The didactic component of the training program is designed around a three-year rotating schedule, based on the Comprehensive Plastic Surgery Curriculum, that will allow the residents exposure to all 12 topics of plastic surgery as set forth by the Program Requirements for Plastic Surgery. The principle of education or “self-learning” is encouraged and expected. The program is centered on a core curriculum for which a schedule of topics is provided each year. All residents, including off-site residents are required to attend. The resident and faculty member assigned to lead the discussion and present the topic prepare a presentation based on primary sources such as core curriculum text, selected readings, and current literature. Clinically related cases are also used for illustrative purposes. Questions are distributed one week prior to the conference, and the other residents who are not assigned the topic are expected to research and prepare for discussion. Residents are expected to research their questions in major textbooks and current journals. At the end of each session, residents are given practice questions to gauge their level of understanding.
A weekly case management conference, plastic surgery grand rounds, monthly morbidity and mortality conference, and weekly hospital ward teaching rounds are held for the residents. In each of these conferences, the resident is responsible for preparing a sharp, crisp presentation and discussion of the pertinent facets of that particular topic. It is expected that he/she will have read about and have a significant understanding of the topic. Where appropriate, clear, well-composed photographs are expected. The discussion is then opened up to the floor for consideration by the rest of the surgical team, including medical students, residents, and faculty. The presentations are designed to help the residents develop and sharpen their presentation skills, thought processes, planning abilities, and problem-solving abilities and to provide a sound foundation for the practice of academic plastic surgery. All full-time faculty members attend these conferences and rounds, and all affiliated faculty are invited and encouraged to attend. All residents, including off-site residents, are required to attend.
Journal Club/Other Conferences
Additional conferences, such as the journal club and the multidisciplinary hand, breast, craniofacial, tumor, and burn conferences, will help provide further exposure to the major categories of plastic surgery in addition to some of the more current information available. The combination of all the conferences and rounds is intended to provide a comprehensive study of plastic surgery, from the elemental aspects of the basic sciences to the art and finesse of clinical practice. Gross and surgical anatomy is covered in many venues and in many different approaches. Where appropriate in each of the above conferences, anatomy is discussed. This is supplemented by gross anatomy dissections, in collaboration with the Department of Anatomy, with specific emphasis on surgical approaches and planning.
In addition to the scheduled conferences and didactic sessions, residents are provided with an annual microsurgical-training course. This “hands-on” course teaches the basics of microsurgery and allows the residents unencumbered practice sessions. Formal evaluation and instructions are provided. The microsurgery lab is available at any time for their use.
Resident Scholarly Activity
Residents are encouraged to become involved in research at all phases of their residency. A faculty member will become his/her mentor early in the residency and help plan and initiate a project. This resident/faculty team will then see the project through the initial stages, the funding aspects, the procurement of data, the interpretation of results, and finally the presentation and submission of a manuscript. All residents are encouraged to present both clinical and basic science projects at local and national meetings. Time is provided for preparation.
The questioning of current practice and ideas and the creation of new ideas and knowledge through clinical and basic research is considered a major responsibility of faculty and residents. Each resident will be expected to become involved in a research project as part of his/her residency training. The goal of this project is to teach the resident how to learn and apply the scientific method of inquiry, problem identification, and potential solutions, be they clinical or basic science, in the field of plastic and reconstructive surgery.
Faculty members closely supervise residents on a continual basis during all clinical rotations. Faculty members are responsible for all patients in all of the clinical settings of this program. Faculty members are present and supervise all clinics. It is a policy at all of the participating hospitals that a faculty member must be present for all “key portions” of a surgical procedure, and this must be documented. Although a faculty member is present for all procedures, independent operating by the residents in all years is encouraged. The residents are given the opportunity to function as assistant surgeon, primary surgeon, or teaching surgeon based on their level of experience and their individual level of technical expertise. All rotations function in the same manner and have faculty available 24 hours a day by pager or home phone number.
Residents do not take in-house call. Residents have one day of seven free of routine responsibilities. All of the residents are on call no more than every third night and have at least one full weekend off call per month. The monthly call schedule is generated by the residents prior to the beginning of the month and is reviewed by the program director or residency coordinators to ensure compliance.
The program director formally reviews all the written evaluations at the end of each rotation. The results are discussed by the program director with each resident individually at the end of each six-month period, and the resident co-signs the evaluation form. In addition, at the sponsoring institution, midway through each rotation, every resident meets with the program director to discuss his/her progress on the specific rotation. If there are any personal or personality problems or conflicts, they are also discussed and written remedies formulated. All evaluation forms are forwarded to the program director for his review and signature.
The program director and the residents formally evaluate all faculty members. A form generated on computer (PC) format is completed by each resident on a quarterly basis at the end of his/her rotation for each faculty member with whom he/she personally worked. The form is given to the program director. The evaluations are discussed anonymously with the faculty members at a staff meeting at the end of the year and are used as part of the program director’s annual evaluation of each faculty member.
Internal Evaluation of the Program
The Coordinating Council on Graduate Medical Education at UT Health San Antonio reviews the residency programs. Representatives from various aspects of the program, including the Chief Residents, are involved in the review process. The Council members then perform a “site” visit, and a written report is issued. In addition, there will be an annual end-of-the-year plastic surgery faculty and resident retreat to discuss the plastic surgery program. All facets of the program including resident case mix, numbers, faculty evaluations, and a review of the goals and objectives for each individual rotation will be discussed. Appropriate changes will be made to rotations, faculty members, and rotation objectives to comply with our goal of educating the plastic surgery residents. A written evaluation will be compiled and issued to members of the faculty.