Plastic Surgery Residency Full Description
The Plastic Surgery Residency at the University of Washington aims to train physicians in all aspects of plastic surgery practice. As a result of this directive, the program will produce independent, safe, effective, and conscientious plastic surgeons that are credits to their communities, the specialty, and the University of Washington.
Ultimately, we desire to promote the best positioned most capable and well-rounded plastic surgeons prepared to sit for the American Board of Plastic Surgery and excel in their care for their future patients. The overall mission of the program will be achieved by participating in our unique institutions, our thorough didactic components and well-supported scholarly research components. We provide an abundant experience to case requirements far exceeding minimum case exposures. We believe and promote the ideal of the physician-scientist and have been routinely acknowledged nationally. We have gathered international leaders in more aspects of plastic surgery than any other program providing testament to leading by the highest example.
Academically, UW Plastic Surgery Residency trains Plastic Surgeons in all four components of academic medicine: patient care, medical education, medical research and administration. There are two pathways through the program that are different on paper, but identical in practice. They are: 1) an “independent” program in which residents match and completed 3 years of General Surgery followed by 3 years of Plastic Surgery, and 2) an “integrated” program in which residents are under the auspices of Plastic Surgery at the outset. The program has transitioned to “integrated” and the last residents in the “independent” pathway will complete residency in 2017. We fully believe that in order to become a high level plastic surgeon you need exposure to being a high level general surgeon. This program allows for development of that principle. The first three years of training are concentrated on general surgery and related specialties so that the trainee can become the best surgeon possible. There is, however, a robust plastic surgery experience in the first three training years, and the training in the final three years is entirely in plastic surgery.
The clinical and basic science faculty members are outstanding and the University is the top ranked public institution in NIH support, and consistently in the top few of all institutions nationwide. At the completion of this program, it is expected that the resident will have an understanding of sound and relevant research and will be capable of designing and executing case reports, case series reports, prospective clinical protocols, and applied surgical laboratory studies and thus be well prepared as a physician-scientist in academic life.
Specific goals and objectives for each component are distributed to each resident, made available to each resident via the web and reviewed with each resident at least semiannually. These goals and objectives are reviewed by faculty and the program director at least annually and revisions are made immediately to residents. All goals and objectives made available further clarify the overall program rationale.
There is a specific set of skills and competencies that the program expects all graduating residents to demonstrate mastery of at time of program completion. These components are listed in the separate “Essential Skills and Competencies” document. Additionally, progression throughout the residency program depends on successful completion of each rotation and year of training. This is detailed in the separate document “Promotion Policy.” Supervisory policies are outlined in three separate documents: “Skill, Supervision and Graduated Procedures Policy”, UW SOM Resident Supervisory Policy”, and “Division Call and Coverage Policy”.
Clinical exposure is paramount in preparation of the practicing plastic surgeon. We utilize four University affiliated hospitals, one private practice and four multidisciplinary relationships in our training curricula. The hospitals include: University of Washington Medical Center (UWMC), Harborview Medical Center (HMC), Veteran’s Administration Puget Sound Health Care System (VAPSHCS), and Seattle Children’s Hospital (SCH). These institutions represent the only level 1 trauma center, only major children’s hospital, only academic VA hospital, and only university-based tertiary referral hospital for a 5-state region, Washington, Alaska, Montana, Idaho, and Wyoming, representing nearly 25% of the U.S. land mass. Clinical experience for our residents, therefore, is outstanding, and arguably, unparalleled. Plastic & Reconstructive Surgeons, Inc. admits patients to Valley Medical Center (VMC) a local hospital in a demographically diverse environment.
The University of Washington Medical Center is a tertiary referral center for WWAMI (Washington, Wyoming, Alaska, Montana and Idaho). This connection provides exposure to an amazingly deep variety of cases.
Harborview Medical Center is owned by King County and operated under a management contract by the University of Washington School of Medicine. It is the primary Seattle metropolitan receiving hospital for trauma and emergency medicine and surgery as well as a health resource for urban and inner-city inhabitants. It is the only Level I Trauma Center and Burn Center for the five-state WWAMI region.
The Veteran’s Administration Puget Sound Health Care System is a Dean’s Committee Hospital. All of the medical staff are UW faculty members. VA Seattle includes a Spinal Cord Injury Center which we participate.
Seattle Children’s Hospital possesses a substantial referral base throughout the WWAMI region. It includes a well-developed and the highest case load craniofacial program in the nation.
The office of Plastic & Reconstructive Surgery, Inc. is one of the premier private practices in the metropolitan area and is located in Renton, Washington, adjacent to Valley Medical Center. Their practice is quite general, including most aspects of Plastic Surgery. These physicians see approximately 9000 outpatient visits annually and admit approximately 250 patients to Valley Medical Center.
Plastic Surgery Associates of Seattle (Drs. Salemy, Peters, Sowder and Haeck) performs a high volume of aesthetic surgery. Residents rotate at this practice, which is near Harborview, in the PGY5 year and are able to return in the PGY6 year for additional cases.
The University of Washington Burn Center is a cooperation between specialized burn surgeons, general surgeons and plastic surgeons. It is located at Harborview Medical Center and is intimately involved in the residency starting early on in the first three years. The University of Washington Burn Center is located at Harborview Medical Center and is one of the largest in the country. It admits over 700 acute burn patients per year, and is one of the original burn centers that focused on early excision and grafting of acute burns. In addition, most of the patients are followed long term in the Burn Center, undergoing secondary reconstruction. Plastic surgery residents participate in both the acute and reconstructive care of burn patients during both the first three and final three years of training.
The remaining multidisciplinary groups are more involved in the final three years of the residency. At Seattle Children’s Hospital is the Craniofacial Center, which is a cooperative effort between neurosurgery, dentistry, otolaryngology and plastic surgery. At University of Washington Medical Center is the Center for Reconstructive Surgery, which is a cooperative effort among otolaryngology, plastic surgery and oncology, orthopedics and others.
Unified Service Structure
In addition, the plastic surgery residency is an integral part of the UW Hand Surgery Institute that is coordinated between the Division of Plastic Surgery and the Department of Orthopaedics. The University of Washington Hand Surgery Institute manages all hand surgery for all of the medical centers and consists of hand surgery attendings, residents, and fellows from both Plastic Surgery and Orthopedics, working together in shared clinics, on-call responsibilities, teaching conferences, and many procedures involving faculty, fellows and residents from diverse training backgrounds and primary specialties. As an integral member of this service, the Plastic Surgery Resident gains a broad, diverse, and comprehensive exposure to hand surgery that is available in very few other Plastic Surgery programs.
Educational Goals and Objectives for Each of the Participating Institutions
As previously stated, the goals and objectives for the various rotations and components of the residency program are appended to this section and are distributed to the residents at the beginning of the program.
Resident responsibilities when assigned to the plastic surgery service
These are described in detail for every rotation in the documents attached to this section.
Since all Plastic Surgery services except Children’s Hospital are well supported with in-house Surgery residents and since it is a goal of the program to keep Surgery residents intimately involved, it is possible and desirable for the Plastic Surgery residents to work at two hospitals on some of the rotations, though on any given day of the week, the resident is generally at just one institution.
Private Practice Surgery Centers and Community Hospitals
The current practice of Plastic Surgery at each of the hospitals and the private office of the Renton group provides exposure to general Plastic Surgery. In addition, the practice at each provides unique clinical exposure. Plastic Surgeons at the University of Washington Medical Center are involved primarily in aesthetic, breast, and truncal surgery. Clinical care at Harborview includes maxillofacial trauma, hand surgery, reconstruction of lower extremities and the trunk, burns, and microsurgery. The practice at the VAPSHCS is very general and includes head and neck cancer reconstruction, hand surgery, and most aspects of Plastic Surgery except pediatric surgery and trauma. Activities at Children’s’ include congenital anomalies of the head and neck and other aspects of pediatric Plastic Surgery. The practice of Drs. Barker, Briscoe, Hutter, and Chang includes aesthetic, maxillofacial and hand trauma, and microsurgery. The practice at Plastic Surgery Associates of Seattle is primarily aesthetic surgery.
The following are the full time academic faculty of the Division of Plastic Surgery in the Department Surgery. Each faculty has an area of clinical and scientific expertise and many are nationally and/or internationally-renowned experts in their fields, representing all of the clinical areas of plastic surgery. As a result, residents in the program are learning from the experts in any given field. All have chosen to be part of the program because of their commitment to educating the next generation of leaders in the field.
All of these faculty members are university-based and fully committed to the educational program of this residency. None of our faculty members have private practices. All of their clinical activities, including clinics and operative procedures are centered on resident education. Many of our faculty members have regular activities at 2 of the 4 primary institutions.
Craniofacial Fellowship Director, Site Director Seattle Children’s
Dr. Birgfeld joined the faculty in 2007. He completed his plastic surgery training at the University of Pennsylvania and a craniofacial surgery fellowship at the University of Washington. Dr. Birgfeld is assistant professor of surgery and his area of specialty is adult and pediatric craniofacial surgery. Dr. Birgfeld practices at both Seattle Children’s Hospital and Harborview Medical Center. He is the residency site director at Seattle Children’s Hospital.
Director UW Microsurgical Flap Course
Dr. Colohan joined the faculty in 2011. She completed her plastic surgery training at Dalhousie University in Halifax, Nova Scotia followed by a fellowship in breast and microsurgery at UT Southwestern in Dallas, TX. During her residency, Dr. Colohan also spent a year at the London School of Hygiene and Tropical Medicine where she completed a Master of Science in Epidemiology. Her clinical interests include reconstruction of cancer defects including microsurgical techniques to reconstruct the breast, and general reconstruction using free flaps, pedicled flaps and perforator flaps. Her research interests include clinical outcomes in reconstructive surgery. She practices at the University of Washington Medical Center.
Residency Program Director, Site Director Harborview
Dr. Friedrich joined the faculty in 2007. He was appointed Residency Program director in 2011. He completed his plastic surgery training at the University of Washington and a fellowship in hand surgery at the Mayo Clinic. Dr. Friedrich’s practice focuses on adult and pediatric hand surgery, brachial plexus surgery, burn hand reconstruction, lower extremity reconstruction and microvascular reconstruction. He has an academic appointment in Orthopedics and is one of 7 plastic and orthopedic surgeons that comprise the University of Washington Combined Hand Surgery program. Dr. Friedrich, along with Dr. Doug Hanel in Orthopaedic surgery, runs the pediatric hand program at Seattle Children’s Hospital. He is also an Adjunct Assistant Professor of Urology and performs urologic reconstruction at Harborview. Dr. Friedrich is active nationally in multiple societies, and has been active in educational efforts with organizations such as the American Society of Plastic Surgeons, the American Society for Surgery of the Hand, AO North America and the American Association of Hand Surgeons. Finally, Dr. Friedrich has developed a research program in patient-reported outcomes following hand injury.
Site Director for Northwest Hospital Chief Resident Cosmetic Clinic
Dr. Gougoutas, completed his plastic surgery training at the University of Pennsylvania. After residency, he completed a microvascular fellowship at the University of Washington in July of 2013. His clinical interests include general and cancer reconstruction, specifically microsurgical breast reconstruction. He also has a strong interest in aesthetic surgery of the breast, body and face. His research interests include clinical outcomes in reconstructive surgery. He practices primarily at the University of Washington Medical Center.
Richard A. Hopper, MD, Professor >>
Marlys C. Larson Professor of Craniofacial Surgery & Chief of Pediatric Plastic Surgery
Dr. Hopper trained at the University of Toronto and was a craniofacial fellow at NYU before joining the faculty in 2001. He is internationally recognized for his expertise in congenital craniofacial reconstruction, especially distraction osteogenesis. He has a basic science research program, focusing on the molecular basis of craniosynostosis, and he serves as an important research mentor to the residents. His practice includes congenital craniofacial and pediatric plastic Surgery at Children’s Hospital as well as maxillofacial trauma and facial reconstructive surgery at Harborview. He is the Surgical Director of Craniofacial Center at Seattle Children’s Hospital and is the Chief of Pediatric Plastic Surgery at Seattle Children’s Hospital. He is highly regarded for his teaching abilities and has been a leading force in expanding the didactic teaching program for the division and is a leading force in the craniofacial education program. He is also the director of the UW’s Craniofacial Surgery fellowship.
Dennis Kao, M.D., is a plastic surgeon at Harborview Medical Center and the Hand, Elbow, and Shoulder Center at Northwest Hospital. He is also a UW assistant professor of Plastic Surgery and an adjunct assistant professor of Orthopedics and Sports Medicine. Dr. Kao specializes in hand and wrist reconstructive surgery. Dr. Kao believes it is important for patients to understand all the treatment options available, and he helps patients choose options that will work best for their individual circumstances. Dr. Kao earned his M.D. from the University of Texas Medical Branch at Galveston. He is fluent in English, Mandarin, and Taiwanese. Dr. Kao is experienced in treating common hand problems such as carpal tunnel syndrome and finger fractures, as well as complex hand issues such as finger replantation, toe-to-hand transfer, and brachial plexus reconstruction.
Assistant Program Director, Site Director and Chief Seattle VA
Dr. Keys joined the faculty in 2012. She trained right here at the University of Washington. As she establishes her practice, she is deeply interested in Resident Education with plans to complete a Master’s Degree in Surgical Education. Her clinical practice divides between the Veterans’ Affairs Hospital and Harborview Medical Center where she has a broad-based practice covering a wide scope of general reconstructive surgery including microsurgery, complex wounds from both trauma and infection, and facial skin cancer reconstruction.
Medical Student Director
Dr. Louie joined the faculty in August 2008. Dr. Louie is the medical student clerkship director for our faculty. He received his plastic surgery training at New York University and then completed a fellowship in microsurgery at the University of California, Los Angeles. His clinical practice is at the University of Washington Medical Center and focuses on reconstructive microsurgery. Dr. Louie is the medical student director for plastic surgery, He also manages plastic surgery quality improvement initiatives at the University of Washington Medical Center.
Director UW Center for Reconstructive Surgery
Dr. Neligan joined the faculty in 2007. Dr. Neligan is well regarded as an international leader in the field of microvascular reconstruction and facial reanimation and co-authored the definitive text on perforator flap reconstruction. Prior to coming to the University of Washington, Dr. Neligan was chief of plastic surgery at the University of Toronto. Dr. Neligan is the Chief of Plastic Surgery and the site director at the University of Washington Medical Center and is the Director of the new UWMC Center for Reconstructive Surgery, a regional complex reconstruction center akin to the regional programs that currently exist within UW Medicine for burn and hand surgery. He holds leadership positions in plastic surgery at the national and international level. He is the Editor of the Journal of Reconstructive Microsurgery and is the Past President of both the Plastic Surgery Educational Foundation and the American Society for Reconstructive Microsurgery. Dr. Neligan is also the Editor of the comprehensive text for the field of Plastic Surgery, the multi-volume Textbook of Plastic Surgery.
Microsurgery Fellowship Director, Site Director University Hospital
Dr. Said joined the faculty in August, 2006. He completed his Plastic Surgery training at Northwestern in 2005 and recently completed the prestigious reconstructive microsurgery fellowship at MD Anderson Cancer. He is based clinically at the University of Washington Medical Center and is the residency site director there. With his excellent reconstructive microsurgery training, he is a vital addition to the UWMC service. With his computer science and engineering background, his research focus is in the area of 3-D modeling of tissue flap reconstruction as well as clinical outcomes research in reconstructive surgery. Dr. Said is also the director for the Microsurgical fellowship based at University of Washington Medical Center.
Dr. Sousa joined the faculty in 2016. She completed plastic surgery residency at the University of Washington, followed by a fellowship in Reconstructive Microsurgery at the Royal Melbourne Hospital in Melbourne, Australia. Her clinical focus is oncologic reconstruction, with an emphasis on breast cancer, head and neck cancer, melanoma, and sarcoma. She is also has a special interest in lymphedema surgery and peripheral nerve reconstruction. She practices at the University of Washington Medical Center.
Dr. Tse joined the faculty in 2009. He completed his Plastic Surgery training at the University of Western Ontario, London, ON, Canada in 2005. He completed a fellowship in Hand Surgery at Stanford in 2006 and a Fellowship in Pediatric Plastic Surgery at the Hospital for Sick Children, Toronto, ON, Canada in 2007. Dr. Tse practices at both Children’s Hospital and Harborview Medical Center. Dr. Raymond Tse comes to the University of Washington with extensive education and experience in academic plastic surgery and in cleft lip and palate surgery and microsurgical soft tissue reconstructions of congenital deformities. The academic environment of Seattle Children’s Hospital Craniofacial Center will allow his academic interest in clinical outcome analysis of cleft lip surgery to flourish. As he develops the pediatric brachial plexus program, Dr. Tse plans to follow an outcome-based care model that will be synergistic with academic productivity in this field./div>
Chief of Plastic Surgery, Associate Chair of Surgery, Associate Program Director
Dr. Vedder’s role is Chief of the Division and associate program director. He joined the faculty in 1990 as only the second faculty member in the division at that time, along with Dr. Engrav. He is an internationally recognized expert in the area of hand and extremity reconstruction and in the basic science of ischemia-reperfusion injury. His primary practice is in hand, upper and lower extremity reconstruction at Harborview and also practices at the UW Medical Center’s Bone & Joint Center and at the Puget Sound Health Care System/Veteran’s Administration Hospital. In addition, he holds a joint appointment in Orthopaedics and he co-founded the University of Washington’s Combined Hand Surgery Service. He holds leadership positions in plastic surgery at the national level. He is the Past Chair of the American Board of Plastic Surgery, a Past Director of the American Board of Surgery, and her serves on the Plastic Surgery.
Annual Training Cycles
Years 1 through 3 in our integrated Plastic Surgery residency are designed to build a solid foundation of surgical technique and care. Plastic Surgery is truly the last general surgery practice. Trainees will require a broad spectrum of knowledge gathered from access to all of our surgical teams. Residents will work alongside both General Surgery residents and other specialty residents covering all aspects of patient care and methodology necessary to succeed in our specialty. These rotations are not only designed to implement the operative experience the American Board of Plastic Surgery outlines but also to give trainees the tools to succeed as a well-rounded plastic surgeon.
While the first 3 years of training are crucial in building the surgical knowledge foundation, it is also important to begin Plastic Surgery training concurrently. In year 1 plastic surgery residents rotate at the University Hospital with our reconstruction team. Trainees learn the fundamentals of evaluation and hone manual skills utilized by plastic surgeons. Also in the first year, integrated plastic surgery residents work at Harborview on the coordinated Burn/Plastic Surgery service. This combined service has been in existence since the Division was founded by Dr. Engrav in 1977 and is an excellent collaborative experience. Finally, first year residents also participate in the Seattle VA Vascular/Plastic Surgery team with good exposure to a variety of both simple and complex plastic surgery cases.
Plastic surgery residents are assigned to a 6-week oral surgery and orthopedic surgery block working alongside Oral/Maxillofacial surgeons and Orthopaedic surgeons at Harborview. This rotation serves as a good foundation for the Hand/Craniofacial rotation in year 4. Residents also complete an otolaryngology/head and neck surgery rotation at the UWMC. This rotation actually includes a significant amount of head and neck microsurgical reconstruction. Also in year 2 are rotations with Thoracic and Vascular Surgery divisions in our department as well as an Anesthesia rotation.
In year 3, residents participate in a Ophthalmology and Dermatology block for 6 weeks. These departments are great resources to our plastic surgeons and further solidify the plastic surgery education experience. Finally, 3rd year residents rotate at Children’s Hospital on the surgery service, which is a good introduction to care of the pediatric plastic surgery patient.
The rotations for the final three years of plastic surgery training are months in duration rather than weeks to give our residents time to develop a more longitudinal relationship with both faculty and patients. These experiences are as follows:
- Harborview Burns and General Reconstruction
- Harborview Hand & Craniofacial
- University of Washington Medical Center
- VA Puget Sound/ Research
- Community Plastic Surgery (Renton Practice with Drs. Barker, Briscoe, Chang, and Hutter)/ Research
- UW Medical Center/Pediatric Hand and Plastic Surgery (Children’s Hospital)
- Harborview Hand & Craniofacial
- Pediatric Plastic Surgery (Children’s Hospital)
- Harborview Hand & Craniofacial
- University of Washington Medical Center
- Harborview Medical Center/University of Washington Medical Center
Every effort has been made to minimize scheduling conflicts and to allow time for nonclinical activities, as well as to minimize covering more than one institution on a given day of the week. The schedules at the various institutions have been carefully integrated. In addition, since each service is staffed with Surgery housestaff as well as Plastic Surgery housestaff, the Plastic Surgery resident has some flexibility.
The fourth year resident spends 2 months at Harborview Burns/Reconstructive Surgery twice a year, 2 months on the Harborview Hand/Craniofacial service twice a year and 2 months at the University of Washington Medical Center twice a year. The resident is exposed to general Plastic Surgery and trauma and will become familiar with the principles and techniques of wound care, grafts, flaps, microsurgery, and trauma. As the resident’s knowledge and technical skills mature, the educational needs of the surgery housestaff are integrated into clinical activities so as to provide the educational objectives of both. This is accomplished by a case distribution that directs more complex procedures to the Plastic Surgery resident and standard wound care, grafts and flaps to the Surgery housestaff. Further, as his/her abilities increase, the resident is allowed more independent clinical activity, but always functions with the supervision and participation of the faculty.
In the fifth year, the residents rotate on the VA service, the Renton Plastic Surgery service and on a combined UWMC/Children’s rotation. Given the clinical schedules at the VA and in Renton, there is ample time for residents to participate in a research project. This research time extends over 8 of the 12 months of the second year. While there is not sufficient time for a resident to conceive, initiate and ultimately complete a sophisticated project of their own, there are several opportunities to complete a basic science or clinical research project with one of the core plastic surgery or other University faculty. During the UWMC/Children’s rotation the resident spends a part of the week participating in microvascular surgery cases at the UWMC and in craniofacial and pediatric hand clinic and surgery cases at Children’s Hospital. During, the Renton rotation, the house officer participates in the practice of a four-physician group that includes the broad spectrum of Plastic Surgery—including both reconstructive and aesthetic cases. These physicians supervise the resident who carries out those procedures and makes those decisions in keeping with his/her level of development.
In the sixth year, the Chief resident again spends 4 months on the Harborview Hand/Craniofacial service, the University of Washington Medical Center service and 4 months at Children’s hospital doing pediatric plastic surgery. On these services, the house officer will be exposed to the clinical activities of those institutions, i.e. aesthetic, breast and pediatric Plastic Surgery, as well as advanced aspects of general reconstruction, head & neck reconstruction, hand, and microsurgery. The resident becomes more familiar and facile with the principles and techniques of all aspects of Plastic Surgery. As he/she develops in these areas, the resident assumes greater responsibility and independence but is always working with the supervision and participation of the faculty. It is expected that the chief resident will take an increasingly greater role in the evaluation of patients, formulation of treatment plan and operative cases commensurate with the advanced level of training. When the third year resident is on the UWMC/SCH rotation, they also have a special “resident-oriented” cosmetic clinic at UWMC that is staffed and supervised by faculty, but allows the resident to assume greater responsibility in the preoperative, operative, and postoperative care of these patients. In addition, the resident participates actively in the education of the Surgery house staff, assisting them in procedures of wound care, grafts and flaps at these institutions.
Continuity of Care
Continuity of care is achieved at all of the institutions through resident participation in the various clinics. There are no “private” or “resident” clinics. Faculty and residents will usually participate in all clinics together.
Philosophy and Rationale
During all three final years and on all rotations the educational philosophy is the same. It is same as that of the Department of Surgery, which prescribes a “wide latitude in intellectual inquiry but very close supervision of specific patient care with gradual assumption of clinical decision-making and operative responsibility.” Two training methods are fundamental to this philosophy, one for cognitive activities and one for technical matters. The first is that in all cognitive activities the resident is required to “make a plan” prior to discussing the problem with the attending. Attendings do not dictate diagnostic or therapeutic plans. The resident “makes a plan” which is then discussed with the attending and together a combined plan is made. This method of “making a plan” and then defending it against the critique of the attending physician trains the resident and permits him to assume increasing levels of independence.
It is the goal that at the completion of his/her training the resident will have made sufficient independent decisions (under faculty supervision) that he/she can easily assume the position of an independent physician. This philosophy holds for all patients on the wards, in the clinics, pre- and postoperatively, and throughout the program. There are no “private” cases in which this philosophy does not apply. 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. In virtually all instances there is an attending in the operating room. However, as the residents experience grows, the attending plays an increasingly supervisory role.
Regular, scheduled participation during every week in the clinics, i.e. the pre- and postoperative care of patients, is mandatory and is an integral part of every rotation. In the clinic setting, the resident usually sees the patient first, performs an evaluation, formulates a plan, then discusses the findings and plan with the attending, who then examines the patient with the resident and modifies/implements the plan.
Resident Responsibilities When Assigned to Other Services
Residents are expected to serve as a member of the team on other services, without distinction as to their standing as Plastic Surgery residents. The goals and objectives for these services are identical for the Plastic Surgery residents and other residents.
Resident Assignments Outside the United States
Residents are not assigned outside the United States.
The didactic component is planned and modified at the beginning of each year in a meeting that includes all of the faculty and residents of the program. The structure and schedule of the plastic surgery didactic program is attached to this section and encompasses all required sections IA and V B&C of the program requirements over a 3-year period. Implementation is coordinated by the program director along with the administrative Chief Resident (the three switch after each rotation). Attendance by faculty and residents is mandatory and attendance is documented. All faculty and all residents participate at one point or another throughout the year. Visiting faculty participate in giving lectures 1-2 times per year.
Ethics, professionalism, systems based practice and the optimal conduct of an interdisciplinary medical team, as well as medicolegal issues are regularly discussed on rounds and at the Wednesday morning conferences. The M&M conferences are actually termed “M&M&X” with the “X” representing cases involving ethics, professionalism, systems based practice and the optimal orchestration of a complex, integrated interdisciplinary medical team, as well as medicolegal issues- potential or real.
In addition to the main Wednesday morning 0630-0815 plastic surgery teaching conference and the preceding evening teaching conferences, the following are also part of the didactic curriculum:
6:30 Hand Conference HMC- Ortho/PS
7:00 Children’s Hospital Craniofacial Conference
10:00 HMC Wound Rounds
12:00 HMC Burn/Plastic Surgery Teaching Rounds
6:30-8:00 Division-wide Plastic Surgery Conference
11:00 HMC Wound Rounds
The subspecialty (hand and craniofacial) conferences are attended by the resident(s) rotating on that service, with the exception of the Tuesday morning hand lecture series, which is attended by all residents. The Divisional conferences are held at Harborview Medical Center and are attended by all Plastic Surgery residents. The Divisional conferences include preoperative case discussion, M&M (statistics are recorded), Selected Readings reviews, literature reviews, topic oriented resident questioning, and formal presentations by faculty, residents, and students. During the preoperative discussions the residents present the cases, including history, physical exam, analysis and plan. During the M&M conferences the residents present the cases and then all participate in the discussion. The Selected Reading reviews are presented by the residents, as are the literature reviews. In all conferences the faculty comment and lead the discussions. The topic oriented resident questioning sessions are based on regular, monthly evening teaching sessions, held by one of the faculty. In addition, there is a series of four lectures on basics of clinical and laboratory research as well as periodic research presentations from the fifth year residents.
Resident Scholarly Activity
Residents are taught to understand and apply the scientific method to clinical medicine throughout the training program. This includes reviews of journal articles as part of the didactic program, presentation of topics based on the literature, and participation with the faculty in clinical and basic science research. Each resident completes one clinical research study during his/her three year training and one grant application is recommended (one manuscript is required for successful completion of the program). Some residents generate and prepare their own clinical and surgical laboratory research ideas and complete the studies during their final three years. Others assume responsibility for studies partially underway.
Clinical Outcomes Studies
The clinical studies are conducted with the faculty of the Division of Plastic Surgery. The topics are those related to the practices of the faculty of the Division. Prior to the start of the second year of plastic surgery training, residents are required to submit to the program director a research plan for the year and a faculty research mentor.
Resident Research Interval
As noted previously, because of the program’s commitment to fostering the development of future academic plastic surgeons, there is dedicated research time during the VA and Renton community plastic surgery rotations during the fifth year. This research rotation, though brief, allows the residents to gain an important insight into research and provides them a valuable education in how to properly evaluate research and scientific contributions. The opportunities at the University of Washington to learn to do and to do research are excellent. The laboratory studies are generally conducted with a faculty person of the Division of Plastic Surgery utilizing laboratory space and equipment of the Department of Surgery and the Division of Plastic Surgery. Such studies are prepared during the first year, executed during the second, and completed during the third. With this experience, UW plastic surgery residents have won the resident research award at the national Plastic Surgery Research Council meeting more than any other program.