GOALS AND TRAINING OBJECTIVES

GOALS AND OBJECTIVES The basic science and clinical skills objectives are listed individually below. The objectives will be emphasized on certain rota...
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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 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) 2)

Ethical, appropriate, specific and effective treatment, independent thinking, life-long learning and improvement. 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 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

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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) 2) 3) 4) 5) 6)

Demonstrate a commitment to professional responsibilities Perform patient care in an ethical manner Display sensitivity to the needs of a diverse patient population Demonstrate the principles of the highest standard of patient care Demonstrate commitment to continuity of patient care Demonstrate sensitivity to patient age, gender and culture

Standard: As judged against applicable standards for the Medical Professional.

Resident

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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 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

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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) 2) 3) 4) 5)

Evaluate patient care through a personal QA program Appraise scientific evidence as to correctness of data Appraise scientific evidence as to applicability in patient care Assimilate new scientific knowledge to improve the care of one’s own patient 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 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

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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 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 demonstrate knowledge of common agents for local anesthesia (esters and amides), regional anesthesia and general anesthesia (intravenous agents, inhalation agents, muscle relaxants, antiemetics, etc). 2) He/she will know the principles and the techniques for administration of local anesthesia and understand the pharmacology and safe utilization of agents in "conscious sedation." Clinical / Surgical Skills Objectives 1) The resident will participate in the decision as to which technique of anesthesia should be used on his patients. 2) He/she will utilize the techniques of local anesthesia and carry out emergency management of burn and trauma patients. 3) He/she will manage all plastic surgical patients postoperatively.

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 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 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 (PC). 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 and develop treatment plans (PC, MK). 3) The resident will débride, repair and close acute and chronic wounds involving both bony and soft tissue injuries of the upper extremity. (PC). 4) He/She will operate on patients with fractures of the extremity and performs closed reductions, open reductions, internal fixations, and bone grafting (PC). 5) The resident will perform rigid bony fixation and be able to access and manage the complication thereof (PC). 6) The resident will understand timing for surgical procedures both of congenital and traumatic nature (PC, PBLI). 7) He/She will evaluate and manage nerve, tendon, fingertip and bony injuries (PC). 8) He/She will diagnose, evaluate and treats upper extremity infections (PC). 9) He/She will perform skin grafting and flap closure of soft tissue defects of the upper extremity (PC). 10) The resident will direct rehabilitation of upper extremity trauma following surgical treatment (SBP). 11) He/She will know and practice the principles of immobilization and splinting (PC, PBLI, SBP). ROTATIONAL COMPETENCIES Resident Name:

Burns and Trauma Basic Sciences / Medical Knowledge Objectives 1) The resident will understand normal skin anatomy, circulation and how it is impacted by injury. 2) He/she will also understand the physiologic changes, which occur with thermal or traumatic injury. 3) He/she understands the relationship between duration of exposure and temperature and the specific changes which occur in the zone of coagulation, stasis, and hyperemia. 4) He/she understands the pathophysiology and treatment of inhalation injuries and carbon monoxide poisoning. 5) He/she also understands the pathophysiologic changes unique to chemical burns. 6) The resident will understand the pharmacology and utilization of topical antibacterial agents, analgesics and antibiotics in the treatment of burns. Clinical / Surgical Skills Objectives 1) He/she will recognizes the Rule of Nines, the use of more detailed body surface charts, and the difference in relative body surface area comparing children to adults. 2) He/she knows the parameters, which define major, moderate and minor 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 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 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) 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) The resident will know the priorities involved in treating patients with multiple trauma, the timing of treatment of head and neck injuries, and the indications for endotracheal intubation and tracheostomy in such patients. 5) He/She knows an orderly, systematic approach to the physical examination of patients with facial trauma. 6) He/She will discuss the indications for specific diagnostic studies including conventional radiography, Panorex films, computer-assisted tomography, three-dimensional CT scan imaging, and magnetic resonance imaging. 7) He/She appreciates the mechanical properties of the facial skeleton and patterns of injury associated with facial trauma including associated cervical and cranial trauma. 8) The resident will demonstrate 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. 9) He/She will discuss the concepts of primary bone healing, malunion, nonunion and osteomyelitis. 10) He/She will recognize the indications for operative treatment of facial fractures. 11) 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. ROTATIONAL COMPETENCIES Resident Name: Flaps and Grafts Basic Sciences / Medical Knowledge Objectives 1) The resident understands the physiology of flaps and grafts, is thoroughly familiar with surgery in all types of flaps and grafts, and can design and utilizes flaps effectively for reconstruction in the full spectrum of plastic surgical practice. 2) He/she will understand the terminology of flap movement, composition and vascular supply. 3) The resident will recognize the physiology of normal flaps, ischemic flaps, and the "delay" phenomenon. 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 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 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: 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: 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.

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. 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. ROTATIONAL COMPETENCIES Ophthalmology Basic Sciences / Medical Knowledge Objectives 1) The resident will demonstrate knowledge of the anatomical features of the bony orbit and surrounding soft tissue structures.

2) The resident will understand the different evaluation tools available for assessment of orbit and surrounding structures. 3) The resident will demonstrate knowledge of the pathological conditions which are a result of abnormal anatomy, pathology and or disease. Clinical: Patient Care (Surgical Skills), IPCS, Professionalism, Systems Based Practice and PBLI Objectives 1) The resident will demonstrate knowledge of common orbit and periorbital problems and develop individual treatment plans (PC, MK). 2) Evaluate patients in clinic, perform complete ophthalmic plastic examinations and formulate assessments and plans, both medical and surgical (PC). 3) The resident will be able to assess eyebrow position for brow ptosis and paralysis and determine its relation to upper lid dermatochalasis (PC). 4) The resident will be able to assess facial paralysis. Evaluate the effect of midface cicatricial, paralytic, and involutional changes on lower eyelid position. 5) The resident will know treatment plans for common orbital disorders including the following (PC, PBLI): a.

Inflammatory disorders i. Orbital cellulitis - know how etiology, organisms, and treatments ii. Thyroid orbitopathy - etiology, diagnosis, physical signs, management, surgical rehabilitation. iii. Orbital pseudotumor iv. Vasculitis - Wegener's, PAN, sarcoidosis, lethal midline granuloma

b.

Neoplasm i. Vascular tumors - cavernous hemangioma, hemangiopericytoma, AV malformations ii. Lacrimal gland tumors - benign and malignant mixed tumors, adenoid cystic carcinoma, and other inflammatory and lymphoid causes of lacrimal gland enlargement. iii. Fibro-osseous tumors - fibrous dysplasia, osteoma iv. Neural tumors - meningioma, schwannoma, optic nerve glioma

c.

Trauma - blow out fractures, le forte fractures, optic canal and other orbital fractures - diagnosis and management, traumatic optic neuropathy, orbital hemorrhage, penetrating orbital injury.

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.

ROTATIONAL COMPETENCIES Resident Name: Research Basic Sciences: Medical Knowledge Objectives

1) Use the medical literature to obtain information necessary to make evidence-based decisions in the management of patients 2) Understand the features of clinical trials 3) Critically appraise the medical literature to make evidence-based clinical decisions 4) Apply the principles of preventive medicine in managing patients 5) Develop a question of interest 6) Search and evaluate the medical related literature 7) Identify appropriate research collaborators 8) Constructively critique and synthesize the literature 9) Develop specific, feasible problem statements 10) Design a study 11) Generate the research methods 12) Develop an area of expertise by mastering the literature and research methods appropriate to that area of interest 13) Conduct a research study 14) Write a manuscript 15) Seek and obtain critique of manuscript 16) Present findings from the literature and individual research at local and national meetings

ROTATIONAL COMPETENCIES Skin Basic Sciences: Medical Knowledge Objectives 1) The resident will appreciate the basic physiology of the aging process of the skin and will discuss the basic physiologic processes of sun exposure on the skin. 2) He/She will discuss the role of lasers in the management of various skin lesions and conditions. 3) He/She will discuss the natural growth history of skin cancers and the value of Mohs Chemosurgery. Clinical: Patient Care (Surgical Skills), IPCS, Professionalism, Systems Based Practice and PBLI 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 (PC, PBLI). 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 (PC, PBLI). 3) He/She will recognize common skin malignancies and formulate plan to include staging, extirpation and reconstruction (PC, PBLI). 4) He/She will become familiar with the pathologic interpretation of common skin malignancies. He/She will discuss the process of Mohs surgery (PC, SBP, PBLI) 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.

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

5) 6) 7) 8) 9) 10) 11) 12)

developmental breast anomalies including amastia, Poland’s syndrome, asymmetry, ectopic mammary tissue, virginal hypertrophy, gynecomastia, etc. He/she will be familiar with chest wall embryology and anatomy as applied to developmental chest wall deformities. 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. 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. He/she will have a thorough knowledge of breast reconstruction including autologous tissue and the use of prosthetic devices. He/she will understand the etiology of gynecomastia and is familiar with the various surgical options for treatment. He/she will understand the basic principles of medical and surgical management of common acute traumatic trunk and breast injuries including sternal wounds. He/she will understand the etiology and nonsurgical management of pressure sores (including preventive measures). He/she will have a detailed knowledge of surgical aspects of pressure 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.

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.

Residency Goals and Objectives: First Year By the end of the first year the resident will be com petent in:

1) Communicating effectively with resident staff, faculty, nursing and others such that patients with emergent needs may be safely transferred from off campus or on campus to the environment appropriate to their specific need within the Tulane and Other Rotation Institutional Systems. (IPC, P and SBP*) 2) Obtaining consultation from appropriate services for elective cases of patients on campus. (SBP) 3) Utilizing the appropriate information systems on and off campus to provide excellent patient care and to facilitate his/her further education. (IPC and P) 4) Delivering a comprehensive one hour didactic conference on a selected topic. (M, IPC) 5) Evaluating his own educational progress through regular recording and review of cases performed and by meeting with faculty and the Program Director and communicating those needs to the faculty and the Program Director. (PC and PBLI) 6) Communicating with patients and families a treatment plan including appropriate informed consent for operation. Describing that treatment plan clearly to other physicians and recording it in textural and other forms. (IPC, P and M) 7) Leading a team consisting of plastic surgeons, general surgeons, nurses, PA’s, medical students and others to perform excellent patient care. (PC, SBP, M, IPC and P) 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 and Third Year By the end of training the resident will be com petent in:

1) Communicating effectively with resident staff, faculty, nursing and others such that patients with emergent needs may be safely transferred from off campus or on campus to the environment appropriate to their specific need within the Tulane and Other Rotation Institutional Systems. (IPC, P and SBP*) 2) Obtaining consultation from appropriate services for elective cases of patients on campus. (SBP) 3) Utilizing the appropriate information systems on and off campus to provide excellent patient care and to facilitate his/her further education. (IPC and P) 4) Delivering a comprehensive one hour didactic conference on a selected topic. (M, IPC) 5) Evaluating his own educational progress through regular recording and review of cases performed and by meeting with faculty and the Program Director and communicating those needs to the faculty and the Program Director. (PC and PBLI) 6) Communicating with patients and families a treatment plan including appropriate informed consent for operation. Describing that treatment plan clearly to other physicians and recording it in textural and other forms. (IPC, P and M) 7) Leading a team consisting of plastic surgeons, general surgeons, nurses, PA’s, medical students and others to perform excellent patient care in an independent and comprehensive manner. (PC, SBP, M, IPC and P) 8) Obtaining the knowledge and technical skills to independently perform procedures and solve patient care problems and perform operative procedures encountered in all the specific rotations. (PC, PBLI and M) 9) Performing microsurgical vascular anastomosis and neural repair on a laboratory animal. (PBLI and M) 10) Assessing aesthetic patients for their suitability for operation and choosing an appropriate operative or non-operative approach. (PC, M, P and IPC) 11) Describing patient care actions in CPT language in an accurate and ethical fashion. (IPC and SBP) 12) Writing a medical paper (case report, chapter, etc) for possible publication. (M and IPC) 13) Accurately assessing the performance of first year residents, rotating residents from other services and medical students. (IPC, P) 14) Evaluating the accuracy, validity and usefulness of a publication or presentation on plastic surgery. (M and PBLI) * 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. Jansen will oversee this rotation. The following categories will be emphasized: • Anesthesia • 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 • Ophthalmology • Dermatology o Mohs o Skin o Benign and Malignant Skin Lesions o Functional Problems The resident (starting with the first three-year residency class) will rotate at Tulane University for three months the first year and three months the third 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 • OMFS The resident (starting with the first three-year residency class) will rotate at Ochsner for three months the first year and three months the third year with graduate responsibility.

CHILDRENS ROTATION OBJECTIVES Dr. Moses will oversee this rotation and the following categories will be emphasized: • • • • • •

Congenital Embryology Flaps and Grafts Facial Trauma Microsurgery OMFS

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 Drs. Moses and St. Hilaire 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 second year.

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 Orthopaedic

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.

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.

TOURO: PRIVATE PRACTICE ROTATION OBJECTIVES PRIVATE PRACTICE OBJECTIVES Dr. Colon will oversee this rotation and the following Rotation Com petencies will be emphasized: • • • • • • •

Practice Management Aesthetics Functional Problems Medicolegal and Psychiatric Assessment Special Procedures Implants and Biomaterials 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 and three months during the third year.

June 9, 2011