Resident Education

Program Description

Education Philosophy
The University of Michigan Integrated Plastic Surgery residency program is designed to provide a broad education in surgery in general, and specific training in plastic surgery. Our goal is to train independent plastic surgeons who are competent practitioners, who excel and become leaders in their field and communities, and are eligible and qualified to become Board Certified by the American Board of Plastic Surgery. The philosophy of our program is complete "integration" of plastic surgical training throughout the residency program: plastic surgery training begins on day one. In addition to a core surgery experience tailored to provide graduated responsibility for patient care and technical expertise for a broad range of surgical disciplines, a significant experience on plastic surgery services and plastic-surgery-related services is provided throughout all six years of the program.

Program Goals
We make a distinction between the two skill sets required of practicing plastic surgeons. The first of these, which we refer to as "surgery-in-general," is comprised of the knowledge and skills that all surgeons, regardless of specialty, must have in order to care for surgical patients. The second skill set encompasses the knowledge and skills unique to the specialty of plastic surgery. Within this conceptual framework are incorporated the six general competencies of all resident training programs: patient care, medical knowledge, practice-based learning and improvement, interpersonal communication skills, professionalism and systems-based practice.

Recognition of these goals is not meant to suggest that plastic surgery consists solely of applying an established principle or technique to the immediate problem. Innovation and creativity are the essence of our specialty. As we develop and implement new techniques, the scope of plastic surgery expands. However, in order to solve problems in new ways we must have knowledge of existing methods and their limitations.

Program Design
Training consists of six clinical years and one research year. The clinical years are conceptually divided into three phases of two years each (with some overlap). The first phase is training the resident to transition from medical student to physician and to be a surgeon-in-general, as well as providing an introduction to plastic surgery. In the second phase, residents solidify their foundation in plastic surgery and become competent surgeons-in-general, capable of overseeing large clinical services utilizing the resources and personnel at hand. In the third phase, they add finesse to their plastic surgery ability and become capable of independent practice as competent plastic surgeons. The standard rotation schedule reflects this design, incorporating progressive responsibility with progressive exposure to plastic surgery and the related subspecialties (see standard rotations table). There is a year free of clinical duties between the fourth and fifth clinical years for the residents to concentrate on research.

Clinical volume is high, and residents are involved in all clinical activities including preoperative evaluation, surgery, postoperative care and follow-up. Residents work side by side with faculty members to provide excellent care for patients and to ensure an excellent educational experience. The resident to faculty ratio is typically 1:1; residents rarely watch other residents perform surgery, and operative opportunities frequently outnumber residents available, allowing the residents to be directed to the more educational cases. We are committed to providing hands-on experience to our residents, and operative responsibilities are awarded progressively as ability develops.

In addition to clinical activities, residents and faculty participate in didactic activities including a weekly educational seminar based on a two-year rotating curriculum, a case presentation conference correlated with the seminar series, a weekly multidisciplinary hand conference, a monthly basic science seminar series, a monthly journal club, morbidity and mortality conference, ethics conference and anatomic dissections in the anatomy lab. These are all structured educational activities with identified goals and objectives. We are also proud of our new Clinical Skills Center, which opened for the 2004-2005 academic year and continues to grow. This center is located in the hospital complex for convenient access and offers several activities aimed at improving clinical skills, including endoscopy simulators and human patient simulators.

Time and funding are provided for residents to attend regional and national meetings to further their education. These include a maxillofacial surgery course, a microsurgery course, the senior residents' meeting and the American Society of Plastic Surgeons Annual Scientific Meeting (as a chief resident). Time and funding are also provided to present research at any meetings at which the resident has had abstracts accepted, and through the generosity of the faculty at Saint Joseph Mercy Hospital, residents are able to attend another meeting of their choosing during their senior years.

As noted above, there is dedicated time between the fourth and fifth clinical years for research. The residents are free of clinical duties during this time, and there is ample opportunity for research. This is an excellent opportunity for career development, and historically our residents have excelled in the laboratory, with multiple publications and national presentations. The faculty members are active in basic science, clinical and educational research with both internal and external funding, and residents play an active role in completing this research. An NIH training grant provides funding for up to two residents for two years of research and a coordinated program in basic science training. In addition, the Section of Plastic Surgery employs several full time Ph.D. research scientists.

Feedback and evaluation of residents is provided during and after each rotation and is done in the context of the six general competencies mentioned above. Four times per year, a summative evaluation takes place between the resident and the program director or associate program director. During this summative evaluation, the resident's progress is discussed and plans made to address any educational needs which may arise during the course of the resident's education. Career planning also takes place during this session, wherein the faculty can provide counsel and support to help the residents achieve their goals. Residents' progress is also discussed semiannually by all faculty members as a group. Each resident is also assigned a faculty mentor. This mentor serves as liaison and confidant through the duration of the training program.

The residents are provided the opportunity to anonymously review the program on a regular basis. In addition, a residency steering committee meets bimonthly to address issues pertinent to resident education and to regularly update the program. Residents from all levels participate in this process to be sure there is appropriate input and representation.