgery. Under Dr.Moses’ direction, the resident will participate in the preoperativeevaluation and planning and post-operative follow-up of these 51
  • 52. patients. This rotation will be for three months during the secondyear.EAST JEFFERSON: HAND ROTATIONOBJECTIVESDr. George will oversee this rotation and the following categorieswill be emphasized: • Upper Extremity Reconstruction • Congenital Hand • Tumors of the Hand • TraumaThis rotation will afford the resident concentrated exposure tohand surgery. Under Dr. George and Clasen’s direction, theresident will participate in the preoperative evaluation andplanning and post-operative follow-up of these patients. Thisrotation will be for three months during the first year. Dr. Georgewill serve as the Local Training Director for this rotation.OUR LADY OF THE LAKE REGIONALMEDICAL CENTER ROATION OBJECTIVESDr. Jonathan Kaplan will oversee this rotation and the following 52
  • 53. categories will be emphasized: • Facial Trauma • Trunk and Breast Reconstruction • Lower Extremity Reconstruction • Burns • Microsurgery • Flaps and Grafts • Wound Care • Anesthesia and Critical Care • Practice ManagementThe resident will rotate on the BR for three month the first year.The resident will interact with and be exposed to a variety ofcases. This will be a General Plastic Surgery RotationTOURO: PRIVATE PRACTICE ROTATIONOBJECTIVESPRIVATE PRACTICE O BJECTI VESDr. Colon will oversee this rotation and the following RotationCompet encies will be emphasized: • Practice Management • Aesthetics • Functional Problems • Medicolegal and Psychiatric Assessment • Special Procedures 53
  • 54. • Implants and Biomaterials • Office Anesthesia • Benign and Malignant Skin LesionsThis rotation is primarily an operative experience with emphasisplaced on aesthetics and practice management butreconstruction will also be covered. The rotation will be for threemonths during the second year.THE EMERGENCY DEPARTMENTThe purpose of the experiences offered in these areas is toacquaint the resident with the characteristics of the critically illand less severely ill "WALKING WOUNDED." Understand thatthe patient believes that an emergency exists even though yourmedical judgment may indicate otherwise. Many problems will beavoided if this fact is kept in mind. Good communication betweenthe physician and the patient assist in continued patientimprovement after discharge.If in doubt, admit. Patients who have been discharged from theemergency department, after being deemed to have mildillnesses, but then subsequently return because of persistent orworsening symptoms shall be admitted. All ER patient contactsshall be discussed with appropriate faculty prior to institution ofcare.CONSULTATIONSConsultations should be seen promptly. When the consultation iscomplete, a telephone call to the physician requesting the 54
  • 55. consultation should be considered as part of your evaluation. If,for reasons of incomplete data a full consult is delayed, a shortprogress note indicating that the patient has been seen and thata formal consult will be forthcoming. A phone call will serve tokeep lines of communication open and will enhance the stream ofconsultations to the service (Systems Bases Practice andProfessionalism ). Surgeons who answer routine consultsimmediately and emergency consults even sooner have superioroperative case lists in both quantity and quality. Also, consultsshould be discussed with the attending staff in a timely mannerjust as any hospital admission would be.When consultations are seen in the Emergency Department, theevaluation should be designed to render an opinion in one houror less. It is far better to admit a patient and complete theevaluation on the plastic surgical service than to prolong the stayin the emergency department. Bickering over which service willadmit the patient will not be tolerated.OPERATING ROOMAnesthesiologists and operating room nurses are fellowprofessionals and full participants in the care of the patient(Systems Bases Practice and Professionalism ). Theydeserve and will receive the consideration and respect offered toany colleague.Remember, it is the patient that takes all of the risks. The fullattention of a skilled and collegial operating team should alwaysbe available. 55
  • 56. Attendance in the operating room is required for allpatients operated upon. First cases in the morning areto be ready and outside the operating room 20 minutesprior to the scheduled time to enable the case to startpromptly. See that permission for operation, X-rays,and orders have been properly handled the nightbefore surgery. The resident shall accompany thepatient into the operating room.The quality of assistance by a surgeon is directlyrelated to his/her understanding of a given procedure.Prior to the start of any procedur e, the residentinvolved should have read about the technic al aspectsof the procedure, possible complications, anymeasures that may be taken to either avoid or correctthese complications, and discuss the technique withhis/her staff. Also, the quality of an assistantindicat es his/her readiness to do a procedur e.Evaluation of a resident as an assistant is therefore animportant indicator of progress. At all times, theteaching assistant should be prepared to assume therole of operating surgeon.OPERATIVE CONSENTFor each procedure done on and for the patient, the patient mustbe fully informed of the risks and benefits of the procedure(Professionalism and Interpersonal and CommunicationSkills ). The operating surgeon should discuss with the patientthe details of the procedure, the other options for themanagement of the specific disease process involved, the 56
  • 57. chances of success and failure of the procedure and the longterm expected outcome. Having gotten consent, the surgeonmust write a preop note, not dealing with labs, but describing theindications, objectives, alternatives, risks and complications ofoperation.You shall rotate at on the particular service based on the blockschedule. Graduated responsibility is offered on all rotations andyou will interact with a variety of staff. You will work one-on-onewith the faculty (who will provide direct supervision) to understandthe importance of patient assessment, formulating and executinga plan and postoperative patient follow up. The emphasis on allrotations will be accomplishing the educational objectives,assisting the resident to develop independent thinking and allowthe faculty to directly assess residency competency.The plastic surgery resident is to assume responsibility for theday-to-day functioning of the plastic surgery clinical servicealways with direct faculty oversight. In order to obtain themaximal educational benefit, the plastic surgery resident shouldattempt to function in a manner as if the final responsibility washis. However, ultimate authority and responsibility, for all thepatients, rests with the attending. This means that the residentshould attempt to assess the problem and formulate a plan ofaction. The residents plan shall be based on accuratelyidentifying and effectively communicating the problem and basedon his medical knowledge the resident shall discuss potentialtreatment options. Through this maneuver, the resident optionfor patient care can be evaluated by the faculty and appropriatefeedback can be given. In addition the practice-based learning 57
  • 58. over time can be accessed.It is stressed however; the above concept shall not beconfused with a lack of resident supervision. Theresident shall not implement any plan of care in anindependent fashion. For all patients, on all services,all aspects of patient care require direct approval andoversight from the attending. In addition, the residentshall not delay treatment in an emergency situation.Furthermore, the resident shall refrain from discussingany therapeutic plan with the patient or family untilconfirmed with the attending.It is our mandatory policy that direct residentoversight, for all aspects of the patients care, on allrotations, without exception is to be ensured. The onlyresident autonomy we encourage is of thought, notaction.Continuity of care is achieved at all of the institutions throughresident participation in the various clinics. Faculty and residentswill participate in clinics together.Resident Expectations 1) The plastics resident is in charge of the plastic surgery clinical service understanding that ALL decisions regarding patient care must be reviewed with the attending staff. The faculty bears sole responsibility for the care of all patients at all times. 2) The plastic surgery resident, along with the faculty, 58
  • 59. assumes responsibility for the day-to-day management and care of all plastic surgery patients.3) He should see the patient in the preoperative holding area with staff. Preoperative markings will be performed by the resident and staff prior to the patient proceeding to the operating room.4) The resident shall accompany the patient into the operating room.5) Intraoperatively, the plastic surgery resident will perform cases with the discretion of the attending supervision.6) The resident is expected to have done pre operative reading and planning prior to surgery.7) The resident will be expected to have formulated a primary operative plan and several “back-up” operations.8) Postoperative orders will be reviewed by the plastic surgery resident and staff.9) The faculty will complete the operative dictation.10)The plastic surgery resident should examine all the patients on the service every day (written progress note). At the time of attending rounds, the plastics resident is responsible for updated information from other services involved in the care of the patients, as well as the patients current status in regards to their plastic surgery problem.11) Medical Student’s notes are not an acceptable form of documenting patient progress. It is acceptable to have the student follow the patient but there is no need for their chart documentation.12)The plastic surgery resident is on call during the day for the patients on service. At night, the call will either be covered by the plastic surgery resident “on-call” or the 59
  • 60. faculty on call.13) Weekends: When patients are in hospital on the weekend, they should be seen each morning by the plastic surgery resident or the general surgery resident on service depending on the call schedule. The attending will be available at all times 24 hours a day during the week AND weekend unless out of town at which time a back-up attending will be equally available.14) The plastic surgery resident should also remain available by beeper while on rotation unless he is scheduled off either for vacation or during his 24hr block off duty.15) The plastic surgery resident is responsible for reading thoroughly on the problems, which are germane to all in- house patients as well as those patients encountered in the clinic.16)The resident is expected to read and concentrate on the goals and objectives for the rotation assigned. Textbooks, journals, and videotapes are available in the Plastic Surgery Library and should be read and viewed on the premises unless special arrangements have been made with the attending. In the clinic, the plastics resident will evaluate all patients and will formulate a therapeutic plan in conjunction with faculty. The staff will examine, review and discuss all patients.17) Research: opportunities for clinical research, as well as basic science research, are available at Tulane, Charity and Ochsner. Experimental designs for basic science research should be presented to the attending and if meritorious will be presented to the research foundation for possible funding. The attending staff will offer assistance and guidance in the preparation and 60
  • 61. presentation of a basic research project. 18)The resident is required to be involved in the development of a paper sometime during his two-year residency. Research in which the resident developed a concept, or did the majority of work in regards to data collection, the resident will be listed as first author. 19) Consults: The plastic surgery resident is responsible for daily compilation of consults. Any new consults that appear should be seen in a timely manner then presented to the attending or seen in conjunction with the attending. Emergency room consults should be seen by the resident who will then contact the attending or in an emergency, contact the attending while in route to examine the patient. 20) All medical records must be done in a timely manner. 21) All communications from other services, whether from attendings, residents, interns, or nurses, should be communicated to the attending in an expedient manner. 22) The resident is an ambassador for the staff and the hospital and will be held to the highest standards. He must present himself in a respectful, professional, honest and congenial manner. 23) Sign all verbal orders within 24 hours. 24) Provide feedback for overall residency improvement.Tulane Rotation Schedule 2008-2009 61
  • 62. PGY 6 PGY 6 PGY 7 PGY 7 Jennifer C lifton Azul Jaffer Perry Liu Chan CannonJulyAugust Tulane EJ Ch ildrens OFHSeptemberOctoberNovember EJ Tulane OFH ChildrensDecemberJanuaryFebruary OLOL OFH Tulane TouroMarchAprilMay OFH OLOL Touro TulaneJuneTulane: Funding 1.0 FTE: Tulane UniversityNewsome Hospital/Lakeside Hospital(GeneralPlastic Faculty: Newsome, Chiu, Chaffin, Colon, St.Rotation) Hilaire, Jansen and Mizgala Tulane Goals and Objectives (Further outlined within the PIF under Section 9D2) • Wound Care 62
  • 63. • Flaps and Grafts • Microsurgery • Implants and Biomaterials • Special Techniques • Functional Problems • Reconstruction of Head and Neck • Reconstruction of Trunk and Breast • Reconstruction of Lower Extremity • Congenital • Mohs • Benign and Malignant Skin LesionsChildrens: Funding 0.5 FTE: Children’s HospitalMoses(PediatricRotation) Faculty: Moses, Chiu and St. Hilaire Childrens Goals and Objectives (Further outlined within the PIF under Section 9D2) • Congenital • Embryology • Flaps and Grafts • Facial Trauma • MicrosurgeryOFH: Funding 1.0 FTE: OchsnerBabycos Teaching Agreements: Ochsner Baptist/Fairway Medical (Secondary)(GeneralPlasticRotation) Faculty: Babycos and St. Hilaire Ochsner Goals and Objectives (Further outlined within the PIF under Section 9D2) • Wound Care • Flaps and Grafts 63
  • 64. • Reconstruction of Trunk and Breast • Facial Trauma • Microsurgery • Aesthetic • Congenital • Benign and Malignant Skin LesionsHand: Funding 0.5 FTE: East Jefferson HospitalGeorge Teaching Agreements: East Jefferson Surgery Center: (Secondary)(Hand Faculty: George, Clasen, Lindsey, Colon, Stokes,Rotation) Jansen, Escobar and Metzinger Hand (EJ) Goals and Objectives (Further outlined within the PIF under Section 9D2) • Upper Extremity Reconstruction • Congenital Hand • Tumors of the Hand • Trauma • Flaps and Grafts • Reconstruction of Trunk and Breast • Facial Trauma • MicrosurgeryTouro: Funding 0.5 FTE: Touro InfirmaryColon Teaching Agreements: Fairway/Hedgewood/Omega/GNO/East Jefferson: (Secondary)(Cosmetic Faculty: Chaffin, Moses, Colon, Lindsey, Church,Rotation) Escobar, Johnson, Black, Jansen, Metzinger, Dupin, Wise, Khoobehi and Mizgala Aesthetics (Touro) Goals and Objectives (Further outlined within the PIF under Section 9D2) • Practice Management • Aesthetics • Functional Problems 64
  • 65. • Medicolegal and Psychiatric Assessment • Special Procedures • Implants and Biomaterials • Office Anesthesia • Benign and Malignant Skin LesionsOLOL Funding 0.5 FTE: Our Lady of The Lake Regional(Baton Medical CenterRouge): Teaching Agreements: Baton RougeKaplan General/Aesthetic Surgery Center (Secondary) (GeneralPlastic Faculty: Kaplan, Boudroux, Williams, Stephens,Rotation) Guillot and Doucet OLOL Goals and Objectives (Further outlined within the PIF under Section 9D2) • Facial Trauma • Trunk and Breast Reconstruction • Lower Extremity Reconstruction • Burns • Microsurgery • Flaps and Grafts • Wound Care • Anesthesia and Critical Care • Practice Management • AestheticsEvaluationYou will be evaluated, throughout your training, on the ACGMEcore competencies. These should be reviewed and understood: 65
  • 66. a. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health b. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care c. Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care d. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals e. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population f. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal valuePlastic & Reconstructive Surgery ProceduralEvaluation Resident_____________________ Date __________________ Year: PS-1 PS-2 Procedure____________________________________________________ Satisfactory Areas for Unsatisfactory improvement 66
  • 67. 1. Demonstrates awareness of the patient’shistory, indications/contraindications andanatomical considerations2. Communication to the patient: operativeplan and informed consent3. Demonstrates appropriate preoperativeplanning4. Overall Surgical technique and handlingof tissues5. Performed the procedure in a safe,effective and expeditious manner5. Ability to recognize pathology ordevelop alternate plans6. Completeness of postop orders andhandwritten operative note COMMENTS:_________________________________________________ _____________________________________________________________ _____________________________________________________________ ____Resident has not yet demonstrated competence for this procedure. ____Resident has demonstrated competence for this procedure. ______________________ ______________________ Supervising Faculty Date Resident DateAs a prerequisite to successfully completing this fellowship you will berequired to successfully demonstrate procedural competence in each ofthe PSOL defined major categories. Once you are ready to be “checkedoff” on a procedure, inform the faculty prior to the procedure and then 67
  • 68. have him/her complete the above evaluation form which must bereturned to Debra Felix.DIDACTIC COMPONENTRotating through a variety of hospitals and clinics, the residencystrives to create a balanced and comprehensive plastic surgerytraining program. We have incorporated the best of both worlds;University based training and Private Practice exposure. Therotations are planned to offer an increase in responsibility duringthe two years of training. Each of the hospitals has asubspeciality area of interest, which allows the resident to focustheir training.During all rotations the educational philosophy is the same. It isthat of wide latitude in intellectual inquiry but very closesupervision of specific patient care with gradual assumption ofclinical decision-making and operative responsibility. Twotraining methods are fundamental to this philosophy, one forcognitive activities and one for technical matters (Medic alKnowledge).The first is that in all cognitive activities the resident is required to"make a plan" prior to discussing the problem with the attending.Basic core knowledge is required for this activity and teaching ofthis material will be performed on a daily basis utilizing patientexamples. Attendings will not dictate diagnostic or therapeuticplans. The resident "makes a plan" which is then discussed withthe attending and together a treatment algorithm is created. Thismethod of "making a plan" and then defending it against thecritique of the attending physician trains the resident and permits 68
  • 69. him to assume increasing levels of independence. It is the goalthat at the completion of his/her training the resident will havemade sufficient independent decisions (under faculty supervision)that he/she can easily assume the position of an independentphysician. This philosophy holds for all patients on the wards, inthe clinics, pre- and postoperatively, and throughout the program.CONFERENCESTo further develop and promote resident education the ProgramDirectors of both Tulane and LSU have, combined our didacticprograms. Faculty from both the schools teach all residents. Weshare one common goal; optimize resident education by utilizing thebest teachers regardless of school affiliation, practice demographicsor even specialty: Dermatology, ENT Plastic Surgery all contribute.With participating dedicated and enthusiastic faculty we will alwaysstrive towards our primary objective: EDUCATION. The 2008-2009 Conference Schedule has been developed to facilitate Competency Based Learning, examples: i. Basic Medical Knowledge 1. Aesthetic Conference 2. Core Curriculum 3. Grand Rounds Topics 4. Hand Conference 5. Mock Oral Exam ii. Patient Care: 1. Case Presentation 2. Visiting Professorship iii. Practice Based Learning and Improvement: 1. Patient Safety Conference (M&M) 2. Journal Club 69
  • 70. iv. Systems Based Practice: 1. Resident Research Day 2. Grand Rounds Topics: a. Patient Placement b. Social Services c. Harassment Training d. Compliance Training 3. Sculpture Class v. Professionalism 1. Grand Rounds Topics: a. Ethical Coding b. Malpractice vi. Interpersonal and Communication Skills: 1. All conferences vii. Procedural 1. Microsurgery Lab 2. Anatomy Lab Curriculum Format and Resident Responsibilities1) It is the resident’s responsibility to approach your assigned staff for the lecture topic at least 1 month in advance. The entire year’s didactic calendar is distributed in advance so failure to do so is unacceptable.2) After discussion with your assigned staff for the topic in question, it will be the staff’s decision whether they would like to give the Grand Rounds on Thursday evening at 5:30pm or if they would like you, the fellow, to give the assigned Grand Rounds. Thursday evening conference is at East Jefferson (EJ) Hospital in the Conference Center.3) The staff will recommend articles for the fellow to collect and then the fellow will distribute those articles electronically to everyone via e-mail at least one week before the topic is discussed in conference. Assigning one article per LSU and Tulane fellow (total of 8 articles) is more than enough. 70
  • 71. 4) The fellow will glean all of the inservice questions from 1998 through 2008 and place the questions appropriate to that week’s topic in a MS Word document (without the correct answer) but leaving the explanation just beneath each question.5) These questions and articles will be discussed from 7am to 8:30am on Friday morning and proctored by either the staff or fellow (staff’s choice). Friday morning conference is in the LSU Allied Health Building.6) From 8:30 to 9am, pre/postop conference will take place. EVERYONE should always be prepared EVERY WEEK to present a case. While your case may not be presented every week, you should always have one available.7) M&M conference is the 4th Thursday of every month from 6:30p to 7:30p at EJ. Cases should be submitted to the program coordinator on Monday of that week. Core Curriculum Conference: The Core Curriculum Conference is a joint conference attended and staffed by the residents and faculty of both programs. A yearly schedule is promulgated in July and adhered to as much as possible. The conference is organized by the faculty with direct resident input. Attendance is mandatory for residents. Medical Students and rotating residents on both services also are required to attend. The basic format utilizes Selected Readings in Plastic Surgery. This well recognized publication contains 40 volumes, including reference materials. Each subject is handled once during the year. Residents are required to read both Selected Readings and assigned articles of clinical significance. Each 71
  • 72. session covers Medical Knowledge, Patient Care,PBLI, Technical aspects of Procedures and oftenSystems Based Practice.The conference is approximately one hour long.Preoperative and Postoperative ConferenceCase ConferenceThis is a weekly conference and resident’s attendanceis mandatory. Medical students and rotating residentsalso attend.Each service presents one or two patients. Thepresentations are done on “Power Point” which is agood use of information technology in residenteducation. All patient presentations include history,photo documentation of the pathology and operativeplan. The resident is evaluated on the accuracy andcompleteness of the information gathered about thepatient. This session covers PBLI, IPCS, MedicalKnowledge, Patient Care, Procedural BasedLearning, and Systems Based Practice.Because the other services are not familiar with thepatient, the presentations are used as an “unknown“for the audience. The residents are asked to proposea diagnosis and asked to explain the basis for theirdecision. The presenting resident then must develop aplan of management and defend alternate plansbefore the faculty: 1) Presenters are expected to provide support based on the literature (text and journals) for the planned management. 2) Presenters are expected to make informed decisions about their treatment plan 72
  • 73. based on the historical record and the scientific evidence supporting the plan and this must be accurately articulated. 3) This allows all to evaluate the resident’s analytical processes and the ability to propose and defend a reasonable management plan.This exercise, in addition to our Patient SafetyConference, allows evaluation of the resident’scommunication skills, Medical Knowledge, PBLI, PCand Procedural Based Learning. We also frequentlydiscuss ethical issues, professionalism and theeconomic impact of treatment plans.Anatomy LaboratoryIn the fall of each year, a joint Anatomy Lab is held.Funding for this session is provided by both schools.A schedule of dissection is published. Each session isapproximately 4-5 hours in length and begins with adiscussion by an assigned faculty member who thenleads the individual breakout resident dissectionteams.A dissection manual is supplied to the residents.Flap procedures are demonstrated during dissectionas well as surgical techniques relevant to theanatomic area. This helps the resident to developskills needed to perform surgical procedurescompetently. This session covers MedicalKnowledge, Procedural Based Learning and PatientCare. 73
  • 74. Microsurgery LaboratoryTulane University has a microsurgery laboratory withveterinary and animal support. This laboratory isheld at the beginning of the academic year and eachresident participates as frequently as required tobecome proficient. Residents learn the basicmicrosurgical skills under the tutelage of a facultymember. Senior residents participate in teaching ofthe junior residents. Residents are expected toperform venous and arterial anastomosis which isanalyzed by the faculty. This session coversProcedural Based Learning, Patient Care andMedical Knowledge.Grand RoundsThursday Grand Rounds involve a variety ofprograms on a regularly scheduled basis. 1) Morbidity and Mortality (Patient Safety Conference) is held monthly. Two patients are presented by each service. These cases are “Power Point” presentations, presented by the resident involved in the care of the patient. The goal of the conference is the prevention of complications by PBLI and changes in patient care, procedures, effective communication among providers ultimately to reduce complications. Treatment of complications is discussed with the faculty to access their practice experience. This session 74
  • 75. covers PBLI, IPCS, Medical Knowledge, Procedural Based Learning, Systems Based Practice to improve Patient Care. 2) Grand Rounds Conference is held twice monthly. In this conference, residents and faculty present lectures on specified topics. We also have lectures by others in the health care field. Recently we have had sessions on coding, ethics, patient safety and access to varying levels of care. As part of our Grand Round Series we have a Visiting Professorship where a nationally known expert comes and presents several focused lectures on an important key topic. This session covers PBLI, IPCS, Medical Knowledge, Procedural Based Learning, Patient Care and Systems Based Practice. Journal Club Journal Club is held monthly. Residents are assigned journals articles to read and present. They are expected to discuss study designs and statistical methods and to appraise the clinical studies. Residents are required to attend, and normally many of the faculty also are in attendance. This session covers PBLI, IPCS, Medical Knowledge, Procedural Based Learning, Patient Care and Systems Based Practice.PLASTIC SURGERY OPERATIVE LOG(PSOL) 75
  • 76. The Plastic Surgery Operative Log (PSOL) is a mandated recordof the operative cases done during the residency training. This isrequired by both the Residency Review Committee (RRC) andthe American Board of Plastic Surgery (ABPS) to assess thenumber of cases done by each individual resident and thesurgery resident corps as a whole. The numbers affect both theaccreditation program and the application for Board examinationof each individual resident. The PSOL is divided into severalcategories of case types, with assigned minimal numbers foreach category, the overall total during residency training and thenumber of cases done during the chief year. These numbersvary and are changed from year to year and therefore are notincluded in this manual. It is urged, however, that you get thecurrent minimum number. It is imperative that this data be keptaccurate and current on a weekly basis. As a requirement forcompleting the residency program, every resident mustdemonstrate competency in each of the defined major PSOLcategories along with meeting the minimum requirements andalso having completed a minimum of 1000 cases/two years.RESEARCH PROJECTS The Tulane Plastic Surgery research program is directed by Dr. Ernest Chiu. Both basic science and clinical research projects are available. Residents are required to produce one research project during the fellowship period. Twice a year, resident research day is held where the residents present, discuss and defend their research efforts. Clinical Sciences Research 76
  • 77. i. Breast Reconstruction (Techniques & Quality of Life Issues) ii. Head & Neck Reconstruction (Anatomical Studies) iii. Vascular Malformation iv. Diabetic Wound Repair using Human Adult Stem CellsSupraclavicular Artery Flap in Head and NeckReconstructionCo-Investigators:Ernest S. Chiu, MD (Department of Surgery)Paul Friedlander, MD (Department of Otolaryngology)We are the first to describe a new less invasive flap foroncologic reconstruction. Donor site morbidity,operative time, and recovery time has been reduced.Clinical outcomes studies are actively beinginvestigated.Basic Sciences Research:Breast Cancer and Adipocyte Stem Cell InteractionCo-Investigators: 77
  • 78. Ernest S. Chiu, MD (Department of Surgery) Bruce Brunnell, PhD (Tulane Gene Therapy Center) Brian Rowan, PhD (Tulane Cancer Center) We are investigating the interaction of adipocyte stem cells with breast cancer cells. Adipocyte stem cells are being used to treat post-mastectomy radiated tissue defects. However, the safety of grafting stem cells into an oncologically transformation prone region is not. ADSCs are multi-potent stem cells that release a number of growth factors, making them mitogenic and potentially carcinogenic, especially in an environment already prone to transformation. Further, the paracrine interactions between ADSCs and malignant epithelial cells promote breast cancer growth, and could increase the risk of recurrence. Internal and extramural grants are being actively completed for funding.Novel Treatment Head/Neck Cancer using Nanotechnology Co-Investigators: Ramesh Ayyala, (Department of Ophthalmology) Ernest S. Chiu, MD (Department of Surgery) Paul Friedlander, MD (Department of Otolaryngology) Working with Dr. Ayala and Friedlander, we are investigating the use of nanotechnology to improve overall outcome in head/neck cancer patients. Cancer therapeutic drugs can be cross-linked with biologically degradable (hyaluronic acid) scaffolds and directed to tumor sites after ablative surgery. Animal models using this novel technique will be needed to examine drug delivery efficiency and efficacy. 78
  • 79. Dr. Newsome and Chiu are also collaborating with Dr. Eckhard Alt in the section of cardiology separating and culturing Stem Cells from human adipocyte tissue (ADSC). Ongoing experiments are designed to: R. Edward Newsome, MD: Participant in the Sun Belt Melanoma Trial. A multicenter trial of adjuvant interferon ALFA-2B for melanoma patients with early lymph node metastasis detected by lymphatic mapping and sentinel lymph node biopsy. Research Space Currently, surgical research is financially supported by the Department of Surgery. A modern laboratory equipped with modern surgical dissecting microscopes, gel electrophoresis, protein purification, tissue culture hoods, EMG recording, is being constructed. The majority of our collaborators are located in the same building. A certified animal care facility is also in the building.ACGME: Definition of surgeonBasic Principle: To be recorded as the surgeon, a resident must be present forall of the critical portions, and must perform the majority of the critical portionsof the procedure. Involvement in the preoperative assessment and thepostoperative management of that patient is an important element of thatparticipation.Clarifications: 1. If a plastic surgery resident completes one side of a bilateral procedure, the resident can count that as one case, surgeon. If a plastic surgery resident completes both sides of a bilateral procedure, this still counts as one case, surgeon. If two residents each do one side of a bilateral procedure, each resident can record the procedure 79
  • 80. as the surgeon, provided that each fulfills the stated criteria for performance as surgeon on one side. 2. In an operation which involves multiple procedures, more than one plastic surgery resident may be recorded as the surgeon, provided that the resident performs the majority of the critical portions of one or more of the procedures, e.g., tendon repair, vascular repair, nerve repair in a complex hand injury case. If there are multiples of the same procedure in one case,(i.e., tendon or nerve repair), and each resident performs to completion one or more of the repairs, each resident may claim that case as surgeon. 3. In the circumstances where a fellow, e.g., a hand fellow, oversees a plastic surgery resident in the performance of a procedure, both the fellow, as the teaching assistant, and the plastic surgery resident may be recorded as the surgeon. 4. If a senior plastic surgery resident oversees a junior plastic surgery resident on a particular case, both may be recorded as the surgeon, providing they meet the stated criteria above.GENERAL INFORMATION a) Orders i) The nurses, other physicians and the hospital must know which physician writes orders and be able to correctly interpret them. The physicians name, physician number, along with the date and time, should be printed legibly in the left hand margin of the order sheet. This is part of your evaluation as determined by Systems Based Practice and Communication Skills. 80
  • 81. ii)Orders should be written in such a manner that the nurse can accurately read and understand them. If your script is hard to read PRINT.iii) Flag the orders properly after completion. If they are emergency or stat orders, hand the chart to the nurse and tell her what the order says. Leave nothing to chance.iv)Medications should be written out mg/kg/day followed by mg/dose and the frequency the dose is to be given.v) Fluid orders should be the type of fluid followed by the rate of administration.vi) The use of verbal orders is discouraged. Residents failing to sign verbal orders which were necessary within 24 hours will have verbal order privilege revoked!vii) Please notify charge nurse or ward clerk if you are removing any chart from the station.viii) Admit orders are needed prior to the admission of the patient.ix)Discharge orders are to be completed as early as possible unless prevented by necessary patient care responsibilities.x) Nursing will ask for order clarification (if unclear) for safe delivery of care. This is not an attempt to challenge your knowledge but to assist in patient care. Clarification will be offered using a professional tone and manner in every instance.xi) Verbal orders MUST all be signed the following day.xii) Prescription for medications and supplies need to be written on Friday for week-end discharges. 81
  • 82. xiii)STATS are expensive - please use discretion when ordering something STAT. xiv)Please return charts to chart rack when completed. xv) Ordering "routine" laboratory studies is not in the best interest of good patient care. Unless you can write down one or more ways in which patient care will be assisted by the study, it is probably unnecessary. Stable values rarely change without a change in clinical condition. Cultures and other laboratory studies are expensive. Do not order unless you have a plan to alter patient care based on the results. Check at least every six months the price of various tests and medication so that you can properly appreciate the rising cost of medical care.b) Progress Notes i) Progress notes should be identified with printed name, physician number, and date and time in the left margin. All notes are to be signed when written. ii) Medical Student’s notes are not an accept able form of documenting patient progress. It is accept able to have the student follow the patient but there is no need for their chart document ation. iii) Progress notes should be written when any procedure is performed or there is a change in the condition. iv)There should be at least one note each day as to the patients general condition and plans for the next 24 hours. 82
  • 83. DRESS CODESA well-groomed professional appearance inspires the confidenceof patients, their families and visitors. Clothing must be neat,clean and appropriate for the work required and moderate instyle. Jeans, cut-offs, shorts, T-shirts, etc., are not acceptableclothing for professionals in the hospital.Patients recognize the white coat as a symbol of a medicalprofessional and should be worn at all times.Operating room attire (scrub suits) must be covered by a whitecoat if worn outside the O.R. When such clothing is worn itshould be clean and not covered by body fluids.Shoes should be medium or low heeled, clean and polished.Sandals are not allowed. Stockings/socks/hose should be clean,in good condition and worn at all times where appropriate.Jewelry should be used with moderation.Good personal hygiene is extremely important to patient care aswell as the comfort of co-workers and is an integral part of aproper professional attire policy. Professionals should be cleanand well-groomed at all times.Tobacco chewing and gum chewing are not appropriate forphysicians on duty. 83
  • 84. SCHEDULING REQUIREMENTSAll patients scheduled for the OR require: 1) History and physical (ODS patients use the ODS history and physical form 2) Consent for surgery (valid for 30 days) 3) Consent for hospital admission 4) Pre-operative work up orders: a. Type of admit (ODS or SSU) b. patients 40 years or older where anesthesia is planned require: CBC, UA, EKG, Chest X-RayCall the Anesthesia Department if you have any questions abouta specific patient while in clinic.Note: Anesthesia writes preoperative medication orders for allgeneral anesthesia patients.Note: For “in custody" patients do not tell the prisoner or theguard the day of surgery or admission. The Admit Office willcontact the facility to inform them of the date.DISASTER PLANThe physician component was developed by the trauma committee andintegrated into the overall hospital plan.A full review of the Disaster Plan is required. Clear lines ofcommunication and responsibility will be distributed as a separate policy:http: / /e mergen cy. t ulane. edu/ 84
  • 85. DAYS OFFOn your days off (including weekends) you are responsible forthe care of your patients prior to leaving the hospital. Do notleave work on your ward to be done by the on-call House Officerat your level. If a patient on your ward needs special attention,discuss this with the On-Call House Officer at your level beforeleaving the hospital.VACATION TIMEEach resident will receive 3 weeks (21 days) of vacation each year. Nomore than 7 days vacation per rotation. Only one resident may takevacation at any one time with senior residents getting priority. NOvacations allowed in June or July. All vacation time requires formalleave request and pre-approval (both Program Director and local trainingdirector). Any changes after the schedule is published must berequested in writing to the Program Director.MeetingsOne paid meeting per resident/residency. With approval, residents mayattend additional meetings at his/her own expense. Meeting attendance(paid or unpaid) does count towards vacation time.Sick LeaveIf a resident calls in sick, it is the prerogative of the Program Director toask for a doctors excuse from the resident.Each resident must be aware that the RRC for plastic surgery allowsonly a certain amount of absence from training per year. Absencebeyond that designated time--be it for vacation or sick leave--will extend 85
  • 86. their time in training.As has been pointed out in other sections of this manual, theresponsibilities to your patients is paramount both now as a resident andfor the rest of your professional life. If you cannot provide that patientcare because of illness, death in the family or required absence from thecity, you must make sure your patients are adequately covered and thatthe staff on the service to which you are assigned understands yourneed to be absent and they have given permission.BenefitsResidents Health Plan: Residents and Fellows are required to enroll inthis plan unless they are covered under another health plan. The cost ofresidents’ health insurance is a responsibility of the school.Spouses or dependents can be enrolled at registration at residentsexpense. Late enrollment is subject to review. Premiums are negotiatedyearly and are determined by the previous years experience and use. Parking – Parking is provided for residents assigned to MCLNO, University Hospital, TUHC, and VAMC NO. Beeper – Beepers are provided for the duration of the residencies. Health Insurance – United Health Care health insurance is provided to residents at no cost. Family health coverage is available and is paid for by the residents. Dental Insurance – Optional dental insurance is provided through Paid Dental Insurance Company and is available to residents and their families. It is paid for by the residents. 86
  • 87. Life Insu rance – A $25,000 life insurance policy is provided at not cost to residents. Disabilit y Insurance – Disability insurance is provided at not cost to the residents. Malpractice Insuran ce – Malpractice insurance is provided at not cost to the residents. Educat ional Leave – With the approval of the program director, educational leave allowed in some programs Vacations – Residents are allowed vacation, the duration is determined by individual programs. Salary – 2007-2008 annual salaries for residents are as follows: HO-I $42,757 HO-II 44,015 HO-III 45,620 HO-IV 47,463 HO-V 49,100 HO-VI 51,247 HO-VII 51,247Institutional Policies: please review the followingwebsite 87
  • 88. http://www.som.tulane.edu/departments/gme/resources_residents.htm Map of the Health Sciences Center Incoming House Officers Resident Handbook Resident Congress Constitution Resident Congress Bylaws Risk Management Medical Malpractice Louisiana Malpractice System Benefits and Compensation Louisiana State Board of Medical Examiners Insurance Information Residents Assistance Program Medical Library Reily Center Tulane University Hurricane Emergency Preparedness Office of Environmental Health and Safety HIPPA Sexual HarassmentAt the above website you will find information regarding theprobation, suspension, termination and grievance policy. 88
  • 89. This is located via the link which says: Resident Handbook.ABPS REQUIREMENTSSee website for updated information:http://www.abplsurg.org/Program Directors of accredited residency training programs in plasticsurgery must require all residents to have an official evaluation andapproval of their prerequisite training by the Board before they beginplastic surgery training.TRA INI NG RE QUIRE MENTSThere are two approved educational (training) models for plastic surgery,the Independent Model and the Integ rat ed Model . A plasticsurgery program director may choose to have both training models in asingle training program. Several organizations provide governance forthese models. These are the Residency Review Committee for PlasticSurgery (RRC-PS) of the Accreditation Council for Graduate MedicalEducation (ACGME), which sets educational requirements and accreditstraining programs in plastic surgery; the Association of AcademicChairmen of Plastic Surgery (AACPS), which helps coordinate thetraining activities of the programs; and The American Board of PlasticSurgery, Inc. (ABPS), which sets educational requirements, examinesand certifies the graduates of those programs. In both the integrated andthe independent models, plastic surgery training is divided into two parts: 1. The acquisition of a basic surgical science knowledge base and experience with basic principles of surgery (PREREQUISITE TRAINING in the Independent Model). 2. Plastic surgery principles and practice, which includes advanced knowledge in specific plastic surgery techniques (REQUISITE TRAINING). 89
  • 90. In the independent model, the residents complete the PREREQUISITETRAINING outside of the plastic surgery residency process, whereas in theintegrated model, residents complete all training in the same training program.In a combined or coordinated program, residents complete the prerequisitetraining for the general surgery training program in the same institution as theplastic surgery program.Residents may transfer, prior to the last two years, from an IndependentProgram to another Independent Program and from an Integrated Program toanother Integrated Program, but they may not exchange accredited years oftraining between the two different models without prior approval by TheAmerican Board of Plastic Surgery, Inc. and the Residency Review Committeefor Plastic Surgery. Residents must request any anticipated transfers in writingand obtain prior approval by the Board well in advance of the proposed changein programs.The minimum acceptable residency year, for both prerequisite and requisitetraining, must include at least 48 weeks of full-time clinical training experienceper year. A leave of absence during training will not be included towardcompletion of the minimum 48 weeks requirement. This includes Military Leaveand Maternity/Paternity Leave.INDEPENDENT MODELThis model includes programs with two or three years of plastic surgerytraining. The Independent Model has two options. The first option has twovariations. Each of the pathways described satisfy the requirements of theBoard for entry into the certification process. 1) Option 1, variation A: requires at least three years of ACGME- approved clinical general surgery residency training in the same institution with progressive responsibility to complete the PREREQUISITE requirements of the Board. Residents must complete a minimum requirement of 36 months of training including specific rotations, which are noted later in this Booklet of Information. This requirement of the Board stipulates that a 90
  • 91. minimum of three years of clinical training in general surgery, with progressive responsibility, in the same program must be completed before the resident enters a plastic surgery residency. 2) Option 1, variation B: is the “combined” or “coordinated” residency. This option is the same as option #1A, with the exception that medical students are matched into an ACGME-approved general surgery training program with a non-contractual understanding that they will become plastic surgery residents at the same institution after satisfactorily completing the three-year minimum PREREQUISITE requirement in general surgery. During this time they are considered residents in general surgery with an “expressed interest” in plastic surgery, but are not considered plastic surgery residents by the RRC- PS, AACPS, or ABPS until completing the PREREQUISITE training program and entering the requisite training years. These programs are not differentiated in the ACGME’s Graduate Medical Education Directory (the “Green Book”), but rather are found listed among general surgery and independent plastic surgery programs. PREREQUISITE AND REQUISITE requirements are completed at the same institution in this model. 4) Option 2: is available for residents who have satisfactorily completed a formal training program (and are board admissible or certified) in general surgery, neurological surgery, orthopedic surgery, otolaryngology, urology, or oral and maxillofacial surgery (the latter requiring two years of clinical general surgery training in addition to an M.D./D.D.S. or D.M.D.). Successful completion of these ACGME or ADA accredited programs fulfills the PREREQUISITE training requirement.Residents can officially begin a plastic surgery training program (REQUISITETRAINING) after completion of any of these PREREQUISITE options, which allrequire confirmation by the Board (Completion of the Request for Evaluation ofTraining Form with receipt of the Board’s Confirmation Letter regarding theacceptability of the prerequisite training for the Board’s certification process).In the Independent Model options, only the REQUISITE period of training is 91
  • 92. under the supervision of the RRC-PS. However in the “combined” model, thegeneral surgery years are accredited by the RRC for General Surgery and notthe RRC-PS. REQUISITE TRAINING Graduate Education in Plastic Surgery Two years of plastic surgery training is required, and the final year must be at the senior level. Residents are required to complete both years of a two-yearprogram in the same institution. Content of TrainingResidents must hold positions of increasing responsibility for the care ofpatients during these years of training. For this reason, major operativeexperience and senior responsibility are essential to surgical education andtraining.An important factor in the development of a surgeon is an opportunity to grow,under guidance and supervision, by progressive and succeeding stages toeventually assume complete responsibility for the surgical care of the patient.It is imperative that residents hold positions of increasing responsibility whenobtaining training in more than one institution, and one full year of experiencemust be at the senior level. The normal training year for the program must becompleted. No credit is granted for a partial year of training.The Board considers a residency in plastic surgery to be a full-time endeavorand looks with disfavor upon any other arrangement. The minimum acceptabletraining year is 48 weeks. Should absence exceed four weeks per annum forany reason, the circumstances and possible make-up time of this irregulartraining arrangement must be approved by the program director and theadditional months required in the program must be approved by the ResidencyReview Committee (RRC-PS) for Plastic Surgery and documentation of thisapproval must be provided to the Board by the program director. No credit but 92
  • 93. no penalty is given for military, maternity/paternity or other leaves duringtraining. Candidates in the examination process called to active military duty donot need to submit a reapplication if five years expire during the active dutyperiod.Training in plastic surgery must cover the entire spectrum of plastic surgery. Itshould include experience in both the functional and cosmetic management ofcongenital and acquired defects of the head and neck, trunk, and extremities.Sufficient material of a diversified nature should be available to prepare theresident to pass the examinations of the Board after the prescribed period oftraining.This period of specialized training should emphasize the relationship of basicscience, anatomy, pathology, physiology, biochemistry, and microbiology, tosurgical principles fundamental to all branches of surgery and especially toplastic surgery. In addition, the training program must provide in-depth exposureto the following subjects: the care of emergencies, shock, wound healing, bloodreplacement, fluid and electrolyte balance, pharmacology, anesthetics, andchemotherapy ACCREDITED RESIDENCY PROGRAMSInformation concerning accredited training programs for the Independent Modelmay be found in the Directory of Graduate Medical Education Programs ("thegreen book") published by the American Medical Association (AMA) under theaegis of the Accreditation Council for Graduate Medical Education (ACGME).This directory is available at many medical schools and libraries, or may beordered directly from the AMA by calling toll free 1-800-621-8335, or by writingto: Order Department OP416702, American Medical Association (AMA), P.O.Box 930876, Atlanta, GA 31193-0876, www.ama-assn.org.The Board does not inspect or approve residencies. The Residency ReviewCommittee (RRC-PS) for Plastic Surgery inspects and makes recommendationsfor or against approval of a residency training program in plastic surgery onlyafter the director of the residency has filed an application for approval by theResidency Review Committee (RRC-PS) for Plastic Surgery. For information 93
  • 94. contact the office of Doris A. Stoll, Ph.D., 515 North State Street, Suite 2000,Chicago, Illinois 60610; (312) 755-5499; www.acgme.org.The Residency Review Committee (RRC-PS) for Plastic Surgery consists ofnine members, three representatives from each of the following: The AmericanBoard of Plastic Surgery, Inc., the American College of Surgeons, and theAmerican Medical Association.Updated: 09/12/08 94