Surgery Education - Plastic Surgery Residency Program
View PowerPoint: About the program, people, facilities (45mb download)
- Mission Statement
- Program Organization
- ACGME Certification
- Program Format
- Educational Goals and Objectives
- Faculty
- Major Teaching Hospitals
- Didactic Component
- Resident Scholarly Activity
- Program Policies/Hours/Evaluation
- Evaluation Policies
1. Mission Statement
The mission of the Division of Plastic Surgery at The University of
Texas Health Science Center at San Antonio (UTHSCSA) is:
- To provide compassionate, state-of-the-art advanced Plastic Surgical clinical care to the citizens of South Texas and the surrounding region.
- To provide the best educational experience possible in the art and science of plastic surgery and produce caring, competent, well-educated practitioners of plastic surgery who will contribute and advance the field of plastic surgery.
- To provide education in the art and science of plastic surgery to the community-at-large and to the medical students of the UTHSCSA Medical School.
- To advance the art and science of plastic surgery through scholarly research and development of new ideas within the broad and diverse fields of plastic surgery including: wound healing, reconstructive and microsurgery, craniomaxillofacial surgery, oncology, and aesthetic surgery.
2. Program Organization
UTHSCSA is the parent institution and the primary teaching facility
for the plastic surgery training program. The Division of Plastic
Surgery in the Department of Surgery provides the formal educational
program based in the University tradition. The principal goal is to
provide a broad-based experience in the principles and practice of
plastic surgery. The curriculum is sequenced so that all topics of the
plastic surgery core curriculum, as described in the Comprehensive
Plastic Surgery Curriculum, are presented in a three-year cycle.
3. ACGME Certification
On July 1, 1998, the ACGME and the RRC for Plastic Surgery (composed of
representatives of the American Board of Plastic Surgery, the American
College of Surgeons, and the AAMC Council on Medical Education) granted
the UTHSCSA Plastic Surgery Residency Training Program provisional
accreditation. As the Wilford Hall Medical Center training program in
Plastic Surgery closed its doors in 1998, its residents completed their
training under the auspices of the UTHSCSA, Division of Plastic Surgery.
We have now been granted full accreditation status following our ACGME
site visit in May 2001.
4. Program Format
The length of training is an inclusive three years, an independent
model, in which the last 12 months are spent as chief resident. Two
residents are selected per year through the plastic surgery match
program. All the residents will have fulfilled the basic requirements as
set forth by the American Board of Plastic Surgery. The prospective
applicants are notified, in a letter, of the length of training at the
time that they request an application for our program.
The strength of our residency program includes the breadth of training in all subspecialties within plastic surgery, including microvascular reconstruction, craniofacial and pediatric plastic surgery, hand surgery, and aesthetic surgery.
5. Educational Goals and Objectives
The educational goals of the Division of Plastic Surgery at UTHSCSA are
to encourage residents to embrace the process of self-motivated learning
and lifelong education. Mastery of the art and science of plastic
surgery is the ultimate goal. This will be accomplished by developing a
solid foundation of fundamental plastic surgery principles in the first
year of training. This knowledge will be added to an existing
infrastructure of sound understanding and practice of basic medical and
surgical principles. The Comprehensive Plastic Surgery Curriculum as
outlined by the Association of Academic Chairmen of Plastic Surgery will
be utilized as one vehicle for the achievement of these goals. We
encourage the development, expansion, and application of these
fundamental plastic surgical principles in various clinical situations,
for all anatomic regions of the human body, in a logical and ethical
manner.
Second-year training involves increased responsibility as an independent operating with appropriate supervision. Third-year, or senior-level, responsibility is designed to provide the independence of a junior staff position and the ability to plan and perform complex reconstruction while still maintaining adequate supervision by faculty. This year is designed to eliminate the need for any "general plastic" or "microvascular fellowships" integrating this training into our overall curricula. Additional hand training may be sought if CAQ is desired.
6. Faculty
Howard T. Wang, MD, Assistant Professor of Plastic Surgery
Interim Chief of Plastic and Reconstructive Surgery
Program Director, Plastic Surgery Residency Program
Biosketch | Reconstructive breast surgery, microsurgery, hand surgery
Aaron Mason, MD, Assistant Professor of Plastic Surgery
Director of the Center for Reconstructive Pediatrics
Biosketch | Craniofacial reconstruction
. . . .
Clinical Faculty:
The following faculty are responsible for overseeing the training of the plastic surgery residents at their respective participating institutions. The program director at the sponsoring institution has the final say as to who may participate in the direct training of the residents at all of the participating institutions.
Rajaram Bala, MD, PA, is clinical faculty for the Santa Rosa Children Hospital plastic surgery residents. Dr. Bala earned his degree in medicine at Stanley Medical College in Madras, India in 1960. In 1965 he completed his General Surgery at Madras University in India. He then came to the United States and attended Sinai Hospital of Baltimore, Maryland and completed his General Surgery requirements in 1971. He then specialized in Plastic and Maxillofacial Surgery at the University of Texas Health Science Center at San Antonio and graduated in 1973. He became board certified by the American Board of General Surgery on February 1972 and The American Board of Plastic Surgery on May 1974.
Douglas T. Cromack, MD, is a Clinical Assistant Professor with a joint
appointment in Plastics and Orthopaedics, and has been a member of the UTHSCSA School of Medicine
faculty since 2000. He is board certified in Plastic & Reconstructive
Surgery with added qualification of surgery of the hand, and has
extensive research experience in wound healing including a 3-year
fellowship at the National Cancer Institute. He has a Certificate of
Added Qualification in Hand Surgery. He completed a fellowship in Hand
Surgery at Washington University in St. Louis. Dr. Cromack earned his
MD from the University of Vermont College of Medicine in Burlington, VT,
in 1983, and his BS from the US Military Academy in West Point, NY.
Donald A. Hollsten, MD, is clinical faculty for the Division of Plastic
Surgery. He is a private surgeon in San Antonio. He is an extremely
competent and well-trained physician and surgeon. Dr. Hollsten obtained
his degree in Medicine from the University of Minnesota Medical School
in 1977. He completed a flexible internship at Fitzsimons Army Medical
Center during 1977 and 1978. In 1980, he enrolled in the Ophthalmology
Residency Program at Brook Army Medical Center which he completed in
1983. He completed a fellowship in Ophthalmic Plastic & Reconstructive
Surgery at the Children's Hospital of Philadelphia in 1987. Dr. Hollsten
is Board certified with American Board of Ophthalmology, October 1984
and American Society of Ophthalmic Plastic and Reconstructive Surgery,
October 1988.
Markian Kunasz, MD, is clinical faculty for Brooke Army Medical Center plastic surgery residents. He is currently the Chief of Plastic Surgery at BAMC. Dr. Kunasz earned his degree in medicine at Georgetown University in Washington, DC in 1994. He completed his General Surgery Residency at Tripler Army Medical Center in 2002. He became board certified by the American Board of Surgery on October 2003. In 2004, he completed his Plastic Surgery Residency at Vanderbilt University in Nashville,TN. The following year, November 2005, he obtained his board certification in plastic surgery from the American Board of Plastic Surgery.
Robert C. Lyons, MD,
is the Residency Coordinator for the Audie Murphy VA Hospital plastic surgery residents.
Dr. Lyons earned his degree in medicine at the Uniformed Services
University Health Sciences in Bethesda, Maryland in 1983. He completed
both a General Surgery Internship in 1984 and Residency in 1991 at the
Uniformed Services University at Fort Gordon, Georgia. He completed his
Plastic Surgery Residency at The University of Texas Health Science
Center at San Antonio, Texas in 2001 and is Board Certified
in Plastic Surgery.
W. Chris Pederson, MD, is the Residency Coordinator responsible for the
rotation at the Hand Center. He is in private practice and has a
clinical appointment at UTHSCSA in the Department of Surgery, Division
of Plastic Surgery, as well as the Department of Orthopedics. Dr.
Pederson has an extended history of training and teaching residents and
fellows in the field of plastic surgery as a former Duke faculty member
and former Division Head of Plastic Surgery at UTHSCSA. He is board
certified in Plastic as well as General Surgery and has a Certificate of
Added Qualification in Hand Surgery. He maintains an active clinical
practice in reconstructive microsurgery.
Jaime R. Garza, MD, DDS, FACS
is a native San Antonian who specializes in the private practice of
plastic and reconstructive surgery. For almost a decade he has been a
pioneer in the south Texas medical community. Double board certified and
skilled in the art and science of plastic surgery, he continually
searches for and implements the best treatment options for his patients.
In addition to his private practice, Dr. Garza is a former chairman and
now clinical professor of plastic surgery as well as otolaryngology at
the University of Texas Health Science Center and is credited with
having built one of the most successful plastic surgery training
programs in the nation.
7. Major Teaching Hospitals
University Hospital and Audie L. Murphy Memorial Veterans Hospital
UTHSCSA is the sponsoring institution and the primary teaching facility
for the plastic surgery training program. The institution has two major
affiliated teaching hospitals, the University Health System Hospital
(UH) and the Audie L. Murphy Memorial Veterans Hospital (ALMMVH). The
faculty members of UTHSCSA staff the hospitals. University Hospital is
a 615-bed hospital supported by the taxpayers of Bexar County and the
city of San Antonio. The ALMMVH is a 450-bed hospital that serves the
veterans of South Texas. The full range of plastic surgery is performed
at these two hospitals with an emphasis on reconstructive and
microsurgery, trauma of the craniomaxillofacial structures and the upper
extremity, and surgery for congenital problems of the craniofacial
structures and the hand.
The Diagnostic Pavilion is the primary setting for university faculty members to see adult and pediatric patients. The chief resident, second-year resident, and first-year resident may rotate with faculty members in the initial evaluation of patients and discuss and formulate treatment plan options. There is a minor surgery suite in this clinic, and the residents and faculty together perform various minor outpatient procedures. There is a weekly Plastic Surgery clinic as well as a combined Hand clinic at the Veterans Hospital. It is staffed by the second-year plastic surgery resident with a faculty member in attendance. The resident is responsible for the evaluation, preliminary treatment planning, and coordination of the preoperative workup and scheduling of the patients for the operating room.
Christus Santa Rosa Northwest (Medical Center area)
Christus Santa Rosa Northwest provides a community hospital
environment for the practice of plastic surgery procedures not requiring
tertiary care. Procedures
such as breast reduction, amputation, mastopexy, and aesthetic surgery
can be performed in a user-friendly environment.
Christus Santa Rosa Children's Hospital
A full range of pediatric plastic surgical procedures can be performed
at the largest and oldest children's hospital in South Texas.
Craniofacial surgery, cleft lip and palate surgery, ear reconstruction,
skin cancer, and tumor surgery provide a unique experience for the
plastic surgery resident.
Center for Reconstructive Pediatrics
The South Texas Craniofacial Team is the region's largest
interdisciplinary network of physicians and health professionals
dedicated to the complete care of the patient with clefting and
craniofacial anomalies. Under the direction of Aaron Mason, MD, the
team is responsible for the continuing care of many patients from birth
through the late teen years. Interdisciplinary conferences are held,
and the resident is responsible for the initial workup and continuing
care of these patients under the direction of faculty.
The Hand Center
This group is composed of seven surgeons from varied backgrounds
(orthopedic, general surgery, plastic surgery) who specialize in surgery
of the upper extremity. The Hand Center has an international reputation
as a center of excellence for surgery of the upper extremity. They
oversee the training and teaching of three Hand Surgery fellows per
year. Dr. W. Chris Pederson, a plastic surgeon, is the Residency
Coordinator for this rotation. The second-year resident is assigned to
two faculty members and spends one month with Dr. David Green and two
months with Dr. Pederson. The residents will have the opportunity,
through established outpatient clinics in this private office setting,
to see patients, to establish provisional diagnoses, and to initiate
plans prior to definitive treatment. The resident will participate in
procedures performed in the office, in the outpatient facility, and in
the main hospital operating rooms.
Additional Facilities
The Department of Surgery at UTHSCSA with the help and support of the
University Health System has developed a new office, library, and study
area for all residents in the Department of Surgery. The Resident
Office and Library is located on the eighth floor of University
Hospital. Not only are books and journals available, but the Resident
Library also houses six computer stations with Internet access to the
Briscoe Library and other electronic databases. Three of the computer
stations are networked with the University Hospital computer system to
allow speedy retrieval of patient information.
The plastic surgery residents have computer and online capability in the Medical School. The plastic surgery residents' library houses current plastic surgery textbooks that cover all aspects of plastic surgery.
A. Core Curriculum
The didactic component of the training program is designed around a
three-year rotating schedule, based on the Comprehensive Plastic Surgery
Curriculum, that will allow the residents exposure to all 12 topics of
plastic surgery as set forth by the Program Requirements for Plastic
Surgery. The principle of education or "self-learning" is encouraged
and expected. The program is centered on a core curriculum for which a
schedule of topics is provided each year. For each topic, there is a
set of approximately 10 to 20 questions that cover the basic science
(anatomy, pathology, embryology, genetics, pharmacology, microbiology,
radiation biology, etc.) and clinical aspects (diagnosis, surgical
design, instrumentation, rehabilitation, etc.) of that topic. The
resident and faculty member assigned to lead the discussion and present
the topic prepare a presentation based on primary sources such as core
curriculum text, selected readings, and current literature. Clinically
related cases are also used for illustrative purposes. Questions are
distributed one week prior to the conference, and the other residents
who are not assigned the topic are expected to research and prepare for
discussion. Residents are expected to research their questions in major
textbooks and current journals. The sessions are designed to promote
discussion among the residents and faculty. At least one and often
several faculty members attend each session and serve as "experts" to
help clarify issues and add detail and insight. Attendance by
affiliated clinical faculty and guest physicians who have particular
expertise in a field is encouraged. Finally, additional topics are
included in the lecture schedule including photography, practice
management, ethics, medicolegal issues, and updated coding. All
residents, including off-site residents, are required to attend. At the
end of each session, residents are given practice questions to gauge
their level of understanding.
B. Conferences
A weekly case management conference, plastic surgery grand rounds,
monthly morbidity and mortality conference, and weekly hospital ward
teaching rounds are held for the residents. In each of these
conferences, the resident is responsible for preparing a sharp, crisp
presentation and discussion of the pertinent facets of that particular
topic. It is expected that he/she will have read about and have a
significant understanding of the topic. Where appropriate, clear,
well-composed photographs are expected. The discussion is then opened
up to the floor for consideration by the rest of the surgical team,
including medical students, residents, and faculty. The presentations
are designed to help the residents develop and sharpen their
presentation skills, thought processes, planning abilities, and
problem-solving abilities and to provide a sound foundation for the
practice of academic plastic surgery. All full-time faculty members
attend these conferences and rounds, and all affiliated faculty are
invited and encouraged to attend. All residents, including off-site
residents, are required to attend.
C. Journal Club/Other Conferences
Additional conferences, such as the journal club and the
multidisciplinary hand, breast, craniofacial, tumor, and burn
conferences, will help provide further exposure to the major categories
of plastic surgery in addition to some of the more current information
available. The combination of all the conferences and rounds is
intended to provide a comprehensive study of plastic surgery, from the
elemental aspects of the basic sciences to the art and finesse of
clinical practice. Gross and surgical anatomy is covered in many venues
and in many different approaches. Where appropriate in each of the
above conferences, anatomy is discussed. This is supplemented by gross
anatomy dissections, in collaboration with the Department of Anatomy,
with specific emphasis on surgical approaches and planning.
D. Microsurgery
In addition to the scheduled conferences and didactic sessions,
residents are provided with an annual four-week microsurgical-training
course. This "hands-on" course teaches the basics of microsurgery and
allows the residents unencumbered practice sessions. Formal evaluation
and instructions are provided. The microsurgery lab is available at any
time for their use.
9. Resident Scholarly Activity
Residents are encouraged to become involved in research at all phases of
their residency. A faculty member will become his/her mentor early in
the residency and help plan and initiate a project. This
resident/faculty team will then see the project through the initial
stages, the funding aspects, the procurement of data, the interpretation
of results, and finally the presentation and submission of a manuscript.
All residents are encouraged to present both clinical and basic science
projects at local and national meetings. Time is provided for
preparation.
The questioning of current practice and ideas and the creation of new ideas and knowledge through clinical and basic research is considered a major responsibility of faculty and residents. Each resident will be expected to become involved in a research project as part of his/her residency training. The goal of this project is to teach the resident how to learn and apply the scientific method of inquiry, problem identification, and potential solutions, be they clinical or basic science, in the field of plastic and reconstructive surgery.
Incoming residents meet with the research director to discuss and identify research and academic interests and goals. The resident will be able to choose or will be offered a project in the form of a research idea at the initial stages of his/her training. This will enable the resident to continue research throughout his/her training. In addition, although the project would ideally be completed within the first year, initiating a study early on allows for a commitment of three years, if necessary. A staff plastic surgeon with either a full-time or clinical appointment will be assigned to the resident during the early stages of the project. The faculty appointee, designated as the mentor, will be responsible for guiding the resident through the stages of his/her study and will meet with the resident on a periodic basis. The resident will thus learn how to pose a scientific inquiry and to conceptualize the research design of a project, which will allow the inquiry to be answered by applying the scientific method. Interdepartmental collaborations are available and will be encouraged. Funding for the project will be facilitated through the vehicle of institutional grants provided by UTHSCSA, departmental funds, and federal research grants through the Department of Defense, National Institutes of Health, or Veterans Administration System. Furthermore, during the second year, the resident will have dedicated time during rotations to complete research projects.
Each project will be expected to be completed and submitted for presentation on a local and/or national level and will be submitted for publication when appropriate. This will allow each resident the opportunity to take an idea from conceptualization through all the stages of development and will hopefully result in enthusiasm for a lifelong process of contributing to his/her chosen field. The Texas Society of Plastic Surgeons, Air Force Society of Clinical Plastic Surgeons, San Antonio Society of Plastic Surgeons, J. Bradley Aust Society, and other specialty programs foster competition among plastic surgery residents for excellence in research and public presentations.
Current projects in the division include a variety of clinical studies. Furthermore, the division has an active basic science laboratory studying hair cryopreservation, tissue engineering and neuroendocrine response to burns. The basic science lab is headed by Dr. Yuchuan Ding in conjunction with the Department of Neurosurgery.
At UTHSCSA there is a 77,000-square-foot, AAALAC-approved, animal care facility with adjoining operating suites. At ALMMVH there is a 9300-square-foot, AAALAC-approved, animal care facility as well as operating suites. These facilities are available to faculty and residents in the Division of Plastic Surgery
10. Program Policies/Hours/Evaluation
A. Supervision
Faculty members closely supervise residents on a continual basis during
all clinical rotations. Faculty members are responsible for all
patients in all of the clinical settings of this program. Faculty
members are present and supervise all clinics. It is a policy at all of
the participating hospitals that a faculty member must be present for
all "key portions" of a surgical procedure, and this must be documented.
Although a faculty member is present for all procedures, independent
operating by the residents in all years is encouraged. The residents
are given the opportunity to function as assistant surgeon, primary
surgeon, or teaching surgeon based on their level of experience and
their individual level of technical expertise. All rotations function
in the same manner and have faculty available 24 hours a day by pager or
home phone number.
B. Working Hours
Residents do not take in-house call, with the exception of one month at
the Burn Unit. Residents have one day of seven free of routine
responsibilities. All of the residents are on call no more than every
third night and have at least one full weekend off call per month. The
monthly call schedule is generated by the residents prior to the
beginning of the month and is reviewed by the program director or
residency coordinators to ensure compliance.
A. Resident Evaluation
The program director formally reviews all the written evaluations at the
end of each rotation. The results are discussed by the program director
with each resident individually at the end of each six-month period, and
the resident co-signs the evaluation form. In addition, at the
sponsoring institution, midway through each rotation, every resident
meets with the program director to discuss his/her progress on the
specific rotation. If there are any personal or personality problems or
conflicts, they are also discussed and written remedies formulated. All
evaluation forms are forwarded to the program director for his review
and signature.
B. Faculty Evaluation
The program director and the residents formally evaluate all faculty
members. A form generated on computer (PC) format is completed by each
resident on a quarterly basis at the end of his/her rotation for each
faculty member with whom he/she personally worked. The form is given to
the program director. The evaluations are discussed anonymously with
the faculty members at a staff meeting at the end of the year and are
used as part of the program director's annual evaluation of each faculty
member.
C. Internal Evaluation of the Program
The Coordinating Council on Graduate Medical Education at UTHSCSA
reviews the residency programs. Representatives from various aspects of
the program, including the Chief Residents, are involved in the review
process. The Council members then perform a "site" visit, and a written
report is issued. In addition, there will be an annual end-of-the-year
plastic surgery faculty and resident retreat to discuss the plastic
surgery program. All facets of the program including resident case mix,
numbers, faculty evaluations, and a review of the goals and objectives
for each individual rotation will be discussed. Appropriate changes
will be made to rotations, faculty members, and rotation objectives to
comply with our goal of educating the plastic surgery residents. A
written evaluation will be compiled and issued to members of the
faculty.
