Surgery Education - Plastic Surgery Residency Program
Congratulations to Surgery residents who took three out of five awards at the 2009 annual meeting of the Texas Society of Plastic Surgeons (TSPS): (pictured left to right) Stacy Stephenson, MD, plastic surgery resident, won the TSPS Cronin Award - Best Senior Resident Paper for her research, "Prevascularization of bony constructs with endothelial differentiated adipose-derived stem cells." First place, Scientific Award, went to Megan Steigelman, MD, general surgery resident, for her study, "In vitro osteogenic differentiation of adipose stem cells after lentiviral transduction with green fluorescent protein." Patrick Schaner, MD, plastic surgery resident, won the 2nd place Clinical Award for his paper, "Hairline lowering with Endotine anchors for foreheadplasty." (10-4-09)
- Mission Statement
- Program Organization
- ACGME Certification
- Program Format
- Educational Goals and Objectives
- 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.
Howard T. Wang, MD, Associate Professor of Plastic Surgery | Biosketch
Chief of Plastic and Reconstructive Surgery
Program Director, Plastic Surgery Residency Program
Clinical interests: Reconstructive breast surgery, microsurgery, hand surgery
Biostatement: Dr. Howard T. Wang is Division Chief, Residency Program Director, and Associate Professor for the Division of Plastic Surgery at the University of Texas Health Science Center San Antonio. His interest is in microvascular reconstruction of the lower extremity, head and neck and breast. Dr. Wang completed his Plastic Surgery Residency at Duke University Medical Center. While at Duke, Dr. Wang spent 6 months training in Hand Surgery at Kleinert, Kutz, and Associates in Louisville, Kentucky. Prior to this, he completed a General Surgery Residency at the University of Rochester School of Medicine. His education began at Cornell University with a Bachelor of Arts in Biology . Following graduation, he attended Johns Hopkins University School of Medicine where he received his Doctor of Medicine in 1995.
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Peter T. H. Wang, MD, Associate Clinical Professor of Plastic Surgery |
Clinical interests: cleft lip and cleft palate, craniosysnostosis, craniomaxillofacial anomalies, hemangiomas, vascular malformations, birthmarks, congenital nevus, jaw deformity, ear deformity and microtia.
Biostatement: Dr. Peter Wang is a board certified plastic surgeon, having earned his medical degree from Columbia College of Physicians and Surgeons in the city of New York, and his dental degree from Harvard School of Dental Medicine. He completed his training in plastic surgery at the Hospital of the University of Pennsylvania, and completed his craniofacial and pediatric plastic surgery fellowship at Childrens Hospital of Los Angeles. Although adept at performing a wide range of plastic surgery, Dr. Wang′s primary mission is to provide specialized care for children born with craniofacial abnormalities and deformities.
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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.
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.
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.
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.
Richard A. Levine, MD, DDS, FACS, has been practicing plastic surgery for more than 25 years in San Antonio, Texas, and focuses exclusively on cosmetic surgery procedures to help patients look their best. He has been on the faculty of numerous medical schools and authored extensively in cosmetic surgery. You will find him to be dedicated to the success and safety of your surgical experience. Dr. Levine aspires to make a positive difference in the lives of his patients and the community. As a result he has been selected amongst the Best Doctors in Texas and the Executive Board of the Baptist and Methodist Hospitals.
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.
David W. Person, MD, earned his MD from Southwestern Medical School on a military scholarship. He then completed an internship and residency in general surgery at Brooke Army Medical Center (BAMC), Ft. Sam Houston, Texas. Dr. Person then studied plastic and reconstructive surgery under Dr. Luis O. Vasconez at The University of Alabama at Birmingham. After two years of intense specialty training, Dr. Person returned to San Antonio and began his subspecialization in hand and microsurgery at The Hand Center of San Antonio. Dr. Person's clinical interests include surgery of the hand and wrist, reconstructive plastic surgery and reconstructive microsurgery.
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 Medical Arts & Research Center (MARC) 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. The MARC has an ambulatory surgical center as well as 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 Peter Wang,DMD, 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.
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.
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.
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.
9. Resident Scholarly Activity
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
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.