Plastic Surgery Integrated (DOC)

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					                    RESIDENCY REVIEW COMMITTEE FOR PLASTIC SURGERY
              515 N State, Ste 2000, Chicago, IL 60654  (312) 755-5000  www.acgme.org

                         TRACK-SPECIFIC PROGRAM INFORMATION FORM
                             INTEGRATED FORMAT (6-Year Program)

10 Digit ACGME Program I.D. #:
Program Name:

TABLE OF CONTENTS

When you have the completed forms, number each page sequentially in the bottom center. Report this
pagination in the Table of Contents and submit this cover page with the completed PIF.

                                        Common PIF                                          Page(s)
Accreditation Information
Participating Sites
Responses to Previous Citations (New Application Only)
  Sponsoring Institution/Single or Limited Residency Institution (If applicable)
Program Personnel/Resources (New Application)
Faculty/Teaching Staff (Continued Accreditation)
  Program Director Information
  Physician Faculty Roster
  Faculty Curriculum Vitae
  Non Physician Faculty Roster
  Non Physician Faculty Curriculum Vitae
  Program Resources (New Application Only)
Resident Appointments
  Number of Positions
  Actively Enrolled Residents (if applicable)
  Aggregated Data on Residents Completing or Leaving the Program for the last 3 years (if
  applicable)
  Residents Completing Program in the Last 3 years (if applicable)
  Transferred, Withdrawn, and Dismissed Residents (if applicable)
Evaluation
Resident Duty Hours
Resident Scholarly Activities (New Application Only)

                                   Specialty Specific PIF                                   Page(s)
Program Personnel and Resources
   Program Director
   Faculty
   Other Program Personnel
Resident Appointment
Patient Care
Medical Knowledge
Interpersonal and Communication Skills
Practice-based Learning and Improvement
Professionalism

                                        Plastic Surgery - Integrated i
                                   Specialty Specific PIF                    Page(s)
Systems-based Practice
Residents’ Scholarly Activities
Resident Operative Experience (continued accreditation only)

                   Track-Specific PIF - Integrated Format (6-Year Program)   Page(s)
Transition to Integrated Program (New Application Only)
Program Personnel & Resources
Patient Care
Medical Knowledge
  Conference Schedule
Residents’ Scholarly Activities
Resident Operative Experience




                                       Plastic Surgery - Integrated ii
                      RESIDENCY REVIEW COMMITTEE FOR PLASTIC SURGERY
                515 N State, Ste 2000, Chicago, IL 60654  (312) 755-5000  www.acgme.org

                            TRACK-SPECIFIC PROGRAM INFORMATION FORM
                                INTEGRATED FORMAT (6-Year Program)

TRANSITION TO INTEGRATED PROGRAM (NEW APPLICATIONS ONLY)

   Provide a description and resident schedule for all years of the transition to the integrated program. (PR
   III.B.1.-3.)



PROGRAM PERSONNEL AND RESOURCES

1. Does the plastic surgery program director have the authority to direct six years of clinical surgical
   education for residents in the integrated program? (PR Intro.B.2.a)) ........................ ( ) YES ( ) NO

   If no, explain:


2. Briefly describe the relationship between the plastic surgery program director and other services
   providing assignments for residents in the integrated program. (PR Intro.B.2.a))



3. Provide a statement from the appropriate official(s) of the sponsoring institution (hospital or medical
   school) that supports the authority of the plastic surgery program director to control the entire integrated
   residency program. (PR Intro.B.2.c))



4. Provide a statement regarding the funding of residency positions for the entire integrated program. (PR
   II.A.1.)



PATIENT CARE

1. How are residents provided with experience in: (PR Intro B.2.c.)

                                                                               Method(s) Used to Assess
    Competency Area                      Settings/Activities                   competence
    Abdominal surgery
    Alimentary tract surgery
    Breast surgery
    Emergency medicine
    Pediatric surgery
    Surgical critical care
    Surgical oncology
    Transplant
    Trauma management


                                           Plastic Surgery - Integrated 1
                                                                        Method(s) Used to Assess
    Competency Area                  Settings/Activities                competence
    Vascular surgery

2. Block Diagram (PR IV.A.5.a and Intro B.2.)

   Complete one for each year of the integrated format program. The block diagram must include the type
   of assignment (general, hand, burn, cosmetic, etc.) and the site where the educational assignment
   occurs. Provide a key for any abbreviations or acronyms used. Note that all sites where residents are
   assigned must be listed. See the Common PIF for the previously listed participating sites.

   a) Year: PY-1

       Month              Rotation Type              Inpatient/Outpatient                Site
       1
       2
       3
       4
       5
       6
       7
       8
       9
       10
       11
       12

   b) Year: PY-2

       Month              Rotation Type              Inpatient/Outpatient                Site
       1
       2
       3
       4
       5
       6
       7
       8
       9
       10
       11
       12

   c) Year: PY-3

       Month              Rotation Type              Inpatient/Outpatient                Site
       1
       2
       3

                                       Plastic Surgery - Integrated 2
   Month        Rotation Type            Inpatient/Outpatient   Site
   4
   5
   6
   7
   8
   9
   10
   11
   12

d) Year: PY-4

   Month        Rotation Type            Inpatient/Outpatient   Site
   1
   2
   3
   4
   5
   6
   7
   8
   9
   10
   11
   12

e) Year: PY-5

   Month        Rotation Type            Inpatient/Outpatient   Site
   1
   2
   3
   4
   5
   6
   7
   8
   9
   10
   11
   12

f) Year: PY-6

   Month        Rotation Type            Inpatient/Outpatient   Site
   1
   2

                           Plastic Surgery - Integrated 3
       Month               Rotation Type               Inpatient/Outpatient                 Site
       3
       4
       5
       6
       7
       8
       9
       10
       11
       12

3. Provide the sample goals and objectives for one rotation.



MEDICAL KNOWLEDGE - CONFERENCE SCHEDULE (PR IV.A.5.b.(1)-(2))

List the didactic conferences offered for resident education. Do not include specific conference schedules,
posters, or advertisements. Use a separate table for conferences at participating sites (add tables as
necessary) and a separate table for conferences during each non-plastic surgery rotation. Describe each
conference topic thoroughly. For example, “Hand” is not sufficient. However, “Evaluation and Treatment of
Compression Fractures of the Upper Extremity” would be sufficient.

Add rows as needed.
Site #1                      Service (e.g., plastic, orthopaedic, hand, etc.):
Conference Type: (Basic                              Required                  Individual(s) or Department
Science, Journal Club,                                   or                          Responsible for
Pathology, etc.)              Conference Topic Optional           Frequency      Conducting Conference




Site #2                      Service:
Conference Type: (Basic                              Required                 Individual(s) or Department
Science, Journal Club,                                  or                          Responsible for
Pathology, etc.)              Conference Topic       Optional       Frequency   Conducting Conference




                                         Plastic Surgery - Integrated 4
Site #3                   Service:
Conference Type: (Basic                          Required                 Individual(s) or Department
Science, Journal Club,                              or                          Responsible for
Pathology, etc.)           Conference Topic      Optional       Frequency   Conducting Conference




Site #4                   Service:
Conference Type: (Basic                          Required                 Individual(s) or Department
Science, Journal Club,                              or                          Responsible for
Pathology, etc.)           Conference Topic      Optional       Frequency   Conducting Conference




Non-Plastic Surgery (add rows as needed)
                                                                           Individual(s) or
              Conference Type:                                               Department
               (Basic Science,             Required                        Responsible for
                Journal Club,   Conference    or                             Conducting
Service        Pathology, etc.)   Topic    Optional Frequency                Conference        Site #




                                     Plastic Surgery - Integrated 5
RESIDENTS’ SCHOLARLY ACTIVITIES

1. How are residents taught to understand and apply the scientific method to clinical medicine? (PR IV.B.1)



2. Computer search access:

   a) How do faculty and residents use these capabilities in scholarly activities and in the preparation of
      conferences, etc.? (PR IV.B.2)



   b) Describe the computer search capabilities available for educational and scholarly activities. (PR
      IV.B.3)



3. How do residents participate in scholarly activities, i.e., participation in ongoing clinical or basic research
   with faculty, preparation of reports for publication or literature reviews, or participation in scientific
   meetings? (PR IV.B.2)



4. List the bibliographies of papers published in peer-reviewed journals by residents in the last three years.
   Underline the resident names. (PR IV.B.2.)



5. List the presentations given by the program’s residents at regional, national, or international meetings in
   the past three years. (PR IV.B.2.)



6. List the research projects in which both faculty and residents are currently participating. (PR IV.B.2.)



NIGHT FLOAT

1. What is the maximum length of night float assignment for residents in the program? (PR VI.G.6.) ( )

2. What is the total number of weeks per year each resident is assigned night float? (PR VI.G.6.) ... ( )

RESIDENT OPERATIVE EXPERIENCE

Currently accredited programs: Append the ACGME Case Log reports for each resident completing the
integrated format program for the past five academic years. DO NOT COMPLETE THE TABLE BELOW.

New Applications: Provide the information requested in the table below for the most recent year for each
site participating in the program.

Type of Procedure                                           Site #1         Site #2      Site #3       Site #4
Head and Neck

                                           Plastic Surgery - Integrated 6
Type of Procedure                                        Site #1          Site #2   Site #3   Site #4
Congenital Defects
  Primary cleft lip repair
  Primary cleft palate repair
  Secondary cleft lip or palate repair
  Cleft lip nasal deformity repair
  Craniomaxillofacial reconstruction (includes
  craniosynostosis, cranioplasties, mandibular
  reconstruction, and maxillary reconstruction)
  Other procedures (e.g. otoplasty, ear
  reconstruction, periorbital operations, treatment of
  cysts, sinuses angiomas, and hygromas)
Neoplasms
  Reconstruction of defect after neoplasm resection
  with skin (or other) graft
  Reconstruction of defect after neoplasm resection
  with local flap
  Reconstruction of defect after neoplasm with free
  flap
  Resection of skin cancer
  Resection of other head and neck neoplasm (e.g.
  parotidectomy, intraoral cancer, neck dissection,
  sentinel lymph node biopsy, excise benign lesion)
  Other procedures (e.g. treat simple laceration)
Trauma
  Treat occlusal injury (treat mandible or lower
  midface fracture)
  Treat upper midface fracture (treat orbital,
  zygomatic, or frontal sinus fracture)
  Treat nasal fracture
  Treat complex soft tissue injury (e.g. facial nerve,
  eyelid, ear, nose, lip)
TOTAL Head and Neck
Breast
Macromastia
  Breast reduction
Absent breast
  Breast reconstruction with implant
  Breast reconstruction with pedicle flap
  Breast reconstruction with free flap
  Secondary procedures (e.g. nipple reconstruction,
  implant exchange, other revisions)
Other deformities
  Treat other deformities
TOTAL Breast
Trunk
Wound or deformity of trunk
  Treat pressure ulcer (excision, primary closure)
  Reconstruction with skin graft
  Reconstruction with flap
  Amputation
Tendon (extensor or flexor) disease process, injury or deformity
  Repair/reconstruct tendon without graft

                                         Plastic Surgery - Integrated 7
Type of Procedure                                           Site #1      Site #2    Site #3   Site #4
  Operative release of tendon adhesion/tendon
  lengthening
  Tendon transfer
Nerve injury
  Repair/reconstruct nerve with or without graft
Fracture or dislocation
  Operative repair of fracture or dislocation
  Release of joint contracture
Dupuytren’s contracture
  Operative treatment of Dupuytren’s contracture
Nerve compression
  Nerve decompression
Arterial insufficiency or traumatic amputation of digit, hand, or upper extremity
  Arterial repair, revascularization, or replantation of
  digit, hand or upper extremity
Other deformity or disease process
  Arthroplasty/arthrodesis
  Treat congenital deformity
  Treat neoplasm (benign or malignant)
  Other procedures
TOTAL Hand and Upper Extremity
Lower Extremity
Wounds and deformities
  Treat with graft
  Treat with local flap
  Treat with free flap or
  revascularization/replantation
Other deformities
  Treat other deformities (e.g., primary repair,
  abscess drainage, grafts
TOTAL Lower Extremity
Integument
Burns
  Burn reconstruction
  Other procedures
Lesions of the integument (excluding head/neck and hand)
  Treat benign lesions
  Treat malignant lesions
Wounds and other lesions of the integument (excluding head/neck and hand)
 Treat deformities (e.g. primary repair, abscess
 drainage, grafts)
TOTAL Integument
PLASTIC SURGERY AESTHETIC INDEX CASES
Head and Neck
Aesthetic deformity
  Facelift
  Browlift
  Blepharoplasty
  Rhinoplasty
  Other procedures (e.g. skin resurfacing, suction
  assisted lipoplasty)


                                          Plastic Surgery - Integrated 8
Type of Procedure                                        Site #1         Site #2   Site #3   Site #4
TOTAL Head and Neck
Breast
Micromastia (hypomastia)
  Breast augmentation
Breast Ptosis
  Mastopexy
Other deformities
  Other procedures (e.g., implant removal, capsular
  contracture)
TOTAL Breast
Trunk and Extremities
Aesthetic deformities
  Brachioplasty
  Abdominoplasty
  Body lift
  Thighplasty
  Suction assisted lipoplasty
  Other procedures
TOTAL Trunk and Extremities




                                        Plastic Surgery - Integrated 9

				
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posted:11/20/2011
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