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Agarwal A, Kamat S, Appel J, Stoff B. Ethics of providing elective cosmetic care at discounted-cost and free clinics. J Am Acad Dermatol 2024; 91:197-198. [PMID: 37321483 DOI: 10.1016/j.jaad.2023.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Aneesh Agarwal
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacob Appel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin Stoff
- Department of Dermatology, Emory School of Medicine, Atlanta, Georgia; Emory Center for Ethics, Atlanta, Georgia
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Bilezikian JA, Kimmel RM, Thurston TE. Plastic and Reconstructive Surgery Resident Indigent Care Clinic Optimization by Improving "No-Show" Rates. Ann Plast Surg 2024:00000637-990000000-00479. [PMID: 38896868 DOI: 10.1097/sap.0000000000003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
ABSTRACT Absenteeism among clinical patients is a significant source of inefficiency in the modern American health care system. Routine absenteeism limits access to care for indigent patients, thus providing additional strain on the health care system and timely administration of care.This quality improvement project set out to quantify, understand, and potentially reduce patient absenteeism in our weekly plastic and reconstructive surgery resident indigent care clinic. One year prior to our study was retrospectively reviewed to determine a baseline rate of absenteeism (no shows). The daily and monthly no-show percentages were calculated. Then, three consecutive 2-month Plan, Do, Study, Act (PDSA) cycles were performed and data were recorded.The initial year analysis demonstrated an average no-show rate of 25%. The first PDSA cycle attempted to ascertain factors contributing to absenteeism and to get patients rescheduled. The rate of clinical absenteeism was 27% over this period compared with a rate of 18% in the control period. During this period, we discovered a limitation of our institution's electronic medical record (EMR). Rescheduled patients were removed from the original schedule and were not counted as a missed appointment even though the opportunity for care was missed. The second PDSA cycle attempted to collect raw data while trying to understand the EMR error and rescheduling process. During this period, there was a 33% no-show rate compared with 27% in the control period. The third PDSA cycle attempted again to establish factors contributing to clinical absenteeism with a better understanding of the limitations of our EMR. A 33% no-show rate during this cycle was recorded compared with 22% in the control period. After three PDSA cycles were completed, our clinic had an average no-show rate of 31% compared with 25% during the same months in the previous year.This project brought to realization that our data were initially skewed by our ignorance of an EMR flaw that did not track patients who either canceled or rescheduled their appointments. We also learned that there is a certain subset of patients who are not able to be contacted and who do not follow up.
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Affiliation(s)
- Jordan A Bilezikian
- From the Department of Plastic and Reconstructive Surgery, University of Tennessee Health Science Center College of Medicine, Chattanooga, TN
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Lăzărescu GM, Vintilă M. The relationship between personality traits and willingness to undergo cosmetic surgery in the non-clinical population - a systematic review and meta-analysis. Front Psychol 2023; 14:1241952. [PMID: 37744591 PMCID: PMC10514507 DOI: 10.3389/fpsyg.2023.1241952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Objective Conducting a systematic review and meta-analysis to synthesize previously obtained results regarding the relationship between interest in cosmetic surgery and personality traits. Methodology A series of criteria were applied (at the level of design, independent variables, dependent variable, participants) in order to decide which existing studies could be considered eligible for inclusion in the meta-analytic procedure. The identification of research that met the eligibility criteria was carried out with the help of the electronic search function in the following databases: ScienceDirect, PsycInfo, Web of Science, Scopus, Springer, and PubMed. Following this approach left 13 studies that were then subjected to the final analysis and included in the meta-analysis. Results The researchers' expectations were partially supported by the results of the analyses, thus demonstrating the existence of a significant relationship between perfectionism (socially prescribed perfectionism; perfectionistic self-promotion), appearance-based rejection sensitivity, and interest in pursuing esthetic surgery. Discussions Identifying these relationships will allow cosmetic surgeons to understand both the mechanisms underlying this decision and the need for psychological assessment/counseling before patients undergo such procedures. It will also allow psychologists to develop best practice guidelines for how they relate to the patient before they perform cosmetic surgery. At the same time, psychotherapists will be able to devise targeted and personalized interventions for each personality profile, so that the decision to undergo an esthetic operation is not made based on a dispositional trait (fear of rejection, stress caused by body dissatisfaction).
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Affiliation(s)
| | - Mona Vintilă
- Faculty of Sociology and Psychology, West University of Timisoara, Timisoara, Romania
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Moog P, Jiang J, Buchner L, Suhova I, Schmauss D, Machens HG, Kükrek H. Aesthetic training concept during plastic surgery residency - Opportunity or risk? Heliyon 2023; 9:e17398. [PMID: 37416684 PMCID: PMC10320284 DOI: 10.1016/j.heliyon.2023.e17398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
Background Aesthetic surgery training renders to be challenging to acquire sufficient hands-on experience during residency. To resolve this problem, the "Munich Model" was established in our clinic: Senior residents perform aesthetic surgeries, supervised by an experienced plastic surgeon while patients benefit from reduced surgery costs. With this model, we hypothesize no significant differences in the postoperative outcome between procedures performed by residents and plastic surgeons. Methods Between August 2012 and December 2017, 481 aesthetic surgeries were included in this retrospective single-center study, of which 283 were performed by residents and 198 by plastic surgeons. Procedures included mastopexy, abdominoplasty, extremity lift, breast reduction, breast augmentation, facial surgery, aesthetic liposuction and lipedema liposuction. Postoperative outcomes were compared regarding surgery time, time of drain removal, inpatient length of stay, duration of wound healing, perioperative blood loss and occurrence of major (surgical revision needed) and minor complications (no surgery needed). Results We found no significant differences in aesthetic surgical procedures between residents and board-certified plastic surgeons in the outcome measures of surgery duration, time of drain removal, inpatient length of stay, perioperative blood loss and complication rate, including major and minor complications. Only the inpatient stay was prolonged in aesthetic liposuctions performed by residents. Conclusion This study demonstrates comparatively that supervised aesthetic surgeries at a university hospital utilizing the "Munich Model" widely meet the specialist surgeons' standards.
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Affiliation(s)
- Philipp Moog
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Jun Jiang
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Lara Buchner
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Inessa Suhova
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Daniel Schmauss
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Haydar Kükrek
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
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Mahrhofer M, Schwaiger K, Weitgasser L, Schoeller T, Hitzl W, Wechselberger G. Patient-Reported Outcome Analysis after Resident Performed Upper Blepharoplasty: A Suitable Procedure for Young Surgeons. Facial Plast Surg 2023; 39:98-103. [PMID: 36100243 DOI: 10.1055/s-0042-1749168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Upper blepharoplasty is one of the most frequently performed aesthetic surgeries worldwide. While it is considered a low risk procedure, patients have high expectations regarding the outcome of elective surgery of the face and the majority of residents usually have little exposure to cosmetic surgeries in the early years of their training. All eligible patients who had undergone bilateral upper blepharoplasty at the senior author's institution between January 2016 and August 2019 were invited to participate in an online questionnaire. Our study used a 27-item questionnaire to evaluate postoperative patient satisfaction and compared the patient reported outcome between operations conducted by surgeons with more than 3 years of experience and less than 3 years. In total, 102 patients returned the completed questionnaire and were included in our study after further screening. There was no significant difference in patient reported satisfaction concerning the aesthetic outcome (8.75 vs. 8.29, p=0.49), and complications (6.2 vs. 18.6%, p=0.63), related to the experience of the surgeons. Overall patient satisfaction was very high, while the rate of complications was low. Patient reported aesthetic outcomes after blepharoplasty demonstrated no significant difference comparing the experience of the surgeons.
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Affiliation(s)
- Maximilian Mahrhofer
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria.,Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Karl Schwaiger
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria
| | - Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Thomas Schoeller
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Paracelsus Medical University Salzburg, Hospital of the Brothers of St. John of God, Salzburg, Austria
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Movassaghi K, Gougoutas AJ. Commentary on: A 10-Year Review of Surgical Outcomes at a Resident Aesthetic Clinic. Aesthet Surg J Open Forum 2022; 4:ojac080. [PMID: 36751380 PMCID: PMC9897167 DOI: 10.1093/asjof/ojac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kiya Movassaghi
- Clinical assistant professor, Department of Plastic Surgery, Oregon Health and Science University, Eugene, OR, USA
| | - Alexander Jacob Gougoutas
- Corresponding Author: Dr Alexander Jacob Gougoutas, 330 N. Garden Way, Suite 100, Eugene, OR 97401, USA. E-mail:
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Taylor AL, Aravind P, Bhoopalam M, Chen J, Girard AO, Colakoglu S, Krucoff KB, Broderick KP, Goldberg NH, Manson PN, Rad AN, Reddy SK. A 10-Year Review of Surgical Outcomes at the Johns Hopkins and University of Maryland Resident Aesthetic Clinic. Aesthet Surg J Open Forum 2022; 4:ojac074. [PMID: 36415222 PMCID: PMC9673761 DOI: 10.1093/asjof/ojac074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In 2014, the Plastic Surgery Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) increased minimum aesthetic surgery requirements. Consequently, the resident aesthetic clinic (RAC) has become an ever more important modality for training plastic surgery residents. Objectives To analyze demographics and long-term surgical outcomes of aesthetic procedures performed at the Johns Hopkins and University of Maryland (JH/UM) RAC. A secondary objective was to evaluate the JH/UM RAC outcomes against those of peer RACs as well as board-certified plastic surgeons. Methods We performed a retrospective chart review of all patients who underwent aesthetic procedures at the JH/UM RAC between 2011 and 2020. Clinical characteristics, minor complication rates, major complication rates, and revision rates from the JH/UM RAC were compared against 2 peer RACs. We compared the incidence of major complications between the JH/UM RAC and a cohort of patients from the CosmetAssure (Birmingham, AL) database. Pearson's chi-square test was used to compare complication rates between patient populations, with a significance set at 0.05. Results Four hundred ninety-five procedures were performed on 285 patients. The major complications rate was 1.0% (n = 5). Peer RACs had total major complication rates of 0.2% and 1.7% (P = .07 and P = .47, respectively). CosmetAssure patients matched to JH/UM RAC patients were found to have comparable total major complications rates of 1.8% vs 0.6% (P = .06), respectively. At JH/UM, the minor complication rate was 13.9%, while the revision rate was 5.9%. Conclusions The JH/UM RAC provides residents the education and training necessary to produce surgical outcomes comparable to peer RACs as well as board-certified plastic surgeons. Level of Evidence 3
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Affiliation(s)
| | - Pathik Aravind
- Hospital resident, Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | - Kate B Krucoff
- Assistant professor of plastic and reconstructive surgery, Department of Plastic and Reconstructive Surgery, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Nelson H Goldberg
- Professor of plastic and reconstructive surgery, Division of Plastic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Paul N Manson
- Professor of plastic and reconstructive surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ariel N Rad
- Plastic and reconstructive surgeon in private practice, Washington, DC, USA
| | - Sashank K Reddy
- Corresponding Author: Dr Sashank K. Reddy, 601 North Caroline Street, JHOC Room 8161, Baltimore, MD 21287, USA. E-mail:
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8
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A Systematic Review on the Implementation and Educational Value of Resident Aesthetic Clinics. Ann Plast Surg 2022; 89:152-158. [PMID: 35180747 DOI: 10.1097/sap.0000000000003101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Resident aesthetic clinics (RACs) provide plastic surgery residents with hands-on aesthetic surgery training. Although RACs have demonstrated successful surgical outcomes without compromising patient care, few studies have evaluated the efficacy or educational value of RACs to increase resident confidence and competence in procedures. In addition, clinic structures vary widely among institutions, with each clinic offering a unique patient volume, caseload, and degree of resident autonomy that impacts the clinic's educational value. This systematic review identifies existing RAC practices, compares clinic structures, and proposes a curriculum framework to maximize educational value for residents. METHODS Following PRISMA guidelines, we performed a systematic review of plastic surgery residency training program RACs. We queried PubMed, Embase, and Web of Science from January 2000 to April 2020. Eligible articles were original articles that discussed RAC structure and educational value. Data abstracted included details on clinic structure (eg, volume, location, cost, clinic operations) and trainee-perceived educational value (eg, resident satisfaction, resident confidence in procedures). RESULTS Of 1199 identified publications, 10 met the inclusion criteria: 6 single-site studies and 4 national survey studies. Among the single-site studies, annual volumes ranged from 22 to 68 patients/year and 35 to 81 cases/year. Resident aesthetic clinics were all staffed by full-time academic faculty (100%); one-third also were staffed by adjunct faculty and 17% also by community plastic surgeons. Resident involvement varied by hours in clinic and degree of autonomy. The survey studies found that RACs increase resident confidence and competence in performing aesthetic procedures and identified critical challenges to RAC implementation (eg, financial viability, continuity of care) that limited RAC educational value. Based on this review's findings, we propose a 6-step RAC curriculum framework for training programs seeking to establish an RAC and maximize the clinic's educational value. CONCLUSIONS Resident aesthetic clinics are increasingly important for providing plastic surgery residents with aesthetic training. Patient and case volume, degree of resident autonomy, and clinic attending physicians are critical determinants of the educational value of RACs. We hope our findings can aid plastic surgery training programs in better organizing educational and sustainable RACs.
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Morris MP, Toyoda Y, Christopher AN, Broach RB, Percec I. A Systematic Review of Aesthetic Surgery Training Within Plastic Surgery Training Programs in the USA: An In-Depth Analysis and Practical Reference. Aesthetic Plast Surg 2022; 46:513-523. [PMID: 34467421 DOI: 10.1007/s00266-021-02557-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/22/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The importance of aesthetic surgery exposure for plastic and reconstructive trainees has been recently validated by the expansion of case requirements for aesthetic procedures from 50 to 150, as well as resident-driven desire for increased cosmetic exposure throughout training. We aim to systematically review the literature at a national level to report on overall trends in aesthetic surgery training within PRS residencies. METHODS A literature search of PubMed, Embase, and Scopus identified all English articles published in the USA between 2000 and 2020, using a combination of "aesthetic surgery", "cosmetic surgery", "plastic surgery", "residency and internship", "education", and "training." RESULTS Our initial search resulted in 415 articles. After review of inclusion and exclusion criteria, in addition to cross-referencing, 41 studies remained, including 15 studies discussing resident and/or program director surveys, eight studies discussing teaching methods, sixteen studies discussing dedicated resident clinics, four studies discussing cosmetic/aesthetic fellowships, three studies discussing cosmetic practice patterns, and eleven studies discussing patient outcomes. CONCLUSION Current literature demonstrates that there are gaps in aesthetic surgery training for PRS residents in the USA, including facial and neck surgeries and non-surgical interventions. Resident clinics have clear benefits for resident education, without sacrificing patient outcomes. Residency programs should consider the development of a resident cosmetic clinic and/or dedicated cosmetic center to increase surgical exposure and increase trainee comfort in providing this subset of procedures. Published literature is limited in consistency of methods of evaluation, and further in-depth analysis of case volume and diversity at training programs within the USA and internationally is indicated. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Martin P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 14th Floor, Philadelphia, PA, 19104, USA
| | - Yoshiko Toyoda
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 14th Floor, Philadelphia, PA, 19104, USA
| | - Adrienne N Christopher
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 14th Floor, Philadelphia, PA, 19104, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 14th Floor, Philadelphia, PA, 19104, USA
| | - Ivona Percec
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion, 14th Floor, Philadelphia, PA, 19104, USA.
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Nasr HY, Boyd CJ, Borab ZM, Vranis NM, Cassidy MF, Gursky AK, Gober R, Zide BM, Ceradini DJ. Productivity and Efficiency of a Department Resident Aesthetic Plastic Surgery Clinic. Aesthet Surg J Open Forum 2022; 4:ojac084. [PMID: 36532257 PMCID: PMC9750105 DOI: 10.1093/asjof/ojac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background There has been increasing demand for aesthetic surgery procedures in the United States, highlighting the critical importance of the competence of plastic surgery residents and rigorous methods of aesthetic surgery training. Objectives The objective of this study was to review procedures and outcomes from our plastic surgery resident aesthetic clinic. Outcomes and costs were compared to national averages and reports from the literature. Methods A retrospective chart review identified all adult patients who presented to the Resident Aesthetic Surgery Clinic at NYU Langone Health in 2021. Patient demographics, comorbidities, procedural data, postoperative complications, revisions, and surgeon fees were compiled. A brief confidence survey was distributed to participating residents before and after their clinic rotation. Data were analyzed using IBM SPSS software (Armonk, NY). Results In 2021, 144/379 consultations led to an operation (38.0% conversion rate), resulting in 420 distinct surgical procedures. The majority (53.3%) of procedures involved the head and neck. Complication and revision rates were 5.5% and 1.0%, respectively, with surgeon fees consistently below the national average. Residents reported being significantly more confident performing face lifts, rhinoplasties, and aesthetic surgery in general following their clinic rotation. Conclusions These data represent the largest annual reported study of plastic surgery resident aesthetic procedures and outcomes, demonstrating the high volume and productivity of the NYU Resident Aesthetic Surgery Clinic. These results further support resident aesthetic clinics as a robust training modality. Level of Evidence 4
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Affiliation(s)
- Hani Y Nasr
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Carter J Boyd
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Zachary M Borab
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Neil M Vranis
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Michael F Cassidy
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Alexis K Gursky
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Rebecca Gober
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Barry M Zide
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - Daniel J Ceradini
- NYU Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
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Baker BG, Winterton RIS. Optimising UK training in aesthetic surgery: A prospective national study using operative logbooks and questionnaires to determine factors associated with trainee participation. J Plast Reconstr Aesthet Surg 2021; 75:1758-1764. [PMID: 34955399 DOI: 10.1016/j.bjps.2021.11.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/14/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We aimed to determine the proportion of UK aesthetic surgery training taking place in the independent sector, how this experience is gained, and factors associated with trainee participation. We also aimed to draw comparisons between training in the National Health Services (NHS) and independent sectors. METHODS Plastic Surgery Trainees were asked to complete a 10-item questionnaire, in addition to their usual operative entry on eLogbook, when logging a procedure with an aesthetic operative code, prospectively over a 6-month period. Anonymised data was exported and analysed using SPSS. RESULTS A total of 285 questionnaires were completed; all UK training regions were represented. The majority were for NHS procedures (88%), of which 56% were for breast surgery, 23% facial surgery, 19% body contouring, and 2% non-surgical. Trainees were significantly more likely to participate in procedures when they were performed in the NHS (odds ratio, OR, 9.7, p < 0.01) or when they were body contouring surgery (OR 1.5, p < 0.01). Trainees were more likely to participate in perioperative care in an NHS setting (p < 0.01). When trainees attend the independent sector, it was usually within contracted training hours (57%) with their consultant trainer with whom they are working in the NHS (63%). CONCLUSIONS The majority of aesthetic surgery training occurs in the NHS but this is not representative of UK aesthetic practice. There is a need to engage the independent sector to provide formal aesthetic surgery training as part of the plastic surgery training programme, including procedural participation and perioperative care. Additional aesthetic fellowships and mechanisms for mentorship by established consultants should be developed.
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Affiliation(s)
- Benjamin G Baker
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Manchester Metropolitan University Business School, Manchester, UK.
| | - Robert I S Winterton
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
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Abstract
The demand for minimally invasive cosmetic procedures is rising, and the public and other physicians deem dermatologists as top providers of these services. Given these expectations, dermatologic residency training must equip resident physician trainees to care for the growing population of patients with aesthetic concerns. As stands, formal hands-on cosmetic dermatology training in residency is lacking specific structure. Educational, cultural, time, and monetary barriers exist, among others, which restrict residents from attaining proficiency in cosmetic dermatology procedures prior to graduation. This may adversely impact patient safety and deter graduates from offering aesthetic procedures. The standardization of core residency competencies in minimally invasive cosmetic procedures is fundamental to guarantee patient safety and satisfaction while ensuring practitioner competence. The balance between these elements is essential for optimal patient care. We review and debate for modifying and strengthening the current curriculum requirements while presenting means to overcome barriers.
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Affiliation(s)
- Elizabeth J Kream
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Virginia A Jones
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA.
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13
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McGuire C, Crawley E, Tang D. The Role of Senior Resident Clinics in Plastic Surgery Education in Canada. Plast Surg (Oakv) 2021; 29:169-177. [PMID: 34568232 DOI: 10.1177/2292550320967401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Senior resident clinics are a means to encourage independent practice and problem solving and enhance surgical skills. The objective of this study is to investigate senior resident clinics across Canada and their utility in providing comprehensive plastic surgery training. Methods A web-based survey was sent to all plastic surgery program directors (PDs) and senior residents (SRs; postgraduate years 3, 4, and 5) across Canada. The surveys focused on demographics, clinic structure, procedures commonly performed, perceived autonomy, educational benefit, competency-based design considerations, and areas for improvement. Chi-square tests were used to compare responses between PDs and SRs. Results A total of 10 PDs (100% response rate) and 26 SRs (41% response rate) responded. Half of the training programs across Canada currently have senior clinics, and the format varies between institutions. Clinics generally focus on hand trauma and aesthetics. Both PDs and SRs felt that there is considerable autonomy for resident care in both the pre/post-operative and operative setting. Common barriers to implementing a senior clinic include not enough staff, not enough time, and the medicolegal risk. Most core competencies are felt to be addressed through the use of senior clinics. Methods to improve senior clinics could include more regular and higher volume clinics, enhanced equipment, and separation of hand and aesthetics clinics. Conclusions Senior clinics are a useful method to improve plastic surgery education and address many core aspects of plastic surgery training. Implementation of supported clinics focused on hand and aesthetics surgery separately may be useful for training programs that currently lack a senior clinic.
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Affiliation(s)
- Connor McGuire
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma Crawley
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Tang
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Wagner RD, Raj S, Davis MJ, Bush M, Perdanasari AT, Izaddoost SA, Reece EM, Winocour S. Financial Analysis of Operating a Resident Aesthetic Clinic. Plast Reconstr Surg 2021; 148:190e-194e. [PMID: 34133411 DOI: 10.1097/prs.0000000000008189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent changes to the plastic surgery residency training requirements along with a general call for expanded education in cosmetic surgery have encouraged many institutions to incorporate resident aesthetic clinics into their curricula. Although the safety and satisfaction rates of resident aesthetic clinics have been well-studied, their financial viability has not. This study reviews the financial viability of the resident aesthetic clinic at the authors' institution through a cost analysis. METHODS Billing data were analyzed for all patient visits to the resident aesthetic clinic of the authors' institution during calendar year 2018. Data were extracted, including type and anatomical location of each procedure, charges collected, and supplies used. A financial analysis was performed based on fixed and variable costs and gross revenue. RESULTS A total of 100 unique patients were seen in the clinic over a 1-year period, resulting in 53 operations. This included 15 face, four breast, and 34 body contouring procedures. In addition, 160 cosmetic injections were performed. The gross revenue was $69,955 and the net revenue was $36,600. CONCLUSIONS The resident aesthetic clinic at the authors' institution proved to be financially viable. The authors encourage other institutions to more closely examine the financial state of their resident aesthetic clinics as well. Furthermore, the authors hope that this analysis demonstrates to other programs that, with certain practice models, cost should not be a barrier to initiating and maintaining this valuable training tool.
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Affiliation(s)
- Ryan D Wagner
- From the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine
| | - Sarth Raj
- From the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine
| | - Matthew J Davis
- From the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine
| | - Matthew Bush
- From the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine
| | | | - Shayan A Izaddoost
- From the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine
| | - Edward M Reece
- From the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine
| | - Sebastian Winocour
- From the Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine
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Hemal K, Cignetti NE, Newsom MR, David LR. Consumer Awareness and Comfort with Resident-run Cosmetic Clinics: A Crowdsourcing Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3681. [PMID: 34262841 PMCID: PMC8274800 DOI: 10.1097/gox.0000000000003681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Abstract
Background: Resident cosmetic clinics (RCCs) are the training modality of choice among both residents and faculty and are a mainstay at most residency programs.1–4 Despite this, knowledge of RCCs among plastic surgery consumers remains untested. We hypothesize that the public would be aware of and receptive to RCCs. Methods: Participants with prior cosmetic procedures or interest in future cosmetic procedures were recruited using Amazon Mechanical Turk and asked to complete a survey in September 2020. First, prior awareness of RCCs was assessed. After a brief description of RCCs, perceptions of safety and preferences for care were assessed. Results: After screening for quality, 815 responses were included. Forty-five percent of consumers were aware of RCCs. Seventy-six percent of consumers believed that RCCs were just as safe as attending clinics and 65% were comfortable receiving care from fourth-year residents or higher. Belief in RCC safety was associated with 4.8 times higher odds of feeling comfortable receiving care at an RCC [95% confidence interval (3.3–7.1), P < 0.001]. When given a hypothetical choice between residents and attendings in two scenarios, 46% of consumers chose residents for abdominoplasty and 60% chose residents for Botox injections. Belief in RCC safety was associated with choosing a resident or being indifferent in both scenarios. Conclusions: Consumer preference regarding RCCs has largely been untested. This study shows that belief in RCC safety influences consumers’ perceived comfort with receiving care at an RCC. This knowledge can help guide RCC practice and maximize learning opportunities for surgeons-in-training.
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Affiliation(s)
| | | | | | - Lisa R David
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston Salem, N.C
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16
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Evaluation of the impact of residents’ participation on free flap reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Perdikis G, Eaves FF, Glassman GE, Walker S, Huang LC, Mast B, Damitz L, Rubin JP, Serletti JM, Hansen J, Potochny J, Kenkel J, Taub PJ, Sobczyk S, Gilman RH, Saint-Cyr MH, Cederna P. Aesthetic Surgery in Plastic Surgery Academia. Aesthet Surg J 2021; 41:829-841. [PMID: 32794545 DOI: 10.1093/asj/sjaa181] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aesthetic surgery is a critical component of academic plastic surgery. As institutions are placing increased focus on aesthetic surgery, there is an opportunity to identify factors that facilitate the creation and maintenance of successful aesthetic plastic surgery programs. OBJECTIVES The aim of this study was to conduct a national survey to evaluate the current state of academic aesthetic surgery and to identify factors that contribute to success. METHODS A REDCap 122-question survey was developed and validated by members of the Academic Aesthetic Surgery Roundtable (AASR). The national survey was distributed to department chairs and division chiefs with active ACGME-approved plastic surgery programs (n = 92). Responses underwent Pearson's chi-squared, Wilcoxon rank-sum, and postselection inference analyses. AASR members convened to interpret data and identify best practices. RESULTS Responses were received from 64 of 92 queries (69.6%). The multivariate analysis concluded traits associated with successful academic aesthetic surgery practices included the presence of aesthetic surgery-focused, full-time faculty whose overall practice includes >50% aesthetic surgery (P = 0.040) and nonphysician aesthetic practitioners who provide injection services (P = 0.025). In the univariate analysis, factors associated with strong aesthetic surgery training programs included resident participation in faculty aesthetic clinics (P = 0.034), aesthetic research (P = 0.006), and discounted resident aesthetic clinics (P < 0.001). CONCLUSIONS The growth of academic aesthetic surgery practices represents a significant opportunity for advancement of resident training, departmental financial success, and diversification of faculty practices. By identifying and sharing best practices and strategies, academic aesthetic surgery practices can be further enhanced.
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Affiliation(s)
- Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Felmont F Eaves
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriella E Glassman
- Department of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sallie Walker
- Departments of Plastic Surgery and Oral Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce Mast
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Lynn Damitz
- University of North Carolina School of Medicine, Columbia, SC, USA
| | - J Peter Rubin
- University of Pittsburg Medical Center, Pittsburgh, PA, USA
| | - Joseph M Serletti
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - John Potochny
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffery Kenkel
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Peter J Taub
- Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Sobczyk
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert H Gilman
- Michigan Medicine University of Michigan, Ann Arbor, MI, USA
| | - Michel Hector Saint-Cyr
- Department of Plastic and Reconstructive Surgery, Baylor Scott and White Health, Temple, TX, USA
| | - Paul Cederna
- Department of Surgery and the chief of the Department of Biomedical Engineering, Michigan Medicine University of Michigan, Ann Arbor, MI, USA
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White-Dzuro CG, Glassman GE, Lee ES, Drolet BC, Forte AJ, Perdikis G, Al Kassis S. Tools to Increase Resident Aesthetic Clinic Volume. Aesthetic Plast Surg 2021; 45:1325-1327. [PMID: 33104859 DOI: 10.1007/s00266-020-02013-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Resident Aesthetic Clinics (RACs) are an important element for training in plastic surgery residency programs. RACs provide increased exposure to aesthetic surgery as well as greater autonomy in clinical decision making. In an effort to increase RAC volume and thereby enhance resident education, we made two important changes to our operations. First, we reduced the resident surgeons' fees by 75%, and second, we began utilizing social media to promote our residency program and their involvement in aesthetic surgery. METHODS Total RAC cases were queried using a RAC specific billing code and individual chief resident case logs for quality control. To generate an accurate timeframe, cases and procedures were compared from 18 months before and after the implemented changes. RESULTS We found that the number of cases and procedures increased by 135% and 255%, respectively. The five most commonly performed procedures were liposuction, augmentation mammoplasty, abdominoplasty, mastopexy, and rhytidectomy. CONCLUSION By both reducing the resident surgeons' fee and promoting the RAC on social media, we have demonstrated a pronounced increase in both cases and procedures performed by residents. As other institutions seek to increase resident exposure to aesthetic surgery, they may consider similar changes to these. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors: www.springer.com/00266 ."
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Affiliation(s)
| | | | - Elizabeth S Lee
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian C Drolet
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Salam Al Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Kumar N, Rahman E. Global Needs-Assessment for a Postgraduate Program on Nonsurgical Facial Aesthetics. Aesthet Surg J 2021; 41:501-510. [PMID: 32090239 DOI: 10.1093/asj/sjaa054] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Standardizing training and education in nonsurgical facial aesthetic procedures during residency training has long been challenging because majority of the procedures are performed outside the usual teaching hospital settings. Several areas of refinement have been suggested and an increased need for more hands-on training identified in the available literature. Despite the growing demand for nonsurgical facial aesthetics (NSFA), it is yet to be fully integrated into standard postgraduate medical or surgical curriculum. OBJECTIVES The objective of this study was to explore the current state and the need for medical education and training of aesthetic clinicians across specialties in a formal postgraduate curriculum. METHODS A mixed-method, cross-sectional, online research was conducted among physicians involved in training and practicing NSFA between July 2018 and December 2018. Focus group discussion was conducted to ensure the face and content validity of the survey items. RESULTS The total responses collected in the trainer's group was 179 and 496 in the trainee's group. The majority of trainers (95%) and trainees (93.8%) across specialties expressed their opinion for the need of a standard postgraduate course in NSFA. Moreover, more than 55% of them felt that 12 months, with a work-based, blended learning approach, would be most suitable for training and education. CONCLUSIONS The survey results have underlined the need for specialized training in NSFA to enable clinicians to pursue independent practice with confidence. The authors recommend the inclusion of evidence-based postgraduate programs on NSFA in higher academic institutions as per their educational curriculum.
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Affiliation(s)
- Narendra Kumar
- Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Eqram Rahman
- Division of Surgical and Interventional Science, University College London, London, United Kingdom
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20
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Perceptions of Preparedness in Plastic Surgery Residency Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3163. [PMID: 33173679 PMCID: PMC7647638 DOI: 10.1097/gox.0000000000003163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
Supplemental Digital Content is available in the text. Graduating competent surgical residents requires progressive independence during training. Recent studies in other surgical subspecialties have demonstrated overall fewer opportunities for resident independence due to changes in residency regulations, medical–legal concerns, and financial incentives. A survey study was conducted to assess perceived autonomy and preparedness during plastic surgery residency training and to assess factors affecting autonomy.
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21
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Brown CA, Nahai F, Miotto GC. Program Director Survey of Aesthetic Plastic Surgery Fellowships in the United States. Ann Plast Surg 2020; 85:464-467. [DOI: 10.1097/sap.0000000000002164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Zebrowski JP, Cawkwell PB, McCoy TH, Taylor JB, Beach SR. Psychiatry Resident Attitudes Toward Practice Habit Data. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:413-417. [PMID: 32162170 PMCID: PMC7853184 DOI: 10.1007/s40596-020-01216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This descriptive study queries the attitudes of psychiatry residents regarding provision of practice habit data to trainees by residency programs, as required by the Accreditation Council for Graduate Medical Education (ACGME). Identifying trainee perspectives may assist program directors in tailoring practice habit data reporting to better engage residents and to increase resident-reported adherence to the ACGME requirement. METHODS Residents at a large, hospital-based adult psychiatry training program completed an anonymous survey of attitudes regarding practice habit data, including perceptions of the residency program's current reporting, preferences toward mechanisms of delivering this data, and perceived relative utility of five hypothetical domains of practice habit data. RESULTS Of 61 eligible residents, 52 (85%) completed surveys. Only 29 (56%) recalled receiving prior-year individual practice habit data, and only 10 (19%) recalled receiving team-based data. Seventy-five percent desired more practice habit data. Out of five hypothetical thematic domains for practice habit reporting, residents preferred patient-oriented domains as opposed to process-oriented domains. Resident concerns about dissemination of these data included confidentiality, effect on evaluations, and difficulty translating data to changes in clinical practice. CONCLUSIONS Residents generally desire increased dissemination of practice habit data that focuses on patient-oriented measures such as adherence to disease-specific guidelines and is both individual and team-based. Residency programs may benefit their trainees and improve resident-reported adherence to the ACGME requirement both by taking resident preferences into account and by addressing concerns about confidentiality when providing practice habit data.
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23
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O’Neill R, Raj S, Davis MJ, Abu-Ghname A, Reece EM, Winocour J, Buchanan EP, Winocour S. Aesthetic Training in Plastic Surgery Residency. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2895. [PMID: 32802638 PMCID: PMC7413815 DOI: 10.1097/gox.0000000000002895] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/09/2020] [Indexed: 01/18/2023]
Abstract
Training in aesthetic surgery is a core element in a plastic surgery residency program. Nevertheless, in the past, many studies have shown the lack of resident confidence in aesthetic procedures upon graduation. In recent years, a number of efforts have been made to address this concern, including increasing the required residency aesthetic case requirements and the integration of resident aesthetic clinics to increase exposure and independence in this aspect of training. Numerous studies have been conducted to evaluate the efficacy of these resident-run clinics and have substantiated their value as an important educational tool in residency training and validated their safety in patient care. In fact, survey studies have shown that though residents today show a markedly increased confidence in their training when compared with the past, they still feel there is room for improvement in areas such as facial and minimally invasive surgeries, along with procedures that require higher patient volume to refine. In this article, we review the current state of aesthetic surgery training during plastic surgery residency and discuss future directions in the field.
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Affiliation(s)
- Rebecca O’Neill
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Sarth Raj
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Matthew J. Davis
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Amjed Abu-Ghname
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Edward M. Reece
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University, Nashville, Tenn
| | - Edward P. Buchanan
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Sebastian Winocour
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Shakir S, Kozak GM, Nathan SL, Davis H, Whitely C, Broach RB, Fosnot J. The Role of a Resident Aesthetic Clinic in Addressing the Trainee Autonomy Gap. Aesthet Surg J 2020; 40:NP301-NP311. [PMID: 31724036 DOI: 10.1093/asj/sjz324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our institution supports a chief resident aesthetic clinic with the goal of fostering autonomy and preparedness for independent practice in a safe environment. OBJECTIVES The aim of this study was to compare safety profiles and costs for common aesthetic procedures performed in our resident versus attending clinics. METHODS A retrospective review was conducted of all subjects presenting for aesthetic face, breast, and/or abdominal contouring surgery at our institution from 2008 to 2017. Two cohorts were identified: subjects undergoing surgery through the chief resident versus attending clinics. Aesthetic procedures queried included: (1) blepharoplasty, rhinoplasty, or rhytidectomy; (2) augmentation mammaplasty, reduction mammaplasty, or mastopexy; (3) abdominoplasty; and (4) combination. Demographics, perioperative characteristics, costs, and postoperative complications were analyzed. RESULTS In total, 262 and 238 subjects underwent aesthetic procedures in the resident and attending clinics, respectively. Subjects presenting to the residents were younger (P < 0.001), lower income (P < 0.001), and had fewer comorbidities (P < 0.001). Length of procedure differed between resident and attending cohorts at 181 and 152 minutes, respectively (P < 0.001), although hospital costs were not significantly increased. Total costs were higher in the attending cohort independent of aesthetic procedure (P < 0.001). Hospital readmissions (P < 0.05) and cosmetic revisions (P < 0.002) were more likely to occur in the attending physician cohort. Postoperative complications (P < 0.50) and reoperative rates (P < 0.39) were not significantly different. CONCLUSIONS The resident aesthetic clinic provides a mechanism for increased autonomy and decision-making, while maintaining patient safety in commonly performed cosmetic procedures.
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Affiliation(s)
- Sameer Shakir
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Geoffrey M Kozak
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Shelby L Nathan
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Harrison Davis
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Cutler Whitely
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Joshua Fosnot
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Al-halabi B, Hazan J, Safran T, Gilardino MS. The Role of Resident-Run Clinics for Aesthetic Surgery Training in the Context of Competency-based Plastic Surgery Education. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2766. [PMID: 32440433 PMCID: PMC7209860 DOI: 10.1097/gox.0000000000002766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
Resident-run clinics (RRCs) have been suggested as a clinical teaching tool to improve resident exposure in aesthetic plastic surgery education. In exchange for reduced cost aesthetic services, RRCs offer trainees the opportunity to assess, plan, execute, and follow surgical procedures in an independent yet supervised manner. With the transition into a competency-based medical education model involving a switch away from a time-based into a milestones-based model, the role of RRCs, within the context of the evolving plastic surgery curriculum has yet to be determined. To that end, the present study summarizes current models of aesthetic surgery training and assesses RRCs as an adjunct to aesthetics education within the framework of competency-based medical education. Explored themes include advantages and issues of RRCs including surgical autonomy, feasibility, exposure, learners' perception, ethics, and quality improvement. In addition, attention is focused on their role in cognitive competency acquisition and exposure to non-surgical techniques. RRCs are considered an effective educational model that provides an autonomous learning platform with reasonable patient satisfaction and safety profiles.
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Affiliation(s)
- Becher Al-halabi
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Jessica Hazan
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Mirko S. Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
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Abstract
BACKGROUND Appropriate, progressive trainee autonomy is critical for training competent plastic surgeons who are adequately prepared to enter independent practice. Evaluation and reporting of meaningful operative autonomy among trainees in plastic surgery are understudied. METHODS Parallel survey instruments were developed using the Zwisch metric for progressive operative autonomy and distributed electronically to trainees and faculties in all accredited training programs. Trainees were queried about their operative autonomy in 17 core plastic surgery procedures, associated approach to logging cases, and perceived readiness to enter practice. Faculties provided assessment of their final-year trainees using the same metrics. RESULTS Trainees in 28 programs and faculties in 35 programs participated. Final-year trainees reported the most operative independence with breast tissue expander reconstruction and carpal tunnel release and the least with facelift and rhinoplasty. A mean of 40% of final-year trainees reached supervision only autonomy in the procedures queried; none achieved this with rhinoplasty. Faculties identified the highest final-year trainee operative autonomy with botulinum toxin injection and burn excision and grafting; the least trainee independence was reported with rhinoplasty, cleft lip repair, and facelift. Faculty perception of final-year trainee autonomy was higher than that of trainees for 82% of procedures queried. CONCLUSIONS Although plastic surgery trainees endorse gradual operative autonomy overall, a majority of final-year trainees do not perceive supervision only independence in the majority of core procedures queried. Faculties perceive higher trainee operative autonomy than trainees for most procedures. Discordant approaches to case logging were identified both among trainees and between trainees and faculties. Standardization may improve both progression and assessment of operative autonomy in plastic surgery training.
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Silvestre J, Caruso VA, Hernandez JM, Serletti JM, Chang B. The Impact of Training Pathway on Breast Surgery Cases Performed during Plastic Surgery Residency. Aesthetic Plast Surg 2019; 43:1663-1668. [PMID: 31218380 DOI: 10.1007/s00266-019-01424-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Operative volume is a critical component of surgical resident education. This study compares reported breast surgery case volume between resident training pathways in plastic surgery. METHODS This retrospective cohort study reviewed case logs of plastic surgery residents in the independent/combined and integrated training pathways. Breast surgery case volume was compared via t tests across two major categories: reconstructive and aesthetic. Differences in intra-pathway variability were compared with F tests. Five consecutive cohorts of plastic surgery residents (n = 818): independent/combined (n = 526, 64%) and integrated (n = 292, 36%) at Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs, were included (2011-2015). RESULTS Independent/combined residents reported significantly more aesthetic cases than integrated residents, but similar reconstructive cases. Independent/combined residents reported more breast augmentations, mastopexy, cosmetic breast fat grafting, and other cosmetic breast cases. Within the reconstructive category, independent residents reported more breast reconstruction fat grafting cases while integrated residents reported more breast reconstruction with pedicle flap, other breast reconstruction, and breast reduction cases. Independent residents had greater intra-pathway variability in five case subcategories, while integrated residents had greater variability in one case subcategory. CONCLUSIONS Disparities in breast surgery case volume exist by plastic surgery residency training pathway. Given the importance of case volume to residents and faculty, these disparities may warrant greater attention. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Jason Silvestre
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA.
| | - Vincenza A Caruso
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
| | - Jade M Hernandez
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
| | - Joseph M Serletti
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
| | - Benjamin Chang
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, 3400 Spruce St, 10 Penn Tower, Philadelphia, PA, 19104, USA
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28
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Peterson EC, Ghosh TD, Qureshi AA, Myckatyn TM, Tenenbaum MM. Impact of Residents on Operative Time in Aesthetic Surgery at an Academic Institution. Aesthet Surg J Open Forum 2019; 1:ojz026. [PMID: 33791617 PMCID: PMC7671284 DOI: 10.1093/asjof/ojz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Duration of surgery is a known risk factor for increased complication rates. Longer operations may lead to increased cost to the patient and institution. While previous studies have looked at the safety of aesthetic surgery with resident involvement, little research has examined whether resident involvement increases operative time of aesthetic procedures. Objectives We hypothesized that resident involvement would potentially lead to an increase in operative time as attending physicians teach trainees during aesthetic operations. Methods A retrospective cohort analysis was performed from aesthetic surgery cases of two surgeons at an academic institution over a 4-year period. Breast augmentation and abdominoplasty with liposuction were examined as index cases for this study. Demographics, operative time, and resident involvement were assessed. Resident involvement was defined as participating in critical portions of the cases including exposure, dissection, and closure. Results A total of 180 cases fit the inclusion criteria with 105 breast augmentation cases and 75 cases of abdominoplasty with liposuction. Patient demographics were similar for both procedures. Resident involvement did not statistically affect operative duration in breast augmentation (41.8 ± 9.6 min vs 44.7 ± 12.4 min, P = 0.103) or cases for abdominoplasty with liposuction (107.3 ± 20.5 min vs 122.2 ± 36.3 min, P = 0.105). Conclusions There was a trend toward longer operative times that did not reach statistical significance with resident involvement in two aesthetic surgery cases at an academic institution. This study adds to the growing literature on the effect resident training has in aesthetic surgery. Level of Evidence: 2 ![]()
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Affiliation(s)
- Erin C Peterson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Trina D Ghosh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ali A Qureshi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Marissa M Tenenbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Review of the Intercollegiate Surgical Curriculum Programme for oral and maxillofacial surgery aesthetics: are we underselling ourselves? Br J Oral Maxillofac Surg 2019; 57:918-922. [PMID: 31451318 DOI: 10.1016/j.bjoms.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022]
Abstract
Aesthetic facial surgery is considered to be within the remit of the maxillofacial surgeon but this is not reflected currently in the trainees' curriculum. In contrast, the plastic surgery curriculum demands detailed training in facial aesthetics. In this paper we have compared the UK OMFS, plastics, and otolaryngology curricula, and used the feedback of trainees to suggest a new aesthetics curriculum. Our method was based on the first three steps of Kern's 1998 six-step model of curricula development: identification of problems, assessment of need, and goals or objectives. The cosmetic certification criterion of the Royal College of Surgeons was used as a baseline for comparison. There was huge variation in the detail and specification of the three specialties' curricula: plastics covered 11/11 of the assessed procedures, while OMFS and otolaryngology covered 7/11 And 4/11, respectively. A total of 45 trainees provided feedback and there was an overall consensus that more training in aesthetics would be beneficial, though accessibility to resources would be an issue. With input from the BAOMS aesthetics lead, our ambitious curriculum increases the number of logbooks to reflect our expertise in the head and neck. It also broadens the span of training over all years of specialist training and, most importantly, relaxes the criteria for transferrable skills. Embracing aesthetics as part of the core curriculum will be beneficial for the future of OMFS, and will produce more rounded surgeons at the end of training. Even the most optimistic observers cannot ignore the financial and logistical setbacks that will have to be faced to achieve this, but we hope that this paper will stimulate a discussion.
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Kaplan J, Volk AS, Ashley JR, Izaddoost S, Reece E, Winocour S. A Systematic Review of Resident Aesthetic Clinic Outcomes. Aesthet Surg J 2019; 39:NP387-NP395. [PMID: 30715241 DOI: 10.1093/asj/sjz020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Providing residents with comprehensive training in aesthetic surgery has proven challenging. Resident aesthetic clinics propose an educational value to trainees while providing successful patient outcomes. OBJECTIVES This study systematically reviewed the available literature regarding resident aesthetic clinic outcomes to determine the efficacy of the clinic in resident training, surgical results, and patient satisfaction. METHODS An electronic database search was performed to identify literature reporting on resident aesthetic clinics. Studies were excluded if the resident clinic was not aesthetic in nature, if only nonsurgical aesthetic procedures were performed, and if clinic outcomes were not evaluated. Study quality was assessed using the Newcastle Ottawa Scale for nonrandomized studies. RESULTS Ten of 148 identified studies met inclusion criteria; 2 utilized a survey, 3 were retrospective cohort studies, and 5 were retrospective cohort studies also utilizing a survey. Clinic schedules, surgical case volume, and surgical procedures performed all varied. One study received a Newcastle Ottawa Scale score of 7 of a possible 9 stars, 2 studies received 5 stars, 5 studies received 4 stars, and 2 could not be assessed using the scoring system. Six studies analyzed surgical results as a primary outcome, reporting acceptable complication and revision rates. Four studies evaluated patient opinions of the clinics and reported overall high satisfaction rates. CONCLUSIONS This systematic review suggests that resident aesthetic clinics enhance resident education while providing safe and successful surgical results to patients.
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Affiliation(s)
- Jordan Kaplan
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Angela S Volk
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Janet R Ashley
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Shayan Izaddoost
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Edward Reece
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
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Qureshi AA, Stevens WG. Why Should Young Aesthetic Plastic Surgeons Care About Aesthetic Medicine? Aesthet Surg J 2019; 39:806-810. [PMID: 30304360 DOI: 10.1093/asj/sjy273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Young aesthetic surgeons may wonder, "Why care about aesthetic medicine?" The answer is based on the "five principles" of aesthetic medicine: patient acquisition, patient retention, patient optimization, patient education, and patient conversion. The explosion in new nonsurgical technologies and treatments combined with patients' demands behoove young plastic surgeons to look at incorporating aesthetic medicine into their practice to help them grow and deliver the best results possible. Beyond injectables, nonsurgical treatments like fat reduction and skin care can help growing surgical practices acquire new patients by offering diverse services at a range of price points.
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Affiliation(s)
| | - W Grant Stevens
- University of Southern California School of Medicine, Division of Plastic Surgery, Los Angeles, CA
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David JA, Rifkin WJ, Saadeh PB, Sinno S. Assessing the Value of a Multimedia-Based Aesthetic Curriculum in Plastic Surgery Residency: A Single-Center Pilot Study. Aesthet Surg J 2018; 38:NP216-NP224. [PMID: 29733345 DOI: 10.1093/asj/sjy110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although global demand for cosmetic surgery continues to rise, plastic surgery residents feel that current models of aesthetic training are inadequate in preparing them for future practice. Digital learning resources offer promising educational possibilities, yet there are no formal studies investigating the integration of these technologies into the aesthetic curriculum. OBJECTIVES Here, we review the current state of aesthetic training for plastic surgery residents and present a pilot study investigating the value of a dedicated multimedia-based aesthetic curriculum at a single, large academic program. METHODS Twenty plastic surgery residents participated in an 8-week curriculum consisting of weekly multimedia-based modules covering a specific aesthetic topic. Participants completed pre- and post-intervention surveys at 0 and 10 weeks, respectively. Surveys evaluated resident perspectives of the current state of aesthetic training, confidence in performing surgical and non-surgical aesthetic procedures, perceived efficacy of multimedia interventions for learning, and preferences for inclusion of such approaches in future curricula. RESULTS 16.7% of participants planned on entering an aesthetic fellowship following residency. The mean number of months of dedicated cosmetic surgery rotations was 1.65 months. Resident confidence level in performing a particular aesthetic procedure significantly increased in 6/14 modules. More than 90% of residents were interested in incorporating the modules into residency. CONCLUSIONS Technology-based aesthetic training is critical for producing the finest future practitioners and leaders of this specialty. Here, we show that plastic surgery residents can benefit from a multimedia-based aesthetic curriculum, even if they do not plan on pursuing a career devoted to cosmetic surgery.
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Affiliation(s)
- Joshua A David
- Chief of Plastic Surgery Service, Bellevue Hospital Center New York University Langone Health, New York, NY
- Director of the Plastic Surgery Residency Program, New York University Langone Health, New York, NY Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Health, New York, NY
| | - William J Rifkin
- Chief of Plastic Surgery Service, Bellevue Hospital Center New York University Langone Health, New York, NY
- Director of the Plastic Surgery Residency Program, New York University Langone Health, New York, NY Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Health, New York, NY
| | - Pierre B Saadeh
- Chief of Plastic Surgery Service, Bellevue Hospital Center New York University Langone Health, New York, NY
- Director of the Plastic Surgery Residency Program, New York University Langone Health, New York, NY Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Health, New York, NY
| | - Sammy Sinno
- Plastic surgeon in private practice in Chicago, IL
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Mitkov MV, Thomas CS, Cochuyt JJ, Forte AJ, Perdikis G. Simulation: An Effective Method of Teaching Cosmetic Botulinum Toxin Injection Technique. Aesthet Surg J 2018; 38:NP207-NP212. [PMID: 29982282 DOI: 10.1093/asj/sjy159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Learning to inject botulinum toxin for cosmetic purposes is difficult for beginners, given the nature of the procedure and patient population. Simulation training is an effective modality for medical professionals to acquire skills in an environment that provides low stress and ample opportunity for questions and correction of mistakes. OBJECTIVES Compare posttraining comfort, knowledge, and practical botulinum toxin injection scores among trainees who underwent simulation vs video training only. METHODS A total of 20 nurse practitioners, physician assistants, and resident physicians underwent cosmetic botulinum toxin injection training either through lecture and video, or lecture and hands-on simulation training. Comfort, knowledge, and practical test scores were recorded and compared between the groups. RESULTS There was no evidence of a statistically significant difference in comfort or knowledge scores between simulation and video groups. The median (range) practical score was significantly higher in the simulation group compared to the video group (59.0 [31-60] vs 44.5 [27-57]; P < 0.01). CONCLUSIONS Despite feeling similarly comfortable and having similar written knowledge test scores, the trainees who underwent simulation training had significantly higher hands-on practical test scores compared to trainees who underwent video training only for cosmetic botulinum toxin injections.
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Affiliation(s)
- Mario V Mitkov
- Department of Dermatology, Mayo Clinic, Jacksonville, FL
| | - Colleen S Thomas
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - Jordan J Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | | | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
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An analysis of the cosmetic surgery experience acquired through UK plastic surgery training. J Plast Reconstr Aesthet Surg 2018; 71:1532-1538. [DOI: 10.1016/j.bjps.2018.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 07/14/2018] [Accepted: 07/28/2018] [Indexed: 11/20/2022]
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Ingargiola MJ, Molina Burbano F, Yao A, Motakef S, Sanati-Mehrizy P, Burish NM, David LR, Taub PJ. Plastic Surgery Resident-Run Cosmetic Clinics: A Survey of Current Practices. Aesthet Surg J 2018; 38:793-799. [PMID: 29548007 DOI: 10.1093/asj/sjy065] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The recently increased minimum aesthetic surgery requirements set by the Plastic Surgery Residency Review Committee of the Accreditation Council for Graduate Medical Education highlight the importance of aesthetic surgery training for plastic surgery residents. Participation in resident aesthetic surgery clinics has become an important tool to achieve this goal. Yet, there is little literature on the current structure of these clinics. OBJECTIVES The authors sought to evaluate current practices of aesthetic resident-run clinics in the United States. METHODS A survey examining specific aspects of chief resident clinics was distributed to 70 plastic surgery resident program directors in the United States. Thirty-five questions sought to delineate clinic structure, procedures and services offered, financial cost to the patient, and satisfaction and educational benefit derived from the experience. RESULTS Fifty-two questionnaires were returned, representing 74.2% of programs surveyed. Thirty-two (63%) reported having a dedicated resident aesthetic surgery clinic at their institution. The most common procedures performed were abdominoplasty (n = 20), breast augmentation (n = 19), and liposuction (n = 16). Most clinics offered neuromodulators (n = 29) and injectable fillers (n = 29). The most common billing method used was a 50% discount on surgeon fee, with the patient being responsible for the entirety of hospital and anesthesia fees. Twenty-six respondents reported feeling satisfied or very satisfied with their resident aesthetic clinic. CONCLUSIONS The authors found aesthetic chief resident clinics to differ greatly in their structure. Yet the variety of procedures and services offered makes participation in these clinics an effective training method for the development of both aesthetic surgical technique and resident autonomy.
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Affiliation(s)
- Michael J Ingargiola
- Division of Plastic and Reconstructive Surgery, Mount Sinai Hospital, New York, NY
| | | | - Amy Yao
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Saba Motakef
- Department of Plastic Surgery, Loma Linda University, Loma Linda, CA
| | | | - Nikki M Burish
- Division of Plastic and Reconstructive Surgery, Mount Sinai Hospital, New York, NY
| | | | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Mount Sinai Hospital, New York, NY
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Papas A, Montemurro P, Hedén P. Aesthetic Training for Plastic Surgeons: Are Residents Getting Enough? Aesthetic Plast Surg 2018; 42:327-330. [PMID: 28916857 DOI: 10.1007/s00266-017-0966-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/24/2017] [Indexed: 12/11/2022]
Abstract
Plastic Surgery is one of the most competitive specialties in the field of medicine. However, this specialty has a unique particularity: the difficulties in Aesthetic Surgery training within the residency program. Despite the fact that the full title of the specialty is Plastic, Reconstructive, and Aesthetic Surgery and that Aesthetic Surgery is a part of the examination syllabus, the actual training in the specific area is limited. One of the solutions to this problem is Fellowships. The first author describes his personal experience with Aesthetic training and how it enhanced his knowledge in the area as well as the status of Fellowships in various training programs. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Athanasios Papas
- Papas Plastic Surgery, Thessaloniki, Greece.
- Department of Plastic Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Weissler JM, Carney MJ, Yan C, Percec I. The Value of a Resident Aesthetic Clinic: A 7-Year Institutional Review and Survey of the Chief Resident Experience. Aesthet Surg J 2017; 37:1188-1198. [PMID: 29044363 DOI: 10.1093/asj/sjx103] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the evolving plastic surgery training paradigm, there is an increasing emphasis on aesthetic surgery education during residency. In an effort to improve aesthetic education and to encourage preparation for independent practice, our institution has supported a resident-run aesthetic clinic for over two decades. OBJECTIVES To provide insight into the educational benefits of a resident-run cosmetic clinic through longitudinal resident follow up and institutional experiential review. METHODS A retrospective review was conducted to identify all clinic-based aesthetic operations performed between 2009 and 2016. To capture residents' perspectives on the cosmetic resident clinic, questionnaires were distributed to the cohort. Primary outcome measures included: volume and types of cases performed, impact of clinic experience on training, confidence level performing cosmetic procedures, and satisfaction with chief clinic. Unpaired t tests were calculated to compare case volume/type with level of confidence and degree of preparedness to perform cosmetic procedures independently. RESULTS Overall, 264 operations performed by 18 graduated chief residents were reviewed. Surveys were distributed to 28 chief residents (71.4% completion rate). Performing twenty or more clinic-based procedures was associated with higher levels of preparedness to perform cosmetic procedures independently (P = 0.037). Residents reported the highest confidence when performing cosmetic breast procedures when compared to face/neck (P = 0.005), body/trunk procedures (P = 0.39), and noninvasive facial procedures (P = 0.85). CONCLUSIONS The continued growth of aesthetic surgery highlights the need for comprehensive training and preparation for the new generation of plastic surgeons. Performing cosmetic procedures in clinic is a valuable adjunct to the traditional educational curriculum and increases preparedness and confidence for independent practice.
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Affiliation(s)
- Jason M Weissler
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Martin J Carney
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Chen Yan
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ivona Percec
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
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Qureshi AA, Parikh RP, Sharma K, Myckatyn TM, Tenenbaum MM. Nonsurgical Facial Rejuvenation: Outcomes and Safety of Neuromodulator and Soft-Tissue Filler Procedures Performed in a Resident Cosmetic Clinic. Aesthetic Plast Surg 2017; 41:1177-1183. [PMID: 28547293 PMCID: PMC7558437 DOI: 10.1007/s00266-017-0892-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/30/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ability to perform nonsurgical facial rejuvenation procedures is a core competency requirement for plastic surgery residents. However, limited data exist on training models to achieve competency in nonsurgical facial rejuvenation and on outcomes of these procedures performed by residents. The purpose here is to evaluate patient-reported outcomes and safety of nonsurgical facial rejuvenation procedures performed by plastic surgery residents. METHODS We prospectively enrolled 50 patients undergoing neuromodulator and/or soft-tissue filler injections in a resident cosmetic clinic between April and August 2016. Patients completed FACE-Q modules pre-procedure, and at 1 week and 1 month post-procedure. Paired t-tests were used to calculate statistical significance of changes between pre- and post-procedure scores. Effect sizes were calculated to assess clinical improvement from pre- to post-procedure. The magnitude of change was interpreted using Cohen's arbitrary criteria (small 0.20, moderate 0.50, large 0.80). RESULTS Forty-five patients completed the study. Patients experienced significant improvements (p < 0.001) in all FACE-Q domains, including aging appearance appraisal (improved from 49.7 ± 29.4 to 70.1 ± 21.6, effect size 0.79), psychological well-being (44.0 ± 14.6-78.6 ± 20.7, effect size 1.93), social functioning (48.6 ± 16.6-75.5 ± 21.7, effect size 1.20), and satisfaction with facial appearance (50.1 ± 13.7-66.2 ± 19.7, effect size 0.95). At 1 month, overall satisfaction with outcome and decision were 75.8 ± 20.7 and 81.1 ± 20.4, respectively. No patients experienced complications. CONCLUSIONS Nonsurgical facial rejuvenation procedures performed by residents can improve patients' quality of life and provide high satisfaction without compromising safety. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Affiliation(s)
- Ali A Qureshi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Rd., Suite 110, Building 3, St. Louis, MO, 63141, USA
| | - Rajiv P Parikh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Rd., Suite 110, Building 3, St. Louis, MO, 63141, USA
| | - Ketan Sharma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Rd., Suite 110, Building 3, St. Louis, MO, 63141, USA
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Rd., Suite 110, Building 3, St. Louis, MO, 63141, USA
| | - Marissa M Tenenbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Rd., Suite 110, Building 3, St. Louis, MO, 63141, USA.
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Sieber DA, Roostaeian J. Commentary on: Aesthetic Surgery Fellowship Selection Criteria: A National Fellowship Director Survey. Aesthet Surg J 2017; 37:967-968. [PMID: 28398463 DOI: 10.1093/asj/sjx054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Jason Roostaeian
- Division of Plastic Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA
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Layliev J, Gupta V, Kaoutzanis C, Ganesh Kumar N, Winocour J, Grotting JC, Higdon KK. Incidence and Preoperative Risk Factors for Major Complications in Aesthetic Rhinoplasty: Analysis of 4978 Patients. Aesthet Surg J 2017; 37:757-767. [PMID: 28472446 DOI: 10.1093/asj/sjx023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Rhinoplasty remains one of the most common aesthetic procedures performed in the United States. Current literature on rhinoplasty complications is inconclusive and is based on retrospective reviews and small cohorts. Objectives The purpose of this study was to examine the incidence and identify predictive risk factors for major complications following rhinoplasty alone or in combination with other aesthetic operations in a large, prospective, multicenter database study. Methods A prospective cohort of patients undergoing rhinoplasty between May 2008 and May 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major complications, defined as complications requiring an emergency room visit, hospital admission, or a reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for major complications including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, and combined procedures. Results A total of 129,007 patients were identified, of which 4978 (3.9%) underwent a rhinoplasty. The overall complication rate was 0.7% (n = 37). Hematoma was the most common complication (0.2%), followed by infection (0.2%), and pulmonary complications (0.1%). Age ≥40 years was found to be an independent risk factor for developing complications. Age ≥40 years was found to have a relative risk of 2.05 (P = 0.04) for any major complication. Complications increased from 0.58% in rhinoplasty alone cases to 1.02% (P < 0.05) with the addition of 1 other body region to 2.09% with the addition of 2 other body regions (P < 0.05). The risk of pulmonary complications increased from 0.1% to 1% (P < 0.05) with the addition of rhinoplasty with 2 other body regions. Gender, type of facility, smoking status, and BMI ≥25 did not appear to significantly impact the risk for major complications. Conclusions The major complication rate following rhinoplasty remains low. The risk is increased with age ≥40 years and with the addition of other cosmetic procedures. Pulmonary complications, although rare, do occur, and also increase when combining rhinoplasty with other aesthetic surgery. These findings are important to consider when planning rhinoplasty and educating patients on the safety of combined aesthetic surgeries. Level of Evidence 2.
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Affiliation(s)
- John Layliev
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN, USA
| | - Varun Gupta
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN, USA
| | | | | | - Julian Winocour
- Division of Plastic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - James C Grotting
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Aesthetic Surgery Journal
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN, USA
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Hashem AM, Waltzman JT, D'Souza GF, Cakmakoglu C, Tadisina KK, Kenkel JM, Zins JE. Resident and Program Director Perceptions of Aesthetic Training in Plastic Surgery Residency: An Update. Aesthet Surg J 2017; 37:837-846. [PMID: 28333253 DOI: 10.1093/asj/sjw275] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This is the third survey exploring the quality of cosmetic training in plastic surgery residency. We focused on determining: (1) the applied modalities and extent of resident exposure; and (2) resident confidence in performing variable cosmetic procedures. Objectives To analyze trends in resident exposure and confidence in aesthetic plastic surgery procedures from the standpoint of program directors (PDs) and residents. Methods The survey was developed and e-mailed to 424 residents enrolled in the ASAPS Residents Program and 95 PDs. Both independent and integrated programs were included. The questions were posed in a five-point ranking format. Univariate statistical analysis was used to examine all aspects. The results were analyzed in relation to our previous surveys in 2008 and 2011. Results Thirty-three PDs (34.7%) and 224 (52.8%) residents responded. Residents felt most confident with abdominoplasty, breast reduction, and augmentation-mammaplasty. Facial aesthetic procedures, especially rhinoplasty and facelift, were perceived as "challenging." The three most preferred modalities of aesthetic education were, in descending order, residents' clinic, staff cosmetic patients, and cadaver dissections. Both residents and PDs felt a need for more training especially in facial procedures. Only 31.5% of residents who planned to focus on cosmetic surgery felt ideally prepared integrating cosmetic surgery into their practice (compared to 50% in previous surveys). Conclusions Despite improvements observed from 2008 to 2011 published surveys, there are still challenges to be met especially in facial cosmetic procedures. It is suggested that resident clinics and cadaver courses be universally adopted by all training programs.
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Affiliation(s)
- Ahmed M Hashem
- Cairo University, Cairo, Egypt.Aesthetic Surgery Journal (ASJ). ; ASJ
| | | | - Gehaan F D'Souza
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Cagri Cakmakoglu
- Dr Lufti Kirdar Training and Research Hospital, Istanbul, Turkey
| | | | - Jeffrey M Kenkel
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Aesthetic Surgery Journal
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Qureshi AA, Tenenbaum MM. Commentary on: Resident and Program Director Perceptions of Aesthetic Training in Plastic Surgery Residency: An Update. Aesthet Surg J 2017; 37:847-849. [PMID: 28333246 DOI: 10.1093/asj/sjw278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ali A Qureshi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Marissa M Tenenbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Qureshi AA, Tenenbaum MM. Commentary on: Disparities in Aesthetic Procedures Performed by Plastic Surgery Residents. Aesthet Surg J 2017; 37:588-590. [PMID: 28025235 DOI: 10.1093/asj/sjw219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali A Qureshi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Marissa M Tenenbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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