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					                            PGY-5: Goals and Objectives


Hospital                Rotation                    Service Chief(s)   PGY

Kaiser – Santa Clara    Plastic Surgery             Dr. R. Menard        5
Stanford                Pediatric Plastic Surgery   Dr. H.P. Lorenz      5
Davies Medical Center   Microsurgery/Hand           Dr. G. Buncke        5
                                             STANFORD UNIVERSITY MEDICAL CENTER
                                                 Plastic Surgery Training Program
                                                    Rotation Description Form


I.    Rotation Format:

Rotation:        Plastic Surgery                 Rotation Duration:        4       Months

Institution:     Kaiser-Santa Clara              Call     responsibility   q2      Night             In House      X    Home
                                                 (q):

Responsible      faculty      member:      (CV   Dr. R. Menard             Training Level:            1             2               3
attached):

II.   Goals and Objectives:                                                Training Level:            4      X      5               6

A. Medical Knowledge
I: Anatomy/Physiology/Embryology
Goal: The resident will achieve detailed knowledge of the anatomy, physiology, embryology of the head and neck, and will apply this
knowledge to the medical management of disorders and processes in this anatomic area.
Objectives:
         1.       Describe the anatomy of the skull including sutures, foramina, and cranial nerves.
         2.       Identify the anatomy of the facial bones.
         3.       Identify the anatomy of the eye including normal dimensions, bony structures, eyelids, extraocular muscles, innervation,
                  vascular supply, and lacrimal apparatus.
         4.       Identify the anatomy of the ear including common measurements, relationships to other structures, and the vascular
                  and sensory supply.
         5.       Draw the anatomy of the nose and septum including bones, nerves and vascular supply.
         6.       Recite the anatomy of the oropharynx including muscular structures and contiguous neurovascular structures.
         7.       Recite the physiology of the oropharynx including palatal function, speech, and swallowing.
         8.       Explain the general principles of embryology of the head and neck, with special reference to the development of the
                  facial structures and the occurrence of congenital anomalies such as cleft lip and palate.
         9.       Recite the basic anatomy of the dental structures and the TMJ.
II: Congenital Disorders
Goal: The resident will achieve familiarity with the anatomy, embryology and principles of treatment of congenital disorders of the head
and neck.
Objectives:
         1.       Demonstrate intimate knowledge of the common congenital disorders of the head and neck including cleft lip and
                  palate, craniofacial syndromes, vascular malformations, and auricular abnormalities
         2.       Discuss the etiology, genetics, embryology and anatomy of congenital disorders of the head and neck.
         3.       Be familiar with growth and development of the craniofacial skeleton and its affect on anomalies and their treatment.
         4.       Be able to recite the diagnostic criteria and discus the evaluation and treatment for congenital anomalies such as:
                  a.        craniosynostosis
                  b.        hemifacial microsomia
                  c.        rare craniofacial clefting
                  d.        orbital hypertelorism
                  e.        Pierre-Robin sequence
                  f.        craniofacial tumors
                  g.        choanal atresia
                  h.        nasal anomalies
                  i.        ear anomalies (prominent ear, microtia)
                  j.        vascular anomalies
                  k.        branchial cleft cysts
                  l.        thyroglossal duct cysts
         5.       Discuss the cephalometric landmarks and analysis in the presurgical planning of patients with congenital head and
                  neck anomalies.
III: Benign and Malignant Tumors
Goal: The resident will obtain knowledge of benign and malignant tumors of the head and neck, understand the biologic basis of
treatment options for these lesions, and perform complete management of such lesions including diagnosis, surgery and nonsurgical
therapy.
Objectives:
         1.       Recognize the clinical presentation of squamous cell carcinoma of the head and neck.
         2.       Recite the lymphatic drainage pattern of the head and neck structures and the relationship to the management of
                  malignant tumors.
         3.       Recite the methods for diagnosis and the options for treatment of squamous cell carcinomas of the head and neck.
         4.       Recite the TNM staging system for tumors of the head and neck; know the features and biologic behavior of these
                  lesions.
         5.       Describe the general principles and techniques of adjuvant therapy such as radiation therapy and chemotherapy for
                  head and neck malignancies.
         6.       Discuss the indications for and the role of neck dissection in the treatment of head and neck malignancies.
         7.       Recite the process of long-term follow-up for patients with head and neck malignancies.
         8.       Recite the diagnosis of and principles of care for:
                  a.       rhinophyma
                  b.       eyelid and lacrimal neoplasms
                  c.       infections of the head and neck
                  d.       disease of nasal cavity and paranasal sinuses
         9.       Discuss the differential diagnosis of hemangiomas and vascular malformations.
         10.      Discuss the treatment options, including steroid therapy, laser therapy, and surgery for hemangiomas and vascular
                  malformations of the head and neck.
IV: Trauma
Goal: The resident will be familiar with the mechanisms of traumatic head and neck injuries, understand the diagnostic techniques and
therapeutic options for such problems, and perform complete management of traumatic injuries of the head and neck.
Objectives:
          1.       Describe the priorities involved in treating patients with head and neck injuries.
          2.       Describe the mechanical and structural properties of the facial skeleton as they relate to fracture patterns in facial
                   trauma.
          3.       Describe the concepts of primary bone healing, malunion, nonunion and osteomyelitis.
          4.       Discuss the advantages and disadvantages of various techniques of treatment of facial fractures including:
                   a.        nonoperative treatment
                   b.        closed reduction
                   c.        mandibulomxillary fixation
                   d.        open reduction with and without fixations
                   e.        intraoral splints
                   f.        external fixation
                   g.        bone grafting
          5.       Describe the treatment of facial fracture complications including:
                   a.        secondary deformities
                   b.        infections and osteomyelitis
                   c.        malocclusion
                   d.        nonunions
                   e.        malunions
          6.       Describe the neuroanatomy, cranial nerve anatomy and soft tissue anatomy pertinent to facial fractures.
          7.       Recite the treatment of soft tissue injuries of the had and face including:
                   a.        parotid gland and duct
                   b.        facial nerve
                   c.        lacrimal apparatus
          8.       Describe the evaluation and treatment of secondary deformities of facial fracture including:
                   a.        malocclusion
                   b.        enopthalmos
                   c.        frontal sinus mucoceles
                   d.        facial nerve paralysis
                   e.        soft tissue contractures
          9.       Discuss the principles of care and the surgical steps in the treatment of the following facial fractures:
                   a.        frontal sinus
                   b.        naso-orbital ethmoid
                   c.        orbital
                   d.        zygomatic
                   e.        nasal
                   f.        maxillary
                   g.        mandibular
                   h.        pan-facial
V: Wound Repair: Principles and Applications
Goal: The resident will demonstrate knowledge of the physiology and biochemistry of wound healing and manage complex wounds using
a variety of techniques to achieve normal healing and maximum aesthetic benefit.
Objectives:
          1.       Recite the physiology and biochemistry of normal healing.
          2.       Discuss the physiology and biochemistry of abnormal wound healing including hypertrophic scars and keloids.
          3.       Discuss common agents and processes which result in abnormal healing.
          4.       Identify the pharmacologic agents and other nonsurgical methods for treatment of abnormal healing.
          5.       Describe the management of dressings, splints and other techniques utilized in wound management.
          6.       Explain the differences in the healing of cortical and cancellous, membranous and endochondral bone.
          7.       Draw and plan techniques of scar revision (such as Z-plasty and W-plasty).
          8.       Describe the various lines of the skin (such as relaxed skin tension) and their importance in placement of incisions for
                     maximum aesthetic result.
         9.          Discuss the role of nutrition in the wound healing process and the standard methods for diagnosis and treatment of
                     nutritional deficiencies.
          10.        Discriminate the pathologic processes involved in keloid formation and the methods available to treat keloids.
          11.        Understand the differences in suture materials and indications for the use of different materials.
          12.        Discuss the basic science of healing, including the anatomy, physiology, biochemistry, microbiology, immunology,
                     wound healing for:
                     a.          skin and soft tissue
                     b.          tendon
                     c.          bone (different types)
                     d.          nerve
                     e.          cartilage
          13.        Discuss abnormal wound healing, including:
                     a.          delayed healing – physiology and treatment
                     b.          excessive healing (hypertrophic scars and keloids)
VI: Flaps and Grafts
Goal: The resident will demonstrate knowledge of the physiology and flaps and grafts, will be familiar with surgery in all types of flaps and
grafts, and will utilize these effectively in the full spectrum of plastic surgical practice.
Objectives:
          1.         Discuss the terminology of flap movement including advancement flap, rotation flap, transposition of flap, etc.
          2.         Recite the terminology of flap vascular supply including random flap, island flap, free flap, etc.
          3.         Identify the variations in flap anatomy including cutaneous flap, fasciocutaneous flap, musculocutaneous flap, etc.
          4.         Explain the physiology of normal flaps, ischemic flaps, and the "delay" phenomenon.
          5.         Discuss the pathophysiology and microbiology of acute, intermediate, and secondary wounds, and the impact this has
                     for the timing and techniques of wound closure surgery; be thoroughly familiar with the factors influencing the choice of
                     flap versus graft for wound closure.
          6.         Explain in detail 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.
          7.         Explain the differences in first degree and second degree wound contraction versus contracture.
          8.         Explain the concept of dermatomes and angiosomes and their implications on wounds and flaps.
          9.         Discern the principles and applications of special grafting techniques including dermabrasion and over-grafting, the
                     crane principle, xenografts, skin matrix and synthetic or chemically manipulated materials.
          10.        Recite the Mathe Classification of muscle flaps.
          11.        Discuss the technological, pharmacological, and physiological monitoring techniques including fluorescence, capillary
                     refill, thermal monitoring, laser flow probes, oxygen saturation, pH monitoring, etc.
B. Patient Care
Goal: The resident will provide patient care that is compassionate, appropriate, and effective.
Objectives:
          1.         Participate in the care and treatment of scars and keloids, including:
                     a.          surgical techniques (Z-plasty, W-plasty, etc)
                     b.          nonsurgical techniques
                     c.          camouflage techniques
          2.         Evaluate patients and their nutritional status as related to wound healing, including:
                     a.          diagnosis of deficiency
                     b.          treatment of deficiency
          3.         Participate in planning surgical incisions, with respect to:
                     a.          selection in relation to skin lines
                     b.          techniques for closure
                     c.          suture materials – types and uses
          4.         Participate in wound management, including:
                     a.          debridement
                     b.          use of splints, dressings, casts, topics agents
                     c.          use of biologic substitutes
          5.         Treat complex wound problems such as dehiscence, delayed healing of complex traumatic wounds.
          6.         Evaluate patients with scar problems and revise scars to achieve functional and aesthetic benefit.
          7.         Perform surgical and pharmacologic treatment of hypertrophic scars and keloids.
          8.         Utilize splints, casts, dressings, topical agents, etc., to optimize healing.
          9.         Place incisions for elective surgery in such a way as to achieve the greatest aesthetic benefit.
          10.        Utilize biologic and artificial skin substitutes in wound management.
          11.        Participate in the surgery of grafts and flaps including: skin, dermis, cartilage, bone, tendon, muscle, fascia, combined
                     tissue; specifically:
                     a.          grafting techniques
                     b.          instruments for harvesting grafts
                     c.          graft preservation techniques
                     d.          donor site management
                     e.          recipient site management
                     f.          special techniques
                     g.          xenografts
          12.        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, etc.
13.   Treat patients who have complications of flaps and grafts including skin graft loss, flap necrosis, wound dehiscence,
      wound infection, etc.
14.   Prepare methyl methacrylate prostheses.
15.   Perform surgical procedures using solid implant materials including:
      a.        silicone implantation to breasts, orbital floor, malar area, chin or joints
      b.        non-vascularized bone grafts for a variety of defects.
16.   Perform soft tissue augmentation using injectable material.
17.   Evaluate and treat patients with localized lipodystrophy, using suction lipectomy techniques.
18.   Participate in the evaluation and treatment of patients with a wide variety of congenital and acquired defects using
      tissue expansion techniques.
19.   Evaluate and treat patients using dermabrasion and/or chemical peel.
20.   Participate in obtaining informed consent from patients; effectively documenting that agreement.
21.   Contribute effectively and accurately to the medical record of both inpatients and outpatients.
22.   Treat patients with physical deformities and explore the psychological aspects of their care.
23.   Participate in the management of problem patients, including angry patients, dissatisfied patients, “doctor shoppers”,
      “drug seekers”, etc.
24.   Participate in the management of critically ill patients in the surgical intensive care unit.
25.   Participate in the critical care management/emergency management of burn and trauma patients, including:
      a.        initial care
      b.        diagnosis
      c.        preparation for the operating room
      d.        postoperative care
26.   Participate in the care of surgical patients with complications including:
      a.        respiratory failure
      b.        cardiovascular problems (arrhythmia, DVT, PE)
      c.        sepsis
      d.        bleeding
      e.        hematoma
27.   Participate in the management of patients with autoimmune and collagen vascular diseases such as lupus
      erythematosus.
28.   Identify patients who are at risk for malignancy because of their immunosuppressed condition and provides screening
      and education to these patients.
29.   Identify and treat patients whose condition warrants allografting (e.g., large body surface burn).
30.   Perform pre- and postoperative management of immunosuppressed patients undergoing plastic surgical procedures.
31.   Diagnose and treat patients with surgical wound infections.
32.   Evaluate and treat patients with infections of the head and neck, breast, skin and hand.
33.   Prescribe analgesics for postoperative care and for pain management.
34.   Prescribe anti-inflammatory agents for appropriate cases.
35.   Utilize steroids for treatment of a variety of plastic surgical problems and in the postoperative care of steroid-dependent
      patients.
36.   Participate in the management of patients undergoing chemotherapy for head and neck and/or skin malignancies.
37.   Manage patients with localized extravasation injuries.
38.   Participate in outpatient management including both a clinic experience in which the resident has independent
      responsibility and an observation of faculty managing private patients including initial consultation and management of
      complications.
39.   Code diagnoses by the ICD-9 system.
40.   Code procedures by the CPT system.
41.   Photograph his/her own patients with a standardized format.
42.   Attend risk management seminar or studies risk management techniques and discuss principles with faculty; apply
      these principles in daily practice of plastic surgery.
43.   Perform a comprehensive head and neck exam followed by facial form analysis.
44.   Utilize radiographic and special diagnostic studies to evaluate head and neck anomalies.
45.   Perform an orderly and systematic physical examination of the patient with facial trauma.
46.   Interpret radiographic diagnostic studies including panorex films, cephalograms, CT/3D CT scans, MR imaging, and
      angiography with respect to the head and neck trauma patient.
47.   Perform the staged management of devastating open facial injuries including wound care, debridement and
      reconstruction.
48.   Perform surgical procedures of facial fracture management including:
      b.        maxillary
      c.        mandibular
      d.        orbital
      e.        frontal sinus
      f.        zygomatic
      g.        zygomatic arch
      h.        nasal
      i.        panfacial.
49.   Perform all surgical techniques of access to the craniofacial skeleton.
50.   Perform a comprehensive examination of the facial nerve.
         51.       Perform acute repair of soft tissue facial trauma.
         52.       Perform secondary scar revision from facial trauma.
         53.       Perform primary facial nerve repair, and associated procedures (i.e. global weight, static, and dynamic reconstruction)
                   for the patient with facial paralysis.
          54.      Obtain cephalometric measurements and analyze cephalometric data in the presurgical planning.
          55.      Perform a comprehensive head and neck exam followed by facial form analysis.
          56.      Utilize radiographic and special diagnostic studies to evaluate head and neck anomalies.
          57.      Formulate a definitive short- and long-term treatment plan for common congenital disorders, choosing the most
                   appropriate surgical or nonsurgical modality.
          58.      Draw the reconstruction of a cleft lip and palate.
          59.      Diagnose and develop a treatment plan for velopharyngeal incompetence.
          60.      Coordinate nonsurgical treatment of congenital head and neck disorders.
          61.      Participate in the Cleft-Craniofacial Team’s multidisciplinary evaluation and treatment planning for congenital disorders
                   of the head and neck.
          62.      Provide perioperative care and participate in surgical treatment of patients with craniofacial anomalies.
          63.      Utilize diagnostic techniques for head and neck tumors including radiographic methods (e.g., sialogram, MRI scan, etc)
                   and fine needle aspiration.
          64.      Perform fine needed aspirate biopsies.
          65.      Recite the steps in the surgical treatment of:
                   a.        oropharyngeal tumors
                   b.        salivary gland tumors
                   c.        neck dissections
                   d.        tumors of bony and dental origin.
          66.      Participate in the extirpative surgery for oropharyngeal tumors, including performing neck dissection.
          67.      Evaluate and treats patients with head and neck tumors of a vascular origin.
          68.      Perform an orderly and systematic physical examination of the patient with facial trauma.
          69.      Interpret radiographic diagnostic studies including panorex films, cephalograms, CT/3D CT scans, MR imaging, and
                   angiography with respect to the head and neck trauma patient.
          70.      Perform the staged management of devastating open facial injuries including wound care, debridement and
                   reconstruction.
          71.      Perform surgical procedures of facial fracture management including:
                   a.        maxillary
                   b.        mandibular
                   c.        orbital
                   d.        frontal sinus
                   e.        zygomatic
                   f.        zygomatic arch
                   g.        nasal
                   h.        panfacial
          72.      Perform all surgical techniques of access to the craniofacial skeleton.
          73.      Perform a comprehensive examination of the facial nerve.
          74.      Perform acute repair of soft tissue facial trauma.
          75.      Perform secondary scar revision from facial trauma.
          76.      Perform primary facial nerve repair, and associated procedures (i.e. global weight, static, and dynamic reconstruction)
                   for the patient with facial paralysis.
          77.      Perform systemic therapy and local injection of steroids for treatment of facial hemangiomas.
          78.      Perform laser treatment for vascular malformations.
C. Practice Based Learning and Improvement
Goal: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and
improved patient care practices.
Objectives:
          1.       Use information technology to prepare for surgical cases, bringing to the OR the knowledge of current modalities of
                   care for patients with head and neck diagnoses and the scientific evidence for that care.
          2.       Routinely analyzes the effectiveness of own practices in caring for head and neck patients.
          3.       Improve own practices in the care of head and neck patients by integrating appropriately gathered data and feedback.
          4.       Educate medical students and other healthcare professional in the practices of head and neck surgery.
          5.       Function independently with graduated advancement and appropriate faculty supervision in the evaluation and
                   treatment of patients with head and neck diagnoses.
          6.       Participate in, and appreciate the value of outcome studies as they apply to diagnoses of the head and neck.
D. Interpersonal and Communication Skills
Goal: The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with
patients, their families, and professional associates.
Objectives:
          1.       Educate patients and families in pre- and post-operative care of head and neck patients.
          2.       Demonstrate compassion for patients and families with congenital and acquired anomalies of the head and neck.
          3.       Provide adequate counseling and informed consent to patients.
          4.       Listen to patients and their families.
          5.       Assimilate data and information provided by the craniofacial team and other members of the health care team, in the
                   care of patients with congenital head and neck anomalies.
           6.        Assimilate date and information provided by the head and neck team and tumor board in the care of patients with
                     congenital head and neck cancer.
E. System Based Practice
Goal: The resident will 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.
Objectives:
          1.         Function within the organization of specialty clinics (Cleft Palate Center, Craniofacial Clinic) including the coordination
                     of all special services in the evaluation of children with these anomalies.
          2.         Be able to coordinate the nonsurgical treatment of patients with congenital anomalies among contributing specialties
                     (prosthetics, orthodontics, speech therapy).
          3.         Understand the value of and function within a team approach to treat patients with head and neck malignancies
          4.         Participate in tumor-board conference.
          5.         Participates in multidisciplinary planning and treatment for patients with head and neck malignancies.
          6.         Coordinate all aspects of head and neck rehabilitation, including physical therapy, sensory reeducation, and
                     maxillofacial prosthetics.
          7.         Direct the rehabilitation of head and neck patients by partnering with the following:
                     a.        physical therapy
                     b.        occupational therapy
                     c.        prosthetic and orthotics specialists
                     d.        ENT cancer services
                     e.        Speech and swallow specialists.
          8.         Demonstrate knowledge of cost-effective head and neck reconstruction.
          9.         Advocate for congenital craniofacial patients within the health care and insurance system.
          10.        Understand the benefits and functionality of multidisciplinary craniofacial teams.
          11.        Refer craniofacial patients to the appropriate practitioners and agencies.
          12.        Appreciate the functioning of the multispecialty fetal diagnosis and treatment committees and the potential role prenatal
                     diagnosis plays in the family unit.
          13.        Facilitate the timely discharge of head and neck patients.
          14.        Partner with pediatricians in the combined care of infants undergoing systemic steroid therapy for head and neck
                     hemangiomas.
F. Professionalism
Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and
sensitivity to a diverse patient population.
Objectives:
          1.         Develop a sensitivity of the unique stress placed on families under care for congenital craniofacial anomalies.
          2.         Exhibit an unselfish regard for the welfare of head and neck patients.
          3.         Demonstrate firm adherence to a code of moral and ethical values.
          4.         Be respectful to head and neck patients and their families especially in times of trauma and stress to the family unit.
          5.         Respect and appropriately integrate other members of the craniofacial team.
          6.         Provide appropriately prompt consultations when requested.
          7.         Demonstrate sensitivity to the individual patient’s profession, life goals, and cultural background as they apply to head
                     and neck diagnoses of trauma, malignancy, and congenital anomalies.
          8.         Be reliable, punctual, and accountable for own actions in the OR and clinic.

References:
An Atlas of Head and Neck Surgery by John M. Lore and Jesus Medina (2004)
Head and Neck Surgery and Oncology, Third Edition by Jatin P. Shah (2003)
Local Flaps in Facial Reconstruction: Text with DVD by Shan R. Baker MD (2007)
Mathes and Hentz (eds). Plastic Surgery.


III.   Conference Schedule/Format:
1.     Stanford Plastic Surgery Lecture Series                    Tuesday           4:30 pm - 6:45 pm        Every week
2.     Quality Assurance Meeting                                  Tuesday           5:45 pm - 6:45 pm        Every month
3.     Journal Club                                               Tuesday           7:00 pm - 9:00 pm        Alternating every other month
4.     Service Review                                             Tuesday           5:45 pm - 6:45 pm        Quarterly
5.     Resident Mock Oral Examination                             Tuesday           6:00 pm - 8:00 pm        Biannually
                                                                                                               st     rd
6.     Kaiser Educational Sessions                                Tuesday           1:00pm – 2:00pm          1 and 3
                                                                                                               nd
7.     Kaiser M and M/QA                                          Tuesday           1:00pm – 2:00pm          2
                                                                                                               th
8.     Kaiser Journal Club                                        Tuesday           1:00pm - 2:00pm          4
                                                                                                               th
9.     Kaiser Special Topics (when applicable)                    Tuesday           1:00pm – 2:00pm          5

IV. Method of assessment of resident academic performance

1.     Monthly written evaluation of resident by faculty
2.     Verbal feedback to resident by faculty
3.     Stanford GME House staff survey (annual)
4.     Program Evaluation (annual)
5.   In-service Examination
6.   360 Evaluation
                                            STANFORD UNIVERSITY MEDICAL CENTER
                                                Plastic Surgery Training Program
                                                   Rotation Description Form


I.    Rotation Format:

Rotation:          Microsurgery                  Rotation Duration:           4     Month(s)

Institution:       Davies Medical Center         Call responsibility (q):     q3    Night(s)               In House       X     Home

Responsible       faculty    member:       (CV   Dr. G. Buncke                Training Level:                1            2              3
attached):



II.   Goals and Objectives:                                                   Training Level:                4      X     5              6

Plastic Surgery of the Lower Extremity
A. Medical Knowledge
I: Anatomy/Physiology/Embryology
Goal: The resident will obtain comprehensive knowledge of the anatomy, physiology, and embryology of the lower extremities, and use
this information in the management of a variety of surgical problems of the leg.
Objectives:
          1.       Draw the vascular, neural and osseous anatomy of the lower extremity.
          2.       Describe the muscular and vascular anatomy of specific flaps including fascia lata, vastus lateralis, rectus femoris,
                   sartorius, and gracilis flaps.
          3.       Describe the boundaries of and vascular anatomy of specific cutaneous flaps including the lateral thigh, medial thigh,
                   posterior thigh and groin flaps.
          4.       Draw the venous anatomy of the leg including the sapheneous vein.
          5.       Describe the muscular, cutaneous, and vascular anatomy of the gastrocnemius, soleus, and tibialis muscle flaps.
          6.       Explain the concept of fasciocutaneous flaps and be able to design them on the distal lower extremity.
          7.       Describe the cutaneous margins and vascular anatomy of foot flaps such as medical plantar, lateral plantar, V-Y plantar,
                   and dorsalis pedis-based flaps.
          8.       Describe the neuroanatomy of and boundaries of sensate flaps in the lower extremity.
          9.       Explain the physiology of arterial insufficiency, venous hypertension, and diabetes as they pertain to the lower extremity.
          10.      Draw the detailed anatomy of the popliteal artery and its branches.
          11.      Describe the normal plantar arch and the fundamentals of normal foot vasculature.
          12.      Discriminate the advantages and disadvantages of the various levels of lower extremity amputation.
          13.      Recite the basic lower extremity embryology, abnormal development and its sequelae.
          14.      Describe the anatomy as applied to specific lower extremity flaps including:
                   a.        skin flaps
                   b.        muscle and skin-muscle flaps
                   c.        fascial and fasciocutaneous flaps
                   d.        sensate flaps
                   e.        flaps which include bone
          15.      Describe the biomechanics of the lower extremity including:
                   a.        function of specific muscles and muscle groups
                   b.        gait
                   c.        functional consequences of use of specific muscles as flaps
II: Trauma/Reconstruction of the Lower Extremity
Goal: The resident will obtain the principles of management of trauma related problems of the lower extremity and carry out surgical
management in the reconstruction of such problems.
Objectives:
          1.       Recite the indications for and timing of closure of soft tissue defects of the lower extremity.
          2.       Describe coverage techniques (including skin grafts, flaps, distant flaps, musculocutaneous flaps, and free flaps) for soft
                   tissue closure of the lower extremity.
          3.       Describe the management of infectious processes (including osteomyelitis) related to traumatic injuries of the lower
                   extremity.
          4.       Describe the pathophysiology of and techniques for nonoperative and operative management of traumatic, ischemic,
                   venous stasis, hypertensive and infectious ulcers.
          5.       Recite the etiology and treatment of lymphedema (including non operative measures).
          6.       Recite the basis for classification of tibial fractures and the treatment modification appropriate for injuries of varying
                   severity.
          7.       Understand the orthopedic management of long-bone injuries including internal and external fixation, leg lengthening,
                  and standard techniques for replacement of bone defects.
         8.       Recite the common congenital deformities of the lower extremity (including constriction defects and syndactyly) and their
                  management.


         9.       Describe the indications of and techniques for replantation or revascularization of lower extremity devascularizing or
                  amputative injuries.
         10.      Recite the principles and techniques of aesthetic contouring of the lower extremity (including excisional and liposuction
                  techniques).
III: Microsurgery
Goal: The resident will demonstrate knowledge of the principles of microsurgery, and master basic microsurgery techniques including
microneural repair and microvascular anastomosis.
Objectives:
          1.       Explain the use of the operating microscope and the technical aspects of microvascular anastomosis (artery and vein)
                   and microneural repair.
          2.       Discern the indications for, the contraindications to, and the techniques for accomplishing replantation of amputated
                   parts. Recognize the techniques of monitoring the success of replantation.
          3.       Discuss the varying types of blood supply to discrete units of tissue (including arterialized flap, musculocutaneous flap,
                   fasciocutaneous flap).
          4.       List the terms and types of free tissue flaps – skin, skin/muscle, skin/muscle/bone, skin/tendon, muscle alone.
          5.       List in detail the anatomy for harvesting the most common flaps, including latissimus dorsi, rectus abdominis, radial
                   forearm.
          6.       Discern the indications for harvesting various flaps and matching donor sites to specific recipient site needs.
          7.       Discuss radiologic techniques for evaluation of both donor and recipient sites.
          8.       Discuss the mechanisms and consequences of the no-reflow phenomenon; knows how to treat a failing flap.
          9.       Discuss the technologic, pharmacologic and physiologic principles of postoperative monitoring of free flaps.
          10.      Recite the basic physiology of nerve injury (axontomesis, neurotomesis, neuropraxia, Wallerian degeneration) and of
                   nerve healing.
          11.      Draw the intraneural anatomy and anatomic relationships of structures of the major peripheral nerves.
          12.      Explain the principles of repair of nerve injury including need for nerve grafting, the anatomy of nerve graft donor sites,
                   and the physiology, timing and techniques of primary, delayed primary and late nerve repair.
          13.      Discuss the principles and techniques of hematologic manipulation of abnormal vascular flow characteristics.
          14.      Discuss the technical aspects of microsurgery including:
                   a.        microscopes – principles, usage
                   b.        sutures – types, indications\
                   c.        microvascular coupling devices
                   d.        suturing techniques.
          15.      Discuss the use of electrophysiologic tools in the evaluation of nerve injury (EMG, NCS).
B. Patient Care
Goal: The resident will provide patient care that is compassionate, appropriate, and effective for the treatment of lower extremity
diagnoses.
Objectives:
          1.       Perform cadaver dissection of the lower extremity.
          2.       Apply anatomic and biomedical knowledge to the choice of procedures for lower extremity reconstruction.
          3.       Classify lower extremity tibial fractures.
          4.       Participate in the orthopedic management of lower extremity trauma.
          5.       Participate in the reconstruction of congenital deformities of the lower extremity.
          6.       Participate in the reconstruction of major vascular lesions or injuries of the lower extremity.
          7.       Perform reconstructions of major tendon or nerve injuries of the lower extremity.
          8.       Participate in the surgical and nonsurgical multidisciplinary care of left ulcers.
          9.       Evaluate and treat patients with lower extremity ulceration of different etiologic origins.
          10.      Undertake perioperative management and surgical treatment of patients with devascularizing injuries or conditions of the
                   lower extremity.
          11.      Evaluate and treat patients with lymphedema of the lower extremity.
          12.      Perform aesthetic reconstruction and liposuction of the lower extremities.
C. Practice Based Learning and Improvement
Goal: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and
improve patient care practices.
Objectives:
          1.       Use information technology to prepare for surgical cases, bringing to the OR the knowledge of current modalities of care
                   for patients with lower extremity diagnoses and the scientific evidence for that care.
          2.       Routinely analyze the effectiveness of own practices in caring for lower extremity patients.
          3.       Improve own practices in the care of lower extremity patients by integrating appropriately gathered data and feedback.
          4.       Educate medical students and other healthcare professionals in the practices of lower extremity reconstruction.
          5.       Function independently with graduated advancement and appropriate faculty supervision in the evaluation and treatment
                   of patients with lower extremity diagnoses.
D. Interpersonal and Communication Skills
Goal: The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with
patients, their families, and professional associates.
Objectives:
          1.        Educate patients and families in post-operative care of lower extremity diagnoses.
          2.        Demonstrate compassion for patients and families with congenital and acquired anomalies of the lower extremity.
          3.        Provide adequate counseling and informed consent to patients.
          4.        Listen to patients and their families.
          5.        Assimilate data and information provided by therapists and other members of the health care team.
E. System Based Practice
Goal: The resident will 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.
Objectives:
          1.        Function within the organization of specialty clinics (diabetic clinic, venous stasis clinic, amputation clinic) including the
                    coordination of all special services in the evaluation of lower extremity lesions.
          2.        Coordinate the nonsurgical treatment of patients with lower extremity lesions among contributing specialists (prosthetics,
                    orthotics and wound care specialists).
          3.        Understand and function within a team approach to treat patients with lower extremity diagnoses.
          4.        Participate in multidisciplinary planning and treatment for patients with lower extremity amputations.
          5.        Direct the rehabilitation of lower extremity patients by partnering with the following:
                    a.        physical therapy
                    b.        occupational therapy
                    c.        prosthetic and orthotics specialists
          6.        Demonstrate knowledge of cost-effective lower extremity reconstruction.
F. Professionalism
Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and
sensitivity to a diverse patient population.
Objectives:
          1.        Develop a sensitivity of the unique stress placed on families under care for traumatic lower extremity injuries.
          2.        Exhibit and unselfish regard for the welfare of lower extremity patients.
          3.        Demonstrate firm adherence to a code of moral and ethical values.
          4.        Be respectful to patients and their families, especially in times of trauma and stress to the family unit.
          5.        Provide appropriately prompt consultations when requested.
          6.        Demonstrate sensitivity to the individual patient’s profession, life goals, and cultural background as they apply to lower
                    extremities diagnoses.
          7.        Be reliable, punctual, and accountable for own actions in the OR and clinic.

Plastic Surgery of the Hand/Upper Extremity
A. Medical Knowledge
I: Anatomy/Physiology/Embryology
Goal: The resident will achieve a detailed knowledge of the anatomy, physiology, and embryology of the upper extremity and will utilize
this knowledge in the complete management of the hand, arm, and brachial plexus.
Objectives:
          1.        Describe in detail the anatomy and physiology of the muscles, tendons, ligaments, and bones of the hand and upper
                    extremity.
          2.        Identify in detail the anatomy of the vascular tree of the upper extremity including relationships to the surrounding
                    structures.
          3.        Identify in detail the anatomy of the major nerves and their branchings in the upper extremity including relationships to
                    surrounding structures.
          4.        Draw the anatomy of the brachial plexus.
          5.        Demonstrate the detailed radiographic anatomy of the bony structures of the upper extremity.
          6.        Utilizes the radiologic techniques, including plain films, CT scan, angiography and MRI of the upper extremities.
          7.        Discriminate the principles of electrical evaluation and recite knowledge of the techniques of electrical examination of the
                    upper extremities including conduction studies and EMG evaluation.
          8.        Recite the principles of upper extremity biomechanics.
II: Trauma
Goal: The resident will understand the principles of diagnosis and treatment of extremity trauma, and perform comprehensive
management of acute injuries and other trauma-related problems of the hand and arm.
Objectives:
          1.        Recite the principles and applications of diagnostic techniques for the evaluation of hand and upper extremity trauma.
          2.        Describe the techniques for operative management of traumatic injuries of the upper extremity, their indications and
                    contraindications, and their possible complications and the treatment thereof.
          3.        Explain the indications for, contraindications to, and techniques in nonoperative management of traumatic injuries of the
                    hand and upper extremity.
          4.        Describe the options for soft tissue coverage of upper extremities including:
                    a.        skin grafts
                    b.        local flaps
                    c.        free tissue transfer
III: Functional Problems of the Upper Extremities
Goal: The resident will achieve familiarity with aesthetic and functional problems of the hand and arm, understand the principles of
rehabilitation of the upper extremity and the management including comprehensive rehabilitation of the upper extremity.
Objectives:
         1.       List the surgical and nonsurgical treatment of nerve compression and entrapment syndromes of the upper extremity.
         2.       Draw the pathologic anatomy and physiology of upper extremity contractures and Dupuytren’s disease.
         3.       Recite the basic pathophysiology of rheumatoid and nonspecific arthritis of the upper extremity.
         4.       Describe with the pharmacological therapy of rheumatoid arthritis.
         5.       Demonstrate the surgical treatment of rheumatoid arthritis, timing of therapeutic treatment and interactions with medical
                  therapy.
         6.       Describe the common circulatory disorders of the upper extremity including, but not limited to: arterial thromboses,
                  aneurysms, embolic disorders, arteriovenous fistulae, vasospastic disease and scleroderma.
         7.       Describe the diagnosis and treatment of common pain syndromes including sympathetic dystrophy.
         8.       Recite the management of upper extremity lymphedema.

IV: Reconstruction
Goal: The resident will understand the principles and techniques of upper extremity reconstruction and apply these to a variety of
developmental, traumatic and acquired problems.
Objectives:
          1.        Recite the diagnostic techniques for evaluation of function including EMG and conduction studies, arteriography, CT
                    scan, and MRI evaluation.
          2.        Recite the use of tendon transfers.
B. Patient Care
Goal: The resident will provide patient care that is compassionate, appropriate, and effective for the treatment of hand problem s.
Objectives:
          1.        Perform the clinical techniques for physical examination of the hand and upper extremity.
          2.        Perform the surgical techniques used to treat congenital and developmental hand anomalies.
          3.        Perform postoperative care of patients with congenital and developmental anomalies of the upper extremity.
          4.        Apply casts and splints for the preoperative and postoperative care of hand patients.
          5.        Utilizes the diagnostic techniques for upper extremity tumors.
          6.        Demonstrate the techniques of management of extremity tumors.
          7.        Performs the procedures for the acute management and participates in the post-operative rehabilitation of traumatic
                    injuries of the upper extremity including:
                    a.         fractures and dislocations
                    b.         nerve injury including brachial plexus
                    c.         major amputation and avulsions
                    d.         joint injury
                    e.         tendon extensor and flexor injury of the hand
                    f.         muscle and tendon injury of the arm
                    g.         nail bed injuries
                    h.         infections
                    i.         fingertip and other minor injuries
          8.        Perform the surgical treatment options for contractures.
          9.        Perform treatment for tenosynovitis and tendon rupture.
          10.       Describe the indications for and perform the techniques of tendon reconstruction including tendon grafting – sources,
                    methods, indications.
          11.       Perform the management of nerve injuries including primary, delayed primary and secondary repair.
          12.       Perform the techniques for reconstruction of the amputated thumb including lengthening, pollicization, free toe to thumb,
                    and free wrap-around techniques.
          13.       Perform the technical methods of soft tissue coverage including skin grafts, local flaps, distant flaps, and transfers.
C. Practice Based Learning and Improvement
Goal: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and
improve patient care practices.
Objectives:
          1.        Uses information technology to prepare for surgical cases, bringing to the OR the knowledge of current modalities of
                    care and the scientific evidence for that care.
          2.        Routinely analyzes the effectiveness of own practices in caring for hand patients.
          3.        Improves own practices in the care of hand patients by integrating appropriately gathered data and feedback.
          4.        Educates medical students and other healthcare professionals in the practices of hand surgery.
          5.        Functions independently with graduated advancement and appropriate faculty supervision.
D. Interpersonal and Communication Skills
Goal: The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with
patients, their families, and professional associates.
Objectives:
          1.        Educates patients and families in post operative strategies for hand therapy.
          2.        Demonstrates compassion for patients and families with traumatic and congenital hand deformities.
          3.        Provides adequate counseling and informed consent to patients.
          4.        Listens to patients and their families.
          5.        Assimilates data and information provided by hand therapists and other members of the health care team.
          6.        Charts and records accurate information.
E. System Based Practice
Goal: The resident will 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.
Objectives:
         1.         Coordinates all aspects of hand and upper extremity rehabilitation, including splinting, prosthesis use, physical therapy,
                    and sensory re-education.
          2.        Direct the rehabilitation of upper extremities following trauma by partnering with the following:
                    a.        Physical Therapy
                    b.        Occupational Therapy
                    c.        prosthetic and orthotic specialists
          3.        Demonstrates knowledge of cost-effective hand care.
          4.        Advocates for hand patients within the health care system.
          5.        Understands the basics of the Worker’s Compensation.
          6.        Refers hand patients to the appropriate practitioners and agencies.
          7.        Facilitates the timely discharge of hand patients.
F. Professionalism
Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and
sensitivity to a diverse patient population.
Objectives:
          1.        Develops a sensitivity of the unique stresses placed on families under care for congenital anomalies of the hand.
          2.        Exhibits an unselfish regard for the welfare of hand patients.
          3.        Demonstrates firm adherence to a code of moral and ethical values.
          4.        Is respectful to hand patients and their families especially in times of trauma and stress to the family unit.
          5.        Respects and appropriately integrates other members of the hand care team.
          6.        Provides appropriately prompt hand consultations when requested.
          7.        Demonstrates sensitivity to the individual patient’s profession, life goals, and cultural background as they apply to hand
                    surgery.
          8.        Is reliable, punctual, and accountable for own actions in the OR and hand clinic.

References:
Green's Operative Hand Surgery e-dition: Text with Continually Updated Online Reference, 2-Volume Set by David Green, Robert
Hotchkiss, William Pederson, and Scott Wolfe (2005)
Tendon, Nerve and Other Disorders (Surgery of Disorders of the Hand and Upper Extremity) by Raoul Tubiana and Gilbert Alain (2004)
Hand Surgery. 2 Volume Set by Richard A Berger and Arnold-Peter C Weiss (2003)



III. Conference Schedule/Format:

1.   Weekly CPMC/Davies Hand/Microsurgery Conference 7:00 – 8:15 am, Monday
2.   Weekly Grand Rounds with Hand/Microsurgery Department CPMC/Davies 7:00 – 9:15 am, Thursday
                st
3.   Monthly (1 Tuesday) case presentation with Plastic Surgery Department and CPMC/Davies Microsurgery Department 7:00 – 8:00
     am.
                                                 rd
4.   Monthly Hand Conference 7:00 – 8:00 am, 3 Tuesday.
5.   All Stanford Plastic Surgery Conferences – Tuesdays 4:30 pm – 6:45 pm.


IV. Method of assessment of resident academic performance

1.   Monthly written evaluation of resident by faculty
2.   Verbal feedback to resident by faculty
3.   Stanford GME House staff survey (annual)
4.   Program Evaluation (annual)
5.   In-service Examination
6.   360 Evaluation
                                             STANFORD UNIVERSITY MEDICAL CENTER
                                                 Plastic Surgery Training Program
                                                    Rotation Description Form


I.   Rotation Format:

Rotation:             Pediatric &                    Rotation Duration:             4    Month(s)
                      Craniomaxillofacial Surgery

Institution:          Stanford/LPCH                  Call responsibility (q):      q3    Night(s)              In House    X      Home

Responsible faculty member: (CV attached):           Dr. H. P. Lorenz             Training Level:               1            2          3

II. Goals and Objectives:                                                            Training Level:               4     X      5        6
A. Medical Knowledge
I. Congenital Disorders
Goal: The resident will demonstrate knowledge of congenital disorders of the trunk, breast, and abdomen, and perform complete plastic
surgical management of these problems.
Objectives:
          1.      Discuss the normal male and female breast growth and development and understand the general physiologic
                  principles of disease in which breast abnormalities may be but one manifestation.
          2.      Discuss the physiologic consequences of developmental chest wall deformities.
          3.      Recite the surgical aspects of treatment of patients with developmental chest wall deformities such as pectus
                  carinatum and pectus carivatum.
          4.      Discusses 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 and gynecomastia.
          5.      Discuss the knowledge of the common deformities of the posterior trunk.
          6.      Discuss the reconstructive surgery of posterior trunk lesions, including meningomyelocele, sacrococcygeal teratomas,
                  etc., and recognize the benefit of a team approach to these problems.
          7.      Recite the embryology and developmental anatomy of congenital abdominal deformities such as gastrocscesis, prune
                  belly and omphalocele.
          8.      Discuss the reconstructive surgical management of congenital abdominal deformities such as gastroscesis, prune
                  belly, and omphalocele.
II. Facial Trauma
Goal: The resident will be familiar with the mechanisms of traumatic head and neck injuries, understand the diagnostic techniques and
therapeutic options for such problems, and perform complete management of traumatic injuries of the head and neck.
Objectives:
          1.      Describe the priorities involved in treating patients with head and neck injuries.
          2.      Describe the mechanical and structural properties of the facial skeleton as they relate to fracture patterns in facial
                  trauma.
          3.      Describe the concepts of primary bone healing, malunion, nonunion and osteomyelitis.
          4.      Discuss the advantages and disadvantages of various techniques of treatment of facial fractures including:
                  a.        nonoperative treatment
                  b.        closed reduction
                  c.        mandibulomxillary fixation
                  d.        open reduction with and without fixations
                  e.        intraoral splints
                  f.        external fixation
                  g.        bone grafting.
          5.      Describe the treatment of facial fracture complications including:
                  a.        secondary deformities
                  b.        infections and osteomyelitis
                  c.        malocclusion
                  d.        nonunions
                  e.        malunions
          6.      Describe the neuroanatomy, cranial nerve anatomy and soft tissue anatomy pertinent to facial fractures.
          7.      Recite the treatment of soft tissue injuries of the had and face including:
                  a.        parotid gland and duct
                  b.        facial nerve
                  c.        lacrimal apparatus
          8.      Describe the evaluation and treatment of secondary deformities of facial fracture including:
                  a.        malocclusion
                  b.        enopthalmos
                  c.        frontal sinus mucoceles
                  d.       facial nerve paralysis
                  e.       soft tissue contractures
         10.      Discuss the principles of care and the surgical steps in the treatment of the following facial fractures:
                  i.       frontal sinus

                 j.        naso-orbital ethmoid
                 k.        orbital
                 l.        zygomatic
                 m.        nasal
                 n.        maxillary
                 o.        mandibular
                 p.        pan-facial
III: Anatomy/Physiology/Embryology
Goal: The resident will achieve detailed knowledge of the anatomy, physiology, embryology of the head and neck, and will apply this
knowledge to the medical management of disorders and processes in this anatomic area.
Objectives:
         1.      Describe the anatomy of the skull including sutures, foramina, and cranial nerves.
         2.      Identify the anatomy of the facial bones.
         3.      Identify the anatomy of the eye including normal dimensions, bony structures, eyelids, extraocular muscles,
                 innervation, vascular supply, and lacrimal apparatus.
         4.      Identify the anatomy of the ear including common measurements, relationships to other structures, and the vascular
                 and sensory supply.
         5.      Draw the anatomy of the nose and septum including bones, nerves and vascular supply.
         6.      Recite the anatomy of the oropharynx including muscular structures and contiguous neurovascular structures.
         7.      Recite the physiology of the oropharynx including palatal function, speech, and swallowing.
         8.      Explain the general principles of embryology of the head and neck, with special reference to the development of the
                 facial structures and the occurrence of congenital anomalies such as cleft lip and palate.
         9.      Recite the basic anatomy of the dental structures and the TMJ
IV: Congenital Disorders
Goal: The resident will achieve familiarity with the anatomy, embryology and principles of treatment of congenital disorders of the head
and neck.
Objectives:
         1.      Demonstrate intimate knowledge of the common congenital disorders of the head and neck including cleft lip and
                 palate, craniofacial syndromes, vascular malformations, and auricular abnormalities
         2.      Discuss the etiology, genetics, embryology and anatomy of congenital disorders of the head and neck.
         3.      Be familiar with growth and development of the craniofacial skeleton and its affect on anomalies and their treatment.
         4.      Be able to recite the diagnostic criteria and discus the evaluation and treatment for congenital anomalies such as:
                 a.        craniosynostosis
                 b.        hemifacial microsomia
                 c.        rare craniofacial clefting
                 d.        orbital hypertelorism
                 e.        Pierre-Robin sequence
                 f.        craniofacial tumors
                 g.        choanal atresia
                 h.        nasal anomalies
                 i.        ear anomalies (prominent ear, microtia)
                 j.        vascular anomalies
                 k.        branchial cleft cysts
                 l.        thyroglossal duct cysts
         5.      Discuss the cephalometric landmarks and analysis in the presurgical planning of patients with congenital head and
                 neck anomalies.
B. Patient Care
Goal: The resident will provide patient care that is compassionate, appropriate, and effective for the treatment of hand and neck
problems.
Objectives:
         1.      Obtain cephalometric measurements and analyze cephalometric data in the presurgical planning.
         2.      Perform a comprehensive head and neck exam followed by facial form analysis.
         3.      Utilize radiographic and special diagnostic studies to evaluate head and neck anomalies.
         4.      Formulate a definitive short- and long-term treatment plan for common congenital disorders, choosing the most
                 appropriate surgical or nonsurgical modality.
         5.      Draw the reconstruction of a cleft lip and palate.
         6.      Diagnose and develop a treatment plan for velopharyngeal incompetence.
         7.      Coordinate nonsurgical treatment of congenital head and neck disorders.
         8.      Participate in the Cleft-Craniofacial Team’s multidisciplinary evaluation and treatment planning for congenital disorders
                 of the head and neck.
         9.      Provide perioperative care and participate in surgical treatment of patients with craniofacial anomalies.
         10.     Utilize diagnostic techniques for head and neck tumors including radiographic methods (e.g., sialogram, MRI scan,
                 etc) and fine needle aspiration.
         11.     Perform fine needed aspirate biopsies.
         12.        Recite the steps in the surgical treatment of:
                    a.         oropharyngeal tumors
                    b.         salivary gland tumors
                    c.         neck dissections
                    d.         tumors of bony and dental origin
          13.       Participate in the extirpative surgery for oropharyngeal tumors, including performing neck dissection.
          14.       Evaluate and treats patients with head and neck tumors of a vascular origin.
          15.       Perform an orderly and systematic physical examination of the patient with facial trauma.
          16.       Interpret radiographic diagnostic studies including panorex films, cephalograms, CT/3D CT scans, MR imaging, and
                    angiography with respect to the head and neck trauma patient.
          17.       Perform the staged management of devastating open facial injuries including wound care, debridement and
                    reconstruction.
          18.       Perform surgical procedures of facial fracture management including:
                    a.         maxillary
                    b.         mandibular
                    c.         orbital
                    d.         frontal sinus
                    e.         zygomatic
                    f.         zygomatic arch
                    g.         nasal
                    h.         panfacial
          19.       Perform all surgical techniques of access to the craniofacial skeleton.
          20.       Perform a comprehensive examination of the facial nerve.
          21.       Perform acute repair of soft tissue facial trauma.
          22.       Perform secondary scar revision from facial trauma.
          23.       Perform primary facial nerve repair, and associated procedures (i.e. global weight, static, and dynamic reconstruction)
                    for the patient with facial paralysis.
          24.       Perform systemic therapy and local injection of steroids for treatment of facial hemangiomas.
          25.       Perform laser treatment for vascular malformations.
          26.       Perform reconstructive surgery on the trunk, breast, and abdomen with increasing independence and surgical
                    responsibility.
          27.       Participate in the surgical care of common developmental breast anomalies, with graduated surgical independence,
                    including amastia, Poland’s syndrome, asymmetry, ectopic mammary tissue, virginal hypertrophy, and gynecomastia.
          28.        Evaluate and surgically treat patients with gynecomastia.
          29.       Participate in the evaluation of patients with developmental breast abnormalities and perform diagnostic studies;
                    interact with appropriate consultants in allied areas.
          30.       Perform perioperative care and surgery on patients with developmental breast abnormalities.
          31.        Critically analyze patients with developmental chest wall deformities for aesthetic and functional reconstruction.
          32.        Participate in reconstructive surgery on patients with developmental chest deformities.
          33.        Participate in the surgical care of posterior trunk lesions, including meningomyelocele, sacrococcygeal teratomas, etc.
          34.        Evaluate and participate in the multispecialty surgical evaluation of patients with congenital deformities of the posterior
                    trunk.
          35.        Participate in the reconstruction of posterior trunk congenital defects.
          36.        Participate in the surgical care of congenital abdominal wall deformities such as gastroscesis, prune belly, and
                    omphalocele.
          37.        Participate in the evaluation and surgical planning (in concert with other surgical specialists) of congenital abdominal
                    wall deformities.
C. Practice Based Learning and Improvement
Goal: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and
improved patient care practices.
Objectives:
          1.        Use information technology to prepare for surgical cases, bringing to the OR the knowledge of current modalities of
                     care for patients with head and neck diagnoses and the scientific evidence for that care.
          2.        Routinely analyzes the effectiveness of own practices in caring for head and neck patients.
          3.        Improve own practices in the care of head and neck patients by integrating appropriately gathered data and feedback.
          4.        Educate medical students and other healthcare professional in the practices of head and neck surgery.
          5.        Function independently with graduated advancement and appropriate faculty supervision in the evaluation and
                    treatment of patients with head and neck diagnoses.
          6.        Participate in, and appreciate the value of outcome studies as they apply to diagnoses of the head and neck.
D. Interpersonal and Communication Skills
Goal: The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming
with patients, their families, and professional associates.
Objectives:
          1.        Educate patients and families in pre- and post-operative care of pediatric plastic surgery patients.
          2.        Demonstrate compassion for patients and families with congenital and acquired anomalies of the head and neck.
          3.        Provide adequate counseling and informed consent to patients.
          4.        Listen to patients and their families.
          5.        Assimilate data and information provided by the craniofacial team and other members of the health care team, in the
                    care of patients with congenital head and neck anomalies.
           6.        Assimilate date and information provided by the head and neck team and tumor board in the care of patients with
                     congenital head and neck cancer.
E. System Based Practice
Goal: The resident will 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.
Objectives:
          1.         Function within the organization of specialty clinics (Cleft Palate Center, Craniofacial Clinic) including the coordination
                     of all special services in the evaluation of children with these anomalies.
          2.         Be able to coordinate the nonsurgical treatment of patients with congenital anomalies among contributing specialties
                     (prosthetics, orthodontics, speech therapy).
          3.         Understand the value of and function within a team approach to treat patients with head and neck malignancies
          4.         Participate in tumor-board conference.
          5.         Participates in multidisciplinary planning and treatment for patients with head and neck malignancies.
          6.         Coordinate all aspects of head and neck rehabilitation, including physical therapy, sensory reeducation, and
                     maxillofacial prosthetics.
          7.         Direct the rehabilitation of head and neck patients by partnering with the following:
                     a.        physical therapy
                     b.        occupational therapy
                     c.        prosthetic and orthotics specialists
                     d.        ENT cancer services
                     e.        Speech and swallow specialists.
          8.         Demonstrate knowledge of cost-effective head and neck reconstruction.
          9.         Advocate for congenital craniofacial patients within the health care and insurance system.
          10.        Understand the benefits and functionality of multidisciplinary craniofacial teams.
          11.        Refer craniofacial patients to the appropriate practitioners and agencies.
          12.        Appreciate the functioning of the multispecialty fetal diagnosis and treatment committees and the potential role
                     prenatal diagnosis plays in the family unit.
          13.        Facilitate the timely discharge of head and neck patients.
          14.        Partner with pediatricians in the combined care of infants undergoing systemic steroid therapy for head and neck
                     hemangiomas.
F. Professionalism
Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and
sensitivity to a diverse patient population.
Objectives:
          1.         Develop a sensitivity of the unique stress placed on families under care for congenital craniofacial anomalies.
          2.         Exhibit an unselfish regard for the welfare of head and neck patients.
          3.         Demonstrate firm adherence to a code of moral and ethical values.
          4.         Be respectful to head and neck patients and their families especially in times of trauma and stress to the family unit.
          5.         Respect and appropriately integrate other members of the craniofacial team.
          6.         Provide appropriately prompt consultations when requested.
          7.         Demonstrate sensitivity to the individual patient’s profession, life goals, and cultural background as they apply to head
                     and neck diagnoses of trauma, malignancy, and congenital anomalies.
          8.         Be reliable, punctual, and accountable for own actions in the OR and clinic.

References:
Plastic Surgery, Vol. 4: Pediatric Plastic Surgery by Stephen J. Mathes MD (2005)
Principles of Practice of Pediatric Plastic Surgery by Michael L. Bentz (2008)
Pediatric Plastic Surgery, An Issue of Clinics in Plastic Surgery (The Clinics: Surgery) by Samuel Stal MD and Larry Hollier MD (2005)



III.   Conference Schedule/Format:
1.     Stanford Plastic Surgery Lecture Series                 Tuesday            5:45 pm - 7:45 pm        Weekly
2.     Quality Assurance Meeting                               Tuesday            5:45 pm - 6:45 pm        Monthly
3.     Journal Club                                            Tuesday            7:00 pm - 9:00 pm        Alternating every other month
4.     Service Review                                          Tuesday            5:45 pm - 6:45 pm        Quarterly
5.     Resident Mock Oral Examination                          Tuesday            6:00 pm - 8:00 pm        Biannually
6.     Resident Teaching Conference                            Tuesday            4:30 pm – 5:30 pm        Weekly


IV. Method of assessment of resident academic performance
1. Monthly written evaluation of resident by faculty
2. Verbal feedback to resident by faculty
3. Stanford GME House staff survey (annual)
4. Program Evaluation (annual)
5. In-service Examination
6. 360 Evaluation