A MANUAL
FOR PLASTIC
SURGERY
RESIDENTS
2008 - 2009
WHAT THE SURGEON OUGHT TO BE
"The conditions necessary for the surgeon are four: First, he should be
learned; second, he should be an expert; third, he must be ingenious; and
fourth, he should be able to adapt himself.
It is required for the First that the Surgeon should not know only the
principles 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 recognize conditions;
and for the Fourth, that he be adaptable and able to accommodate himself to
circumstances.
Let the surgeon be bold in all sure things, and fearful in dangerous things; let
him avoid all faulty treatments and practices. He ought to be gracious to the
sick, considerate to his associates, cautious in his prognostications. Let him
be modest, dignified, gentle, pitiful, and merciful; not covetous nor an
extortionist of money; but rather let his award be according to his work, to
the means of the patient, to the quality 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 a
human being than to become a physician. In the care of suffering he needs
technical skill, scientific knowledge and human understanding. He who uses
these with courage, with humility and with wisdom will provide a unique
service for his fellowman and will build an enduring edifice of character
within himself. The physician could ask of his destiny no more than this; he
should be content with no less."
Tinsley R. Harrison, M.D.
Principles of Internal Medicine 1950
2
CONTENTS
FACULTY ...................................................................................... 7
2008-2009 Tulane/LSU Plastic Surgery Residency
Contact Information ............................................................. 12
THE RESIDENCY IN PLASTIC SURGERY ........................ 15
COGNITIVE SKILLS ................................................................ 19
GOALS AND OBJECTIVES ..................................................... 22
Residency Goals and Objectives: First Year ................. 49
Goals and Objectives: Second Year ................................. 50
TULANE ROTATION OBJECTIVES...................................... 52
OCHSNER ROTATION OBJECTIVES .................................. 53
CHILDRENS ROTATION OBJECTIVES.............................. 54
EAST JEFFERSON: HAND ROTATION OBJECTIVES .... 55
OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER
ROATION OBJECTIVES ......................................................... 56
TOURO: PRIVATE PRACTICE ROTATION OBJECTIVES
....................................................................................................... 57
THE EMERGENCY DEPARTMENT ....................................... 57
CONSULTATIONS .................................................................... 58
OPERATING ROOM ................................................................ 59
OPERATIVE CONSENT ........................................................... 60
Resident Expectations .......................................................... 63
3
Evaluation ................................................................................. 71
Plastic & Reconstructive Surgery Procedural
Evaluation ................................................................................. 72
DIDACTIC COMPONENT ....................................................... 73
CONFERENCES ......................................................................... 75
PLASTIC SURGERY OPERATIVE LOG (PSOL) ............... 82
RESEARCH PROJECTS ........................................................... 82
ACGME: Definition of surgeon ........................................... 85
SCHEDULING REQUIREMENTS.......................................... 91
DISASTER PLAN ...................................................................... 91
DAYS OFF ................................................................................... 92
VACATION TIME ...................................................................... 92
Meetings .................................................................................... 93
Sick Leave ................................................................................. 93
Benefits ...................................................................................... 93
Institutional Policies: please review the following
website ....................................................................................... 95
ABPS REQUIREMENTS .......................................................... 97
FOREWARD
4
Welcome! The Faculty is pleased that you have chosen to continue your
education in Plastic Surgery with us. Few departments offer the educational
and clinical opportunities that are available here. The overall clinical and
academic strength of the University is the foundation of our program.
This manual has been written for your benefit and it will give you an insight
into the philosophy of our plastic surgical training program. It outlines certain
suggestions to help you in your educational process and it also lists certain
requirements that we ask of our residents.
The faculty joins me in emphasizing to you the necessity to assume, as
early in your training as possible, certain critical behavior patterns which are
typical of successful surgeons. These are embodied, in brief form in the
passage from Guy de Chauliac, which is reproduced on the front inside
cover of this manual. Inherent in the professional behavior of the surgeon is
the commitment to provide first-class, continuous care for his/her patient.
This means that whenever you are not available to care for your patient you
will be certain that the level of care provided by your substitute is identical in
intensity to the care that you would provide personally. The patient and his
family should be aware of any change in the personnel responsible for their
care, even for a brief interval.
The conceptual foundation is the belief of the faculty that the program
should be flexible enough to meet the needs of the trainees in the program.
You are allowed to review your evaluations and hopefully give feed back to
5
us so that we may continually improve the residency. You are required to
meet with the Program Director at least once each quarter.
You should be aware that the ultimate responsibility for your education rests
with you. This faculty places a great deal of emphasis on academic and
research activities. Any of the faculty will be happy to assist you in meeting
these requirements.
Once again, the Faculty welcomes you to the Tulane Plastic Surgery
Residency and we look forward to fostering your growth during your surgical
training.
R. EDWARD NEWSOME, M.D.
Program Director and Chief
6
FACULTY
Edward Newsome, MD
Program Director and Chief
Assistant Dean GME
Division of Plastic Surgery
Plastics: Temple University
American Board of Plastic Surgery, 2000
Rick I. Ahmad, MD
Private Practice
Fellowship: The Indiana Hand Center, Indianapolis, IN
Hand Surgery Fellowship
American Board of Orthopaedic Surgery
Certificate of Added Qualification in Hand Surgery
Christopher R. Babycos, MD
Department of Surgery, Ochsner Clinic
Plastics: Tulane University
Fellow in Craniofacial Surgery:
Australian Craniofacial Unit,
Adelaide, Australia
American Board of Plastic Surgery, 1998
Benjamin J. Boudreaux, MD
Division of Plastic Surgery
Plastics: Cleveland Clinic Foundation
Residency: University of Tennessee Hlth. Sciences Ctr. – Memphis, TN
Ernie Chiu, MD
Chief of Plastic Surgery; University Hospital
Director of Plastic Surgery Research
Plastics: NYU
Post-Doctoral Research Fellow: NYU
Microsurgery/Breast Reconstructive Fellow: Memorial-Sloan
Kettering Cancer Center New York, NY
7
American Board of Plastic Surgery, 2005
Abigail Chaffin, MD
Assistant Clinical Professor of Surgery
Division of Plastic Surgery
Plastics: Tulane University
Residency: Wayne State University – Detroit, MI
John Church, MD
Private Practice
Plastic Fellowship: Tulane University
American Board of Plastic and Reconstructive Surgeons, 1977
Louisiana Society of Plastic and Reconstructive Surgeons
Calvin Johnson, Jr., MD
Faculty – Aesthetic: Touro
American Board of Plastic Surgery
American Academy of Facial Plastic and Reconstructive Surgery, 1989
American Board of Otolaryngology-Head and Neck Surgery, 1974
William P. Coleman, III, MD
Private Practice
Dermatology Residency: Tulane
American Board of Dermatology, 1978
American Board of Cosmetic Surgery, 1985
Gustavo Colon, MD
Director of Aesthetic Surgery
Plastics: Tulane University
American Board of Plastic Surgery, 1973
Director of American Society of Plastic Surgeons 1999-2006
Former President of the Aesthetic Society
Charles L. Dupin, MD
Clinical Professor of Plastic Surgery
Program Director and Chief
LSU Division of Plastic Surgery
8
Plastics: Lenox Hill Hospital, NY
American Board of Plastic Surgery, 1979
Frank J. Dellacroce, MD
Private Practice
Otolaryngology/Head and Neck Surgery Residency, University of Texas
Health Sciences Center at Houston
Plastics: LSU Health Science Center at New Orleans American Board of
Otolaryngology/Head and Neck Surgery
American Board of Plastic Surgeons
Jonathan L. Kaplan, MD
Training Director: Our Lady of the Lake Regional Medical Center
Plastics: Cleveland Clinic Foundation
American Board of Plastic Surgery
Lucius Doucet, MD
Chief Plastic: Our Lady of the Lake Regional Medical Center
Plastics: UC-Davis
American Board of Plastic Surgery
Juan R. Escobar, MD
Private Practice
Plastics: Maricopa Medical Center, Mayo Clinic Scottsdale and
Tulane University
Eric George, MD
Private Practice
Plastics: Grand Rapids, Michigan
Hand Fellowship: Phoenix Integrated Mayo Clinic
American Board of Plastic Surgery, 1997
Certification of added qualifications in Surgery of the Hand
David Jansen, MD
Private Practice
Plastics: Baylor College of Medicine
American Board of Plastic Surgery, 1995
9
Kamran Khoobehi, MD
Assistant Clinical Professor of Surgery
Division of Plastic Surgery
Plastics: LSU School of Medicine-New Orleans
American Board of Plastic Surgery, 2000
Alan Lewis, MD
Tulane University Department of Dermatology
Dermatology Residency: Baylor, Houston, TX
Fellowship: Dermatologic Surgery and Cutaneous Oncology
Dermatologic Surgicenter, Philadelphia, PA
John Lindsey, MD
Private Practice
Plastics: UT Southwestern Medical Center, Dallas, TX
Fellowship, Hand and Microsurgery:
UT Southwestern Medical Center, Dallas, TX
American Board of Plastic Surgery, 1996
Added qualifications Surgery of the Hand, ABS 1996
Cynthia Mizgala, MD
Private Practice
Plastics: Plastic Surgery Associates, PA
Woodbridge Cosmetic Surgery Hospital
Scarborough General Hospital
Plastic Surgery: Fellow of the Royal College of Surgeons (Canada), 1991
Michael Moses, MD
Private Practice
Chief, Division of Plastic Surgery Touro Infirmary
Director, Craniofacial Clinic Children’s Hospital
Plastics: Massachusetts General Hospital, Boston, MA
Fellow in Craniofacial Surgery:
Children’s Hospital and Brigham and Women’s Hospital,
10
Boston, MA
American Board of Plastic Surgery, 1985
Michael R. Robichaux, Jr., MD
Private Practice
Residency: Alton Ochsner Medical Foundation, New Orleans, LA
Orthopaedic Surgery
American Board of Orthopaedic Surgery: Hand
Stephen E. Metzinger, MD
Private Practice
Plastics: American Academy of
Facial Plastic and Reconstructive Surgery,
Preceptor: G. McCollough, Birmingham, AL
Fellowship: Craniomaxillofacial Surgery/Microvascular Surgery,
University of Maryland Medical Center, Baltimore, Maryland
American Board of Otolaryngology
American Board of Facial Plastic and Reconstructive Surgery
American Board of Plastic Surgery
Hugo St. Hilaire MD, DDS
Assistant Professor of Clinical Surgery
Plastics: LSU Health Sciences Center at New Orleans
Fellowship: Johns Hopkins OMF, 2008
Anthony Stephens, MD
Clinical Assistant Professor – Plastic Surgery
Plastics: LSU Health Sciences Center at New Orleans
American Board of Plastic Surgery, 2001
Harold Stokes, MD
Clinical Professor of Plastic Surgery and Orthopaedic Surgery
LSU Department of Orthopaedic Surgery
Orthopaedic Surgery: Henry Ford Hospital, Detroit, MI
Hand Fellowship: R. Guy Pulvertaft, Derby, England
American Board of Orthopaedic Surgery, 1974
Added Qualifications in Surgery of the Hand, 1989, 1996
11
Scott K. Sullivan, MD
Private Practice
Plastics: LSU Health Sciences Center at New Orleans
American Board of Plastic Surgeons
John Williams, MD
Private Practice
Plastics: The New York Hospital-Cornell Medical Center
American Board of Plastic Surgeons, 1984
M. Whit Wise, MD
Assistant Professor of Plastic Surgery
LSU Division of Plastic Surgery
Plastics: Cleveland Clinic Foundation
American Board of Plastic Surgery, 2004
2008-2009 Tulane/LSU Plastic Surgery Residency
Contact Information
06/12/08
Name Contact Number Pager Number Email Address
RESIDENTS
Perry Liu 504-343-2264 (c) 504-861-2822 (h) 504-213-1619 perryhliu@gmail.com
12
Azul Jaffer 413-841-3903 (c&h) 504-213-1599 azulmd@hotmail.com
Clifton Cannon (1st yr.) 912-547-1091 (c) 504-267-7748 504-213-0176 Cliff_cannon@yahoo.com
(h)
Jennifer Chan (1st yr.) 505-463-3131 (c&h) 504-213-0172 Jennifer_chan@yahoo.com
Mary J. Wright (09-10) mjwright@tulane.edu
Thomas T. Sands (09-10) sandstrey@yahoo.com
Jonathan Weiler 504-931-4088 Jweiler86@gmail.com
Alireza Sadeghi 646-460-3741 DSSADEGHI@yahoo.com
Kiran Narra (LSU- 1st yr.) 504-423-3409 kpolav@yahoo.com
Ryan Wong (LSU- 1st yr.) 504-423-3446 ryeguy77@gmail.com
Andrew Freel (09-10) afreel@lsuhsc.edu
FACULTY
Edward 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.com
Ernie 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.edu
Jyoti Arya 303-319-3654 504-538-9496 aryaj@mac.com
Hugo St. Hilaire 917-655-2726 504-423-3523 hugost1@gmail.com
Kamran 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
(Helen Roussel) 504-842-3950 (o) hroussel@ochsner.org
David Jansen 504-231-6353 (c) djansenmd@hotmail.com
(Debbie) 504-455-1000 (o) drjansen@drdavidjansen.com
Debbie@drdavidjansen.com
13
FACULTY
Gus 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.net
Juan 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.com
John Williams 225-281-2816 dr_williams@ascsurgery.com
John Lindsey 504-885-4508 (0) jlindseyplassurg@aol.com
(Robin) 504-885-4715 (f) drjlindsey@aol.com
Stephen 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
504-454-2191
Eric George (Pattie) 504-378-1818 (o) handfixer@aol.com
504-378-1837 (f)
Charlie Clasen cclasen@bellsouth.net
Jonathan Kaplan 504-669-3222 jkapla@hotmail.com
Donald Faust 504-899-1000 (o) dcfaustmd@yahoo.com
Scott Sullivan 504-352-0341 (c) scsullimd@aol.com
Frank DellaCroce 504-220-5942 (c) fjdmd@cox.net
Michelle Cooper 985-646-2227 (p) michele@michelecoopermd.com
Hamid Massiha 504-455-9441 (o) massihamd@aol.com
504-885-5063 (f)
Thomas Guillot 225-769-2955 (o) tomguillotmd@aol.com
Lucius Doucet 225-769-2955 (o) drdoucet@cox.net
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
14
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.com
THE RESIDENCY IN PLASTIC SURGERY
CLINICAL EXPERIENCE
The clinical experience available during your training will be designed
to give you an in-depth education in the care of patients that fall
under the broad definition of plastic surgery. The resident will rotate
15
through eight institutions with the main core component being Tulane
and Ochsner.
1. Tulane University Hospitals and Clinic
In 1834, seven physicians banded together to form the Medical
College of Louisiana, which today is Tulane University Health
Sciences Center. At that time there were only fourteen medical
schools in the United States and none west of the Allegheny
Mountains. It closed during the Civil War, but during the last 100
years, has come to be known as one of the leading medical schools
in the nation. Prior to Hurricane Katrina the Hospital included a 300-
bed tertiary care facility staffed by the faculty of the medical school.
Tulane University Hospital and Clinic and the Tulane University
School of Medicine are components of the Tulane University Health
Sciences Center. The facility is rapidly rebuilding and has resumed
operations. Seventy-two medical specialties are recognized in the
Medical Center. At Tulane, the plastic surgery resident will be offered
the entire breadth of our specialty and be given graded responsibility
under direct faculty supervision.
2. Ochsner Foundation Hospital
Includes a 442-bed tertiary care hospital dedicated to patient care,
education and research. Ochsner Foundation Hospital and Clinic was
founded under the leadership of Dr. Alton Ochsner, Sr., former
16
Professor and Chairman of the Department of Surgery, Tulane
University School of Medicine and several Tulane Faculty. Since its
origin the Ochsner Hospital and Clinic has had congruent interests
and cooperative programs with Tulane. Ochsner Foundation Hospital
and Clinic has a distinguished history of excellence and teaching and
provides highly tertiary services as well as primary surgical care. A
close relationship exists between the Department of Surgery at
Ochsner and the Department of Surgery at Tulane. For nearly 60
years Ochsner has cared for residents in the greater New Orleans
communities. The Ochsner main campus, which includes the hospital
and clinic, are located in Jefferson Parish, but Ochsner Clinic
Foundation (OCF) has 27 clinics throughout the region.
3. Touro Infirmary
Founded in 1852, Touro Infirmary is New Orleans' only community
based, not-for-profit faith-based hospital.
For more than 150 years, Touro has been in the vanguard of medical
excellence. As one of New Orleans' most enduring monuments,
Touro Infirmary stands for stability with modern facilities utilizing the
latest technology. Touro is known for its quality and excellence.
In 1923, Touro was one of only fifteen hospitals in the country
approved to use insulin to treat diabetes. Today, thousands of people
from our community take advantage of our free diabetes screenings
and education seminars.
17
4. East Jefferson Hospital
On February 14, 1971, the hospital opened its doors with 250 beds
and 250 physicians. Today, East Jefferson General Hospital has 450
beds and a medical staff of nearly 900. With over 3,000 team
members, the hospital is one of the largest employers in the parish.
East Jefferson General has grown over the past three decades to
become a medical landmark with the addition of medical office
buildings, the Yenni Pavilion for outpatient cancer treatment, and the
Domino Pavilion, which houses Same Day Surgery, outpatient
laboratory and outpatient radiology services. Most recently, the
Wellness Center, a 38,000 square foot, state-of-the-art fitness facility,
was added to the hospital's main campus.
5. Our Lady of the Lake Regional Medical Center
Our Lady of the Lake Regional Medical Center is the dominant
institution in healthcare in the Greater Baton Rouge area. It is also
the largest private medical center in Louisiana, with 763 licensed
beds. Opened in 1923, the Lake has grown from its modest
beginning to a major player in healthcare, with an outreach spanning
geographical and political boundaries. In a given year, Our Lady of
the Lake treats approximately 25,000 patients in the hospital, and
18
serves about 350,000 persons through outpatient locations with the
assistance of almost 900 physicians 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 SKILLS
Education in surgery is designed to simultaneously develop cognitive
knowledge, judgment, technical ability and teaching skills. The
practice of surgery requires the application of clinical data and
technical skills to cure disease. Surgical judgment is that
combination of knowledge, confidence, ability, and compassion that
leads to the successful practice of our specialty.
The cognitive basis of plastic surgery is summarized and developed
in a body of literature pertinent to the specialty. Mastery of this
resource is a necessary task. The resident will be expected to study
the literature of our specialty diligently and apply the information
therein to the problems of his patients. As the resident moves toward
senior responsibility a greater breadth and depth of knowledge is
required, such they will be required to know how to perform
operations that they have never seen and will be required to teach
19
students and junior residents the discipline necessary to search the
literature.
Evaluating the literature is a difficult skill acquired only through
practice. 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 buffeted
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 evidence 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.
Annals of Surgery 142:321, 1955
20
The 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.
21
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, 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. Your most
frequent question to yourself, the faculty and colleagues should be
"Why”.
GOALS AND OBJECTIVES
The basic science and clinical skills objectives are listed
individually below. The objectives will be emphasized on certain
rotations; however it will be important for the resident to be able to
integrate these broad topics into an effective comprehensive
patient treatment and care. Regarding technical skills, the resident
22
is expected to master the less complex procedures before
proceeding to the more complex. Furthermore, he/she is expected
to first assist until he/she understands the principles and methods,
at which time the resident becomes the operating surgeon with
faculty supervision, and eventually moves to teaching others.
Tulane Plastic Surgery Residency
Training Objectives- Core Competencies
GOALS AND TRAINING OBJECTIVES
The 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 cognitive
knowledge, judgment, technical ability and teaching skills. The practice of
surgery requires the application of clinical data and technical skills to cure
disease. 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 be
important for the resident to be able to integrate these broad topics into an
effective comprehensive patient treatment and care. Regarding technical skills,
the resident is expected to master the less complex procedures before proceeding
to the more complex. Furthermore, he/she is expected to first assist until he/she
understands the principles and methods, at which time the resident becomes the
operating surgeon with faculty supervision, and eventually moves to teaching
23
others.
The following resident has demonstrated cognitive knowledge, technical ability and
sound surgical judgment in meeting the goals and training objectives in the required
plastic surgical residency rotations. He/she has acted in a professional manner and
can now be considered to have completed the Tulane University Plastic Surgery
Residency.
Resident Program Director’s Signature
PROFESSIONALISM
Required Professionalism of Patient Care during each Plastic Surgery Rotation.
Goal:
Upon completion of this rotation the Plastic Surgical Resident will understand
commitment to professional responsibilities, adherence to ethical practices and
sensitivity to diverse patient populations. He/she will present himself in a
respectful, professional, honest and congenial manner in all interaction with
patients, colleagues, other health care professionals and ancillary staff.
Terminal Performance Objective:
The Surgical Resident will be able to demonstrate a commitment to their
professional responsibilities, adherence to ethical principles and sensitivity to
diverse patient populations as judged against applicable standards of patient
care.
Enabling Objectives:
Condition: Upon completion of this rotation the Surgical Resident will:
1) Demonstrate a commitment to professional responsibilities
24
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 culture
Standard: As judged against applicable standards for the Medical Professional.
Resident Program Director’s Signature
INTERPERSONAL AND COMMUNICATION SKILLS
Required Interpersonal and Communication Skills of Patient Care during each Plastic
Surgery Rotation
Goal:
Upon completion of this rotation the Surgical Resident will be able to communicate in a
collaborative model with patients, patient’s families and members of the health care team
relevant and important information.
Terminal Performance Objective:
The Plastic Surgical Resident will be able to demonstrate effective communication with
members of the health care team, counsel and educate the patient, patient’s family and
health care team and accurately document all patient care information as judged against
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
25
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
PRACTICED BASED LEARNING AND IMPROVEMENT
Required Practice Based Learning and Improvement of Patient Care during each
Plastic Surgery rotation.
Goal:
Upon completion of this rotation the Surgical Resident will understand the role
of Practice-Based Learning and Improvement in the management of their
patients and as a life-long process for optimal health care.
Terminal Performance Objective:
The Plastic Surgical Resident using an individual critique of their patient care
practice outcomes will be able to demonstrate methods of improvement in
patient care through the recognition and practice of lifelong learning skills in the
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
26
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 standards
Standard: As judged against applicable standards of physician knowledge, skill
improvement and quality improvement.
Resident Program Director’s Signature
SYSTEMS BASED PRACTICE
Required Systems Based Practice of Patient Care during each Plastic Surgery Rotation.
Upon completion of the each rotation the Plastic Surgical Resident will meet the
following 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 system
Terminal Performance Objective:
The Surgical Resident will be able to demonstrate an awareness of the health care system,
respond to the larger context of the health care system and manage health care system
resources to provide optimal care as judged against applicable standards of patient 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
27
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 system
Standard: As judged against applicable standards of medical practice.
Resident Program Director’s Signature
ROTATIONAL COMPETENCIES Resident Name:
Aesthetics
Basic 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
28
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 Surgery
Clinical / 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
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 Care
Basic Sciences / Medical Knowledge Objectives
1) The resident will demonstrates knowledge of common agents for local
anesthesia (esters and amides), regional anesthesia and general anesthesia
29
(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.
ROTATIONAL COMPETENCIES Resident Name:
Benign and Malignant Skin Lesions
Basic Sciences / Medical Knowledge Objectives
1) The resident will understand the natural history of benign lesions and the
30
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.
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 Objectives
Basic Sciences / Medical Knowledge Objectives
1) The resident will know, in detail, the anatomy of the muscles, tendons, and
31
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
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 Trauma
Basic Sciences / Medical Knowledge Objectives
32
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 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/Dermatology
33
Basic 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
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/Embryology
34
Basic 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
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
35
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:
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 Grafts
Basic Sciences / Medical Knowledge Objectives
36
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.
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 Problems
37
Basic 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.
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 Reconstruction
38
Basic 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.
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:
39
Implants and Biomaterials
Basic Sciences / Medical Knowledge Objectives
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:
40
Lower Extremity Reconstruction
Basic Sciences / Medical Knowledge Objectives
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.
41
ROTATIONAL COMPETENCIES Resident Name:
Medicolegal and Psychiatric Aspects of Plastic Surgery
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.
42
ROTATIONAL COMPETENCIES Resident Name:
Microsurgery
Basic 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.
43
ROTATIONAL COMPETENCIES Resident Name:
Practice Management
Basic 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.
44
ROTATIONAL COMPETENCIES Resident Name:
Special Techniques
Basic 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.
45
ROTATIONAL COMPETENCIES Resident Name:
Trunk and Breast Reconstruction
Basic 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
46
sore reconstruction.
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.
47
ROTATIONAL COMPETENCIES Resident Name:
Wound Care
Basic 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.
48
Residency Goals and Objectives: First Year
By the end of the first year the resident will be competent 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
49
and others to perform excellent patient care. (PC,
SBP, M, IPC and P)
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 Skills
Goals and Objectives: Second Year
By the end of training the resident will be
competent 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
50
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 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)
51
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)
* Competencies: PC = Patient Care, M = Medical
Knowledge, SBP = Systems Based Practice, PBLI
= Practice Based Learning and Improvement, IPC
= Interpersonal and Communication Skills
TULANE ROTATION OBJECTIVES
Dr Newsome will oversee this rotation. The following categories
will 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
52
Mohs
Benign and Malignant Skin Lesions
The resident will rotate at Tulane University for three months the
first year and three months the second year with graduate
responsibility.
OCHSNER ROTATION OBJECTIVES
Dr. Babycos will oversee this rotation. The following categories
will be emphasized:
Wound Care
Flaps and Grafts
Reconstruction of Trunk and Breast
Facial Trauma
Microsurgery
Aesthetic
Congenital
Benign and Malignant Skin Lesions
The resident will rotate at Ochsner for three months the first year
and three months the second year with graduate responsibility .
53
CHILDRENS ROTATION OBJECTIVES
Dr. Moses will oversee this rotation and the following categories
will be emphasized:
Congenital
Embryology
Flaps and Grafts
Facial Trauma
Microsurgery
Attention will be given to the care of patients at Children’ s
Hospital. This rotation will afford the resident concentrated
exposure to the breadth of pediatric plastic surgery. Under Dr.
Moses’ direction, the resident will participate in the preoperative
evaluation and planning and post-operative follow-up of these
patients. This rotation will be for three months during the second
year.
54
EAST JEFFERSON: HAND ROTATION
OBJECTIVES
Dr. George will oversee this rotation and the following categories
will be emphasized:
Upper Extremity Reconstruction
Congenital Hand
Tumors of the Hand
Trauma
This rotation will afford the resident concentrated exposure to hand
surgery. Under Dr. George and Clasen’ s direction, the resident
will participate in the preoperative evaluation and planning and
post-operative follow-up of these patients. This rotation will be for
three months during the first year. Dr. George will serve as the
Local Training Director for this rotation.
55
OUR LADY OF THE LAKE REGIONAL MEDICAL
CENTER ROATION OBJECTIVES
Dr. Jonathan Kaplan will oversee this rotation and the following
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 Management
The resident will rotate on the BR for three month the first year.
The resident will interact with and be exposed to a variety of
cases. This will be a General Plastic Surgery Rotation
56
TOURO: PRIVATE PRACTICE ROTATION
OBJECTIVES
PRIVATE PRACTICE OBJECTIVES
Dr. Colon will oversee this rotation and the following Rotation
Competencies will be emphasized:
Practice Management
Aesthetics
Functional Problems
Medicolegal and Psychiatric Assessment
Special Procedures
Implants and Biomaterials
Office Anesthesia
Benign and Malignant Skin Lesions
This rotation is primarily an operative experience with emphasis
placed on aesthetics and practice management but reconstruction
will also be covered. The rotation will be for three months during
the second year.
THE EMERGENCY DEPARTMENT
57
The purpose of the experiences offered in these areas is to acquaint
the resident with the characteristics of the critically ill and less
severely ill "WALKING WOUNDED." Understand that the patient
believes that an emergency exists even though your medical
judgment may indicate otherwise. Many problems will be avoided if
this fact is kept in mind. Good communication between the physician
and the patient assist in continued patient improvement after
discharge.
If in doubt, admit. Patients who have been discharged from the
emergency department, after being deemed to have mild illnesses,
but then subsequently return because of persistent or worsening
symptoms shall be admitted. All ER patient contacts shall be
discussed with appropriate faculty prior to institution of care.
CONSULTATIONS
Consultations should be seen promptly. When the consultation is
complete, a telephone call to the physician requesting the
consultation should be considered as part of your evaluation. If, for
reasons of incomplete data a full consult is delayed, a short progress
note indicating that the patient has been seen and that a formal
consult will be forthcoming. A phone call will serve to keep lines of
communication open and will enhance the stream of consultations to
58
the service (Systems Bases Practice and Professionalism).
Surgeons who answer routine consults immediately and emergency
consults even sooner have superior operative case lists in both
quantity and quality. Also, consults should be discussed with the
attending staff in a timely manner just as any hospital admission
would be.
When consultations are seen in the Emergency Department, the
evaluation should be designed to render an opinion in one hour or
less. It is far better to admit a patient and complete the evaluation on
the plastic surgical service than to prolong the stay in the emergency
department. Bickering over which service will admit the patient will
not be tolerated.
OPERATING ROOM
Anesthesiologists and operating room nurses are fellow
professionals and full participants in the care of the patient (Systems
Bases Practice and Professionalism). They deserve and will receive
the consideration and respect offered to any colleague.
Remember, it is the patient that takes all of the risks. The full
attention of a skilled and collegial operating team should always be
available.
59
Attendance in the operating room is required for all patients
operated upon. First cases in the morning are to be ready and
outside the operating room 20 minutes prior to the scheduled time
to enable the case to start promptly. See that permission for
operation, X-rays, and orders have been properly handled the night
before surgery. The resident shall accompany the patient into the
operating room.
The quality of assistance by a surgeon is directly related to his/her
understanding of a given procedure. Prior to the start of any
procedure, the resident involved should have read about the
technical aspects of the procedure, possible complications, any
measures that may be taken to either avoid or correct these
complications, and discuss the technique with his/her staff. Also,
the quality of an assistant indicates his/her readiness to do a
procedure. Evaluation of a resident as an assistant is therefore an
important indicator of progress. At all times, the teaching assistant
should be prepared to assume the role of operating surgeon.
OPERATIVE CONSENT
For each procedure done on and for the patient, the patient must be
fully informed of the risks and benefits of the procedure
60
(Professionalism and Interpersonal and Communication Skills).
The operating surgeon should discuss with the patient the details of
the procedure, the other options for the management of the specific
disease process involved, the chances of success and failure of the
procedure and the long term expected outcome. Having gotten
consent, the surgeon must write a preop note, not dealing with labs,
but describing the indications, objectives, alternatives, risks and
complications of operation.
You shall rotate at on the particular service based on the block
schedule. Graduated responsibility is offered on all rotations and
you will interact with a variety of staff. You will work one-on-one
with the faculty (who will provide direct supervision) to understand
the importance of patient assessment, formulating and executing a
plan and postoperative patient follow up. The emphasis on all
rotations will be accomplishing the educational objectives,
assisting the resident to develop independent thinking and allow
the faculty to directly assess residency competency.
The plastic surgery resident is to assume responsibility for the day-
to-day functioning of the plastic surgery clinical service always with
direct faculty oversight. In order to obtain the maximal educational
benefit, the plastic surgery resident should attempt to function in a
61
manner as if the final responsibility was his. However, ultimate
authority and responsibility, for all the patients, rests with the
attending. This means that the resident should attempt to assess
the problem and formulate a plan of action. The residents plan
shall be based on accurately identifying and effectively
communicating the problem and based on his medical knowledge
the resident shall discuss potential treatment options. Through
this maneuver, the resident option for patient care can be
evaluated by the faculty and appropriate feedback can be given.
In addition the practice-based learning over time can be accessed.
It is stressed however; the above concept shall not be confused
with a lack of resident supervision. The resident shall not
implement any plan of care in an independent fashion. For all
patients, on all services, all aspects of patient care require direct
approval and oversight from the attending. In addition, the
resident shall not delay treatment in an emergency situation.
Furthermore, the resident shall refrain from discussing any
therapeutic plan with the patient or family until confirmed with the
attending.
It is our mandatory policy that direct resident oversight, for all
aspects of the patients care, on all rotations, without exception is
to be ensured. The only resident autonomy we encourage is of
62
thought, not action.
Continuity of care is achieved at all of the institutions through
resident participation in the various clinics. Faculty and residents
will participate in clinics together.
Resident Expectations
1) The plastic's 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,
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
63
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 plastic's resident is
responsible for updated information from other services
involved in the care of the patients, as well as the patient's
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 faculty on
call.
13) Weekends: When patients are in hospital on the weekend,
they should be seen each morning by the plastic surgery
64
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 plastic's 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
65
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 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
66
congenial manner.
23) Sign all verbal orders within 24 hours.
24) Provide feedback for overall residency improvement.
Tulane Rotation Schedule 2008-2009
PGY 6 PGY 6 PGY 7 PGY 7
Jennifer Clifton Azul Perry Liu
Chan Cannon Jaffer
July
August Tulane EJ Childrens OFH
September
October
November EJ Tulane OFH Childrens
December
January
February OLOL OFH Tulane Touro
March
April
May OFH OLOL Touro Tulane
67
June
Tulane: Funding 1.0 FTE: Tulane University
Newsome Hospital/Lakeside Hospital
(General
Plastic 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
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 Lesions
Childrens: Funding 0.5 FTE: Children’s Hospital
Moses
(Pediatric
Rotation) Faculty: Moses, Chiu and St. Hilaire
Childrens Goals and Objectives (Further outlined
68
within the PIF under Section 9D2)
Congenital
Embryology
Flaps and Grafts
Facial Trauma
Microsurgery
OFH: Funding 1.0 FTE: Ochsner
Babycos Teaching Agreements: Ochsner Baptist/Fairway
Medical (Secondary)
(General
Plastic
Rotation) Faculty: Babycos and St. Hilaire
Ochsner Goals and Objectives (Further outlined
within the PIF under Section 9D2)
Wound Care
Flaps and Grafts
Reconstruction of Trunk and Breast
Facial Trauma
Microsurgery
Aesthetic
Congenital
Benign and Malignant Skin Lesions
Hand: Funding 0.5 FTE: East Jefferson Hospital
George 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
69
Trauma
Flaps and Grafts
Reconstruction of Trunk and Breast
Facial Trauma
Microsurgery
Touro: Funding 0.5 FTE: Touro Infirmary
Colon 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
Medicolegal and Psychiatric
Assessment
Special Procedures
Implants and Biomaterials
Office Anesthesia
Benign and Malignant Skin Lesions
OLOL
Funding 0.5 FTE: Our Lady of The Lake Regional
(Baton Medical Center
Rouge): Teaching Agreements: Baton Rouge General/Aesthetic
Kaplan Surgery Center (Secondary)
(General
Plastic Faculty: Kaplan, Boudroux, Williams, Stephens,
Rotation) Guillot and Doucet
70
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
Aesthetics
Evaluation
You will be evaluated, throughout your training, on the ACGME
core competencies. These should be reviewed and understood:
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
71
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 value
Plastic & Reconstructive Surgery Procedural Evaluation
Resident_____________________ Date __________________
Year: PS-1 PS-2
Procedure____________________________________________________
Satisfactory Areas for Unsatisfactory
improvement
1. Demonstrates awareness of the patient’s
history, indications/contraindications and
anatomical considerations
2. Communication to the patient: operative
plan and informed consent
3. Demonstrates appropriate preoperative
planning
4. Overall Surgical technique and handling
of tissues
5. Performed the procedure in a safe,
effective and expeditious manner
5. Ability to recognize pathology or
develop alternate plans
6. Completeness of postop orders and
handwritten operative note
72
COMMENTS:_________________________________________________
_____________________________________________________________
_____________________________________________________________
____Resident has not yet demonstrated competence for this procedure.
____Resident has demonstrated competence for this procedure.
______________________ ______________________
Supervising Faculty Date Resident Date
As a prerequisite to successfully completing this fellowship you will be
required to successfully demonstrate procedural competence in each of the
PSOL defined major categories. Once you are ready to be “checked off” on
a procedure, inform the faculty prior to the procedure and then have him/her
complete the above evaluation form which must be returned to Debra Felix.
DIDACTIC COMPONENT
Rotating through a variety of hospitals and clinics, the residency
strives to create a balanced and comprehensive plastic surgery
training program. We have incorporated the best of both worlds;
University based training and Private Practice exposure. The
rotations are planned to offer an increase in responsibility during the
73
two years of training. Each of the hospitals has a subspeciality area
of interest, which allows the resident to focus their training.
During all rotations the educational philosophy is the same. It is
that of wide latitude in intellectual inquiry but very close
supervision of specific patient care with gradual assumption of
clinical decision-making and operative responsibility. Two training
methods are fundamental to this philosophy, one for cognitive
activities and one for technical matters (Medical Knowledge).
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 of
this material will be performed on a daily basis utilizing patient
examples. Attendings will not dictate diagnostic or therapeutic
plans. The resident "makes a plan" which is then discussed with
the attending and together a treatment algorithm is created. This
method of "making a plan" and then defending it against the
critique of the attending physician trains the resident and permits
him to assume increasing levels of independence. It is the goal
that at the completion of his/her training the resident will have
made sufficient independent decisions (under faculty supervision)
that he/she can easily assume the position of an independent
74
physician. This philosophy holds for all patients on the wards, in
the clinics, pre- and postoperatively, and throughout the program.
CONFERENCES
To further develop and promote resident education the Program
Directors of both Tulane and LSU have, combined our didactic
programs. Faculty from both the schools teach all residents. We share
one common goal; optimize resident education by utilizing the best
teachers regardless of school affiliation, practice demographics or even
specialty: Dermatology, ENT Plastic Surgery all contribute. With
participating dedicated and enthusiastic faculty we will always strive
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
iv. Systems Based Practice:
1. Resident Research Day
75
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 Responsibilities
1) 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.
76
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
77
clinical significance. Each session covers Medical
Knowledge, Patient Care, PBLI, Technical aspects of
Procedures and often Systems Based Practice.
The conference is approximately one hour long.
Preoperative and Postoperative Conference
Case Conference
This is a weekly conference and resident’s attendance is
mandatory. Medical students and rotating residents also
attend.
Each service presents one or two patients. The
presentations are done on “Power Point” which is a
good use of information technology in resident
education. All patient presentations include history,
photo documentation of the pathology and operative
plan. The resident is evaluated on the accuracy and
completeness of the information gathered about the
patient. This session covers PBLI, IPCS, Medical
Knowledge, Patient Care, Procedural Based Learning,
and Systems Based Practice.
Because the other services are not familiar with the
patient, the presentations are used as an “unknown “for
the audience. The residents are asked to propose a
diagnosis and asked to explain the basis for their
decision. The presenting resident then must develop a
plan of management and defend alternate plans before
the faculty:
1) Presenters are expected to provide
support based on the literature (text and
journals) for the planned management.
78
2) Presenters are expected to make
informed decisions about their treatment
plan 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 Safety
Conference, allows evaluation of the resident’s
communication skills, Medical Knowledge, PBLI, PC
and Procedural Based Learning. We also frequently
discuss ethical issues, professionalism and the economic
impact of treatment plans.
Anatomy Laboratory
In 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 is
approximately 4-5 hours in length and begins with a
discussion by an assigned faculty member who then
leads the individual breakout resident dissection teams.
A dissection manual is supplied to the residents.
Flap procedures are demonstrated during dissection as
well as surgical techniques relevant to the anatomic
area. This helps the resident to develop skills needed to
perform surgical procedures competently. This session
covers Medical Knowledge, Procedural Based
79
Learning and Patient Care.
Microsurgery Laboratory
Tulane University has a microsurgery laboratory with
veterinary and animal support. This laboratory is held
at the beginning of the academic year and each resident
participates as frequently as required to become
proficient. Residents learn the basic microsurgical skills
under the tutelage of a faculty member. Senior residents
participate in teaching of the junior residents. Residents
are expected to perform venous and arterial anastomosis
which is analyzed by the faculty. This session covers
Procedural Based Learning, Patient Care and Medical
Knowledge.
Grand Rounds
Thursday Grand Rounds involve a variety of programs
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
80
discussed with the faculty to access their
practice experience. This session 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.
81
PLASTIC SURGERY OPERATIVE LOG (PSOL)
The Plastic Surgery Operative Log (PSOL) is a mandated record of
the operative cases done during the residency training. This is
required by both the Residency Review Committee (RRC) and the
American Board of Plastic Surgery (ABPS) to assess the number of
cases done by each individual resident and the surgery resident
corps as a whole. The numbers affect both the accreditation
program and the application for Board examination of each individual
resident. The PSOL is divided into several categories of case types,
with assigned minimal numbers for each category, the overall total
during residency training and the number of cases done during the
chief year. These numbers vary and are changed from year to year
and therefore are not included in this manual. It is urged, however,
that you get the current minimum number. It is imperative that this
data be kept accurate and current on a weekly basis. As a
requirement for completing the residency program, every resident
must demonstrate competency in each of the defined major PSOL
categories along with meeting the minimum requirements and also
having completed a minimum of 1000 cases/two years.
RESEARCH PROJECTS
The Tulane Plastic Surgery research program is directed by Dr.
82
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
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 Cells
Supraclavicular Artery Flap in Head and Neck
Reconstruction
Co-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 for
oncologic reconstruction. Donor site morbidity, operative
time, and recovery time has been reduced. Clinical
outcomes studies are actively being investigated.
83
Basic Sciences Research:
Breast Cancer and Adipocyte Stem Cell Interaction
Co-Investigators:
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)
84
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.
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 surgeon
Basic Principle: To be recorded as the surgeon, a resident must be present for
all of the critical portions, and must perform the majority of the critical portions
85
of the procedure. Involvement in the preoperative assessment and the
postoperative management of that patient is an important element of that
participation.
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 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
86
i) The nurses, other physicians and the hospital must know
which physician writes orders and be able to correctly
interpret them. The physician's 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.
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.
87
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.
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
88
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 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.
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
patient's general condition and plans for the next 24
hours.
DRESS CODES
A well-groomed professional appearance inspires the confidence of
patients, their families and visitors. Clothing must be neat, clean and
89
appropriate for the work required and moderate in style. Jeans, cut-
offs, shorts, T-shirts, etc., are not acceptable clothing for
professionals in the hospital.
Patients recognize the white coat as a symbol of a medical
professional and should be worn at all times.
Operating room attire (scrub suits) must be covered by a white coat if
worn outside the O.R. When such clothing is worn it should 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 as well
as the comfort of co-workers and is an integral part of a proper
professional attire policy. Professionals should be clean and well-
groomed at all times.
Tobacco chewing and gum chewing are not appropriate for
physicians on duty.
90
SCHEDULING REQUIREMENTS
All 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-Ray
Call the Anesthesia Department if you have any questions about a
specific patient while in clinic.
Note: Anesthesia writes preoperative medication orders for all
general anesthesia patients.
Note: For “in custody" patients do not tell the prisoner or the guard
the day of surgery or admission. The Admit Office will contact the
facility to inform them of the date.
DISASTER PLAN
91
The physician component was developed by the trauma committee and
integrated into the overall hospital plan.
A full review of the Disaster Plan is required. Clear lines of communication
and responsibility will be distributed as a separate policy:
http://emergency.tulane.edu/
DAYS OFF
On your days off (including weekends) you are responsible for the
care of your patients prior to leaving the hospital. Do not leave work
on your ward to be done by the on-call House Officer at your level. If
a patient on your ward needs special attention, discuss this with the
On-Call House Officer at your level before leaving the hospital.
VACATION TIME
Each resident will receive 3 weeks (21 days) of vacation each year. No
more than 7 days vacation per rotation. Only one resident may take
vacation at any one time with senior residents getting priority. NO
vacations allowed in June or July. All vacation time requires formal leave
request and pre-approval (both Program Director and local training
director). Any changes after the schedule is published must be
requested in writing to the Program Director.
92
Meetings
One paid meeting per resident/residency. With approval, residents may
attend additional meetings at his/her own expense. Meeting attendance
(paid or unpaid) does count towards vacation time.
Sick Leave
If a resident calls in sick, it is the prerogative of the Program Director to
ask for a doctor's excuse from the resident.
Each resident must be aware that the RRC for plastic surgery allows only
a certain amount of absence from training per year. Absence beyond
that designated time--be it for vacation or sick leave--will extend their time
in training.
As has been pointed out in other sections of this manual, the
responsibilities to your patients is paramount both now as a resident and
for the rest of your professional life. If you cannot provide that patient
care because of illness, death in the family or required absence from the
city, you must make sure your patients are adequately covered and that
the staff on the service to which you are assigned understands your need
to be absent and they have given permission.
Benefits
Residents Health Plan: Residents and Fellows are required to enroll in
this plan unless they are covered under another health plan. The cost of
93
residents’ health insurance is a responsibility of the school.
Spouses or dependents can be enrolled at registration at resident's
expense. Late enrollment is subject to review. Premiums are negotiated
yearly 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.
Life Insurance – A $25,000 life insurance policy is provided at
not cost to residents.
Disability Insurance – Disability insurance is provided at not
cost to the residents.
Malpractice Insurance – Malpractice insurance is provided at
94
not cost to the residents.
Educational 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 51,247
Institutional Policies: please review the following website
http://www.som.tulane.edu/departments/gme/resources_residents.htm
Map of the Health Sciences Center
Incoming House Officers
95
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 Harassment
At the above website you will find information regarding the
probation, suspension, termination and grievance policy.
This is located via the link which says: Resident Handbook.
96
ABPS REQUIREMENTS
See website for updated information:
http://www.abplsurg.org/
Program Directors of accredited residency training programs in plastic
surgery must require all residents to have an official evaluation and
approval of their prerequisite training by the Board before they begin
plastic surgery training.
TRAINING REQUIREMENTS
There are two approved educational (training) models for plastic surgery,
the Independent Model and the Integrated Model. A plastic surgery
program director may choose to have both training models in a single
training program. Several organizations provide governance for these
models. These are the Residency Review Committee for Plastic Surgery
(RRC-PS) of the Accreditation Council for Graduate Medical Education
(ACGME), which sets educational requirements and accredits training
programs in plastic surgery; the Association of Academic Chairmen of
Plastic Surgery (AACPS), which helps coordinate the training activities of
the programs; and The American Board of Plastic Surgery, Inc. (ABPS),
which sets educational requirements, examines and certifies the
graduates of those programs. In both the integrated and the independent
models, plastic surgery training is divided into two parts:
1. The acquisition of a basic surgical science knowledge base and
97
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).
In the independent model, the residents complete the PREREQUISITE
TRAINING outside of the plastic surgery residency process, whereas in the
integrated model, residents complete all training in the same training program. In
a combined or coordinated program, residents complete the prerequisite training
for the general surgery training program in the same institution as the plastic
surgery program.
Residents may transfer, prior to the last two years, from an Independent
Program to another Independent Program and from an Integrated Program to
another Integrated Program, but they may not exchange accredited years of
training between the two different models without prior approval by The
American Board of Plastic Surgery, Inc. and the Residency Review Committee
for Plastic Surgery. Residents must request any anticipated transfers in writing
and obtain prior approval by the Board well in advance of the proposed change
in programs.
The minimum acceptable residency year, for both prerequisite and requisite
training, must include at least 48 weeks of full-time clinical training experience
per year. A leave of absence during training will not be included toward
completion of the minimum 48 weeks requirement. This includes Military Leave
and Maternity/Paternity Leave.
INDEPENDENT MODEL
98
This model includes programs with two or three years of plastic surgery training.
The Independent Model has two options. The first option has two variations.
Each of the pathways described satisfy the requirements of the Board 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 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
99
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 (REQUISITE
TRAINING) after completion of any of these PREREQUISITE options, which all
require confirmation by the Board (Completion of the Request for Evaluation of
Training Form with receipt of the Board’ s Confirmation Letter regarding the
acceptability of the prerequisite training for the Board’ s certification process).
In the Independent Model options, only the REQUISITE period of training is
under the supervision of the RRC-PS. However in the “ combined” model, the
general surgery years are accredited by the RRC for General Surgery and not
the RRC-PS.
REQUISITE TRAINING
Graduate Education in Plastic Surgery
Two years of plastic surgery training is required, and the final year must be at
100
the senior level. Residents are required to complete both years of a two-year
program in the same institution.
Content of Training
Residents must hold positions of increasing responsibility for the care of patients
during these years of training. For this reason, major operative experience and
senior responsibility are essential to surgical education and training.
An important factor in the development of a surgeon is an opportunity to grow,
under guidance and supervision, by progressive and succeeding stages to
eventually assume complete responsibility for the surgical care of the patient.
It is imperative that residents hold positions of increasing responsibility when
obtaining training in more than one institution, and one full year of experience
must be at the senior level. The normal training year for the program must be
completed. No credit is granted for a partial year of training.
The Board considers a residency in plastic surgery to be a full-time endeavor
and looks with disfavor upon any other arrangement. The minimum acceptable
training year is 48 weeks. Should absence exceed four weeks per annum for any
reason, the circumstances and possible make-up time of this irregular training
arrangement must be approved by the program director and the additional
months required in the program must be approved by the Residency Review
Committee (RRC-PS) for Plastic Surgery and documentation of this approval
must be provided to the Board by the program director. No credit but no penalty
is given for military, maternity/paternity or other leaves during training.
Candidates in the examination process called to active military duty do not need
to submit a reapplication if five years expire during the active duty period.
101
Training in plastic surgery must cover the entire spectrum of plastic surgery. It
should include experience in both the functional and cosmetic management of
congenital and acquired defects of the head and neck, trunk, and extremities.
Sufficient material of a diversified nature should be available to prepare the
resident to pass the examinations of the Board after the prescribed period of
training.
This period of specialized training should emphasize the relationship of basic
science, anatomy, pathology, physiology, biochemistry, and microbiology, to
surgical principles fundamental to all branches of surgery and especially to
plastic surgery. In addition, the training program must provide in-depth exposure
to the following subjects: the care of emergencies, shock, wound healing, blood
replacement, fluid and electrolyte balance, pharmacology, anesthetics, and
chemotherapy
ACCREDITED RESIDENCY PROGRAMS
Information concerning accredited training programs for the Independent Model
may be found in the Directory of Graduate Medical Education Programs ("the
green book") published by the American Medical Association (AMA) under the
aegis of the Accreditation Council for Graduate Medical Education (ACGME).
This directory is available at many medical schools and libraries, or may be
ordered directly from the AMA by calling toll free 1-800-621-8335, or by writing
to: 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 Review
Committee (RRC-PS) for Plastic Surgery inspects and makes recommendations
for or against approval of a residency training program in plastic surgery only
102
after the director of the residency has filed an application for approval by the
Residency Review Committee (RRC-PS) for Plastic Surgery. For information
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 of nine
members, three representatives from each of the following: The American Board
of Plastic Surgery, Inc., the American College of Surgeons, and the American
Medical Association.
Updated: 09/12/08
103