Plastic Surgery Residency Full Description
The following are the full time academic faculty of the Division of Plastic Surgery in the Department Surgery. Each faculty has an area of clinical and scientific expertise and many are nationally and/or internationally-renowned experts in their fields, representing all of the clinical areas of plastic surgery. As a result, residents in the program are learning from the experts in any given field. All have chosen to be part of the program because of their commitment to educating the next generation of leaders in the field.
All of these faculty members are university-based and fully committed to the educational program of this residency. None of our faculty members have private practices. All of their clinical activities, including clinics and operative procedures are centered on resident education. Many of our faculty members have regular activities at 2 of the 4 primary institutions.
Craig B. Birgfeld, MD, Assistant Professor
Dr. Birgfeld joined the faculty in 2007. He completed his plastic surgery training at the University of Pennsylvania and a craniofacial surgery fellowship at the University of Washington. Dr. Birgfeld is assistant professor of surgery and his area of specialty is adult and pediatric craniofacial surgery. Dr. Birgfeld practices at both Children’s Hospital and Harborview Medical Center. He is the residency site director at Children’s Hospital.
Shannon M. Colohan, MD, Assistant Professor
Dr. Colohan joined the faculty in 2011. She completed her plastic surgery training at Dalhousie University in Halifax, Nova Scotia followed by a fellowship in breast and microsurgery at UT Southwestern in Dallas, TX. During her residency, Dr. Colohan also spent a year at the London School of Hygiene and Tropical Medicine where she completed a Master of Science in Epidemiology. Her clinical interests include reconstruction of cancer defects including microsurgical techniques to reconstruct the breast, and general reconstruction using free flaps, pedicled flaps and perforator flaps. Her research interests include clinical outcomes in reconstructive surgery. She practices at the University of Washington Medical Center.
Dr. Engrav is a Professor and was the Chief of the division since founding it in 1977 and was program director from the inception of the residency in 1988 until Dr. Vedder assumed these roles in 2001. He is internationally recognized for his expertise in the areas of burn and burn reconstruction and general reconstructive surgery. He is formerly Associate Director of the Harborview Burn Unit and was one of the pioneers in the area of early excision and grafting of burns and of facial grafting. He has an active NIH-funded basic science lab, investigating the molecular and cellular basis of hypertrophic scarring as well as federally funded research in burn and burn reconstruction outcome studies.
Jeffrey B. Freidrich, MD, Assistant Professor, Residency Program Director
Dr. Friedrich joined the faculty in 2007. He was appointed Residency Program director in 2011. He completed his plastic surgery training at the University of Washington and a fellowship in hand surgery at the Mayo Clinic. Dr. Friedrich’s practice focuses on adult and pediatric hand surgery as well as microvascular reconstruction. He has an academic appointment in Orthopedics and is one of 5 plastic and orthopedic surgeons that comprise the University of Washington Combined Hand Surgery program. Dr. Friedrich, along with Dr. Doug Hanel in Orthopaedic surgery, runs the pediatric hand center at Children’s Hospital. He is also an Adjunct Assistant Professor of Urology and performs urologic reconstruction at Harborview. Finally, Dr. Friedrich has developed a research program in patient-reported outcomes following hand injury.
Joseph S. Gruss, MD, Professor
Dr. Gruss is an internationally recognized pioneer in maxillofacial surgery and was the first surgeon in North America to use rigid internal fixation in the craniomaxillofacial skeleton. He was already a respected figure in 1990 when he joined the faculty, moving from the University of Toronto. Since that time, he has built the craniofacial program at Children’s Hospital into the highest volume congenital craniofacial program in the nation. His practice includes congenital craniofacial and pediatric plastic Surgery at Children’s Hospital as well as maxillofacial trauma and facial reconstructive surgery at Harborview. His clinical educational abilities and commitment are outstanding. He recently was awarded the Lifetime Achievement Award from the American Society of Maxillofacial Surgeons.
Richard A. Hopper, MD, Associate Professor
Dr. Hopper trained at the University of Toronto and was a craniofacial fellow at NYU before joining the faculty in 2001. He is internationally recognized for his expertise in congenital craniofacial reconstruction, especially distraction osteogenesis. He has a basic science research program, focusing on the molecular basis of craniosynostosis, and he serves as an important research mentor to the residents. His practice includes congenital craniofacial and pediatric plastic Surgery at Children’s Hospital as well as maxillofacial trauma and facial reconstructive surgery at Harborview. He is the Surgical Director of Craniofacial Center at Children’s Hospital and is the Chief of Pediatric Plastic Surgery at Seattle Children’s Hospital. He is highly regarded for his teaching abilities and has been a leading force in expanding the didactic teaching program for the division and is a leading force in the craniofacial education program. He is also the director of the UW’s craniofacial surgery fellowship.
Matthew B. Klein, MD, MS, Associate Professor
Dr. Klein trained at Stanford, then was the UW’s Burn Fellow and joined the faculty in 2004. Dr. Klein is the holder of the David and Nancy Auth-Washington Research Foundation Endowed Chair for Restorative Burn Surgery and Associate Director of the UW Burn Center. In addition, he holds an adjunct appointment in the Department of Epidemiology in the School of Public Health. He is an expert in acute burn care and burn reconstruction, as well as general reconstructive surgery. His clinical practice is at Harborview and includes burns and burn reconstruction as well as general reconstructive plastic surgery. His research focuses on outcomes following burn injury and his research program is supported by a research training grant from the NIH.
Otway Louie, MD, Assistant Professor
Dr. Louie joined the faculty in August 2008. Dr. Louie is the medical student clerkship director for our faculty. He received his plastic surgery training at New York University and then completed a fellowship in microsurgery at the University of California, Los Angeles. His clinical practice is at the University of Washington Medical Center and focuses on reconstructive microsurgery.
David W. Mathes, MD, Assistant Professor
Dr. Mathes joined the faculty in August, 2006. He completed a full categorical residency in Surgery at New York Presbyterian/Cornell and spent 3 very productive years as a research fellow in the Department of Surgery at Harvard/Massachusetts General Hospital where he made a number of seminal contributions to the field of composite tissue allotransplantation. He recently completed his Plastic Surgery training at the University of Texas Southwestern Medical Center. Dr. Mathes is based clinically at the Puget Sound Health Care System/Veteran’s Administration Hospital, where he is the Chief of Plastic Surgery and residency site director. In addition, he devotes part of his clinical time at the University of Washington Medical Center. His research focus is in the area of transplantation immune tolerance and he is a Research Affiliate at the Fred Hutchinson Cancer Research Center.
Peter C. Neligan, MB, Professor
Dr. Neligan joined the faculty in 2007. Dr. Neligan is well regarded as an international leader in the field of microvascular reconstruction and facial reanimation and co-authored the definitive text on perforator flap reconstruction. Prior to coming to the University of Washington, Dr. Neligan was chief of plastic surgery at the University of Toronto. Dr. Neligan is the Chief of Plastic Surgery and the site director at the University of Washington Medical Center and is the Director of the new UWMC Center for Reconstructive Surgery, a regional complex reconstruction center akin to the regional programs that currently exist within UW Medicine for burn and hand surgery. He holds leadership positions in plastic surgery at the national and international level. He is the Editor of the Journal of Reconstructive Microsurgery and is the Past President of both the Plastic Surgery Educational Foundation and the American Society for Reconstructive Microsurgery. Dr. Neligan is also the Editor of the comprehensive text for the field of Plastic Surgery, the multi-volume Textbook of Plastic Surgery.
Hakim K. Said, MD, Assistant Professor
Dr. Said joined the faculty in August, 2006. He completed his Plastic Surgery training at Northwestern in 2005 and recently completed the prestigious reconstructive microsurgery fellowship at MD Anderson Cancer. He is based clinically at the University of Washington Medical Center and is the residency site director there. With his excellent reconstructive microsurgery training, he is a vital addition to the UWMC service. With his computer science and engineering background, his research focus is in the area of 3-D modeling of tissue flap reconstruction as well as clinical outcomes research in reconstructive surgery.
Raymond Tse, MD, Assistant Professor
Dr. Tse joined the faculty in 2009. He completed his Plastic Surgery training at the University of Western Ontario, London, ON, Canada in 2005. He completed a Fellow ship in Hand Surgery at Stanford in 2006 and a Fellowship in Pediatric Plastic Surgery at the Hospital for Sick Children, Toronto, ON, Canada in 2007. Dr. Tse practices at both Children’s Hospital and Harborview Medical Center. Dr. Raymond Tse comes to the University of Washington with extensive education and experience in academic plastic surgery and in cleft lip and palate surgery and microsurgical soft tissue reconstructions of congenital deformities. The academic environment of Seattle Children’s Hospital Craniofacial Center will allow his academic interest in clinical outcome analysis of cleft lip surgery to flourish. As he develops the pediatric brachial plexus program, Dr. Tse plans to follow an outcome-based care model that will be synergistic with academic productivity in this field.
Nicholas B. Vedder, MD, Professor and Chief, Division of Plastic Surgery, Associate Program Director
Dr. Vedder’s role is Chief of the Division and associate program director. He joined the faculty in 1990 as only the second faculty member in the division at that time, along with Dr. Engrav. He is an internationally recognized expert in the area of hand and extremity reconstruction and in the basic science of ischemia-reperfusion injury. His primary practice is in hand, upper, and lower extremity reconstruction at Harborview and also practices at the UW Medical Center’s Bone and Joint Center and at the Puget Sound Health Care System/Veteran’s Administration Hospital. In addition, he holds a joint appointment in Orthopaedics and he co-founded the University of Washington’s Combined Hand Surgery Service. He holds leadership positions in plastic surgery at the national level. He is the Past Chair of the American Board of Plastic Surgery, a Past Director of the American Board of Surgery, and her serves on the Plastic Surgery Residency Review Committee (the committee that develops the curriculum requirements for and accredits all plastic surgery residencies). He is also a Past President of the American Association for Hand Surgery and is the Vice President for Academic Affairs of the ASPS/PSF.
Christopher Allan, MD, Douglas Hanel, MD, Jerry Huang, MD and John Sack, MD are adjunct faculty in the Division and are the Orthopedic members of the UW’s Combined Hand Surgery Service. Dr. Hanel is an internationally recognized expert in hand surgery and all of these faculty are strongly committed to the joint education of Plastic Surgery and Orthopedic residents through the Combined Hand Surgery Service.
Mark Egbert, MD, DDS are adjunct faculty in the Department of Oral and Maxillofacial Surgery. Dr. Englestad is a key member of the interdisciplinary craniomaxillofacial trauma service at Harborview and Dr. Egbert is a key member of the interdisciplinary craniofacial program at Children’s Hospital.
Neal Futran, MD, DMD is an adjunct faculty and is the Chairman of the Department of Otolaryngology/Head and Neck Surgery. He is a nationally-recognized leader in head and neck cancer and microsurgical reconstruction and is the Director of Head and Neck Reconstruction within the UWMC Center for Reconstructive Surgery.
Active Clinical Faculty:
Wallace Chang, MD, David Barker, MD, Patty Briscoe, MD, and Jonathan Hutter, MD are the clinical faculty in the Renton Plastic Surgery group. Dr. Chang is the site director there, and is the former Chief and Program Director at the University of Massachusetts program. Dr. Hutter is a recent graduate of this program. Drs. Michael Leff is an active clinical faculty at the Puget Sound Health Care System/Veteran’s Administration Hospital. All of these faculty members are outstanding clinicians and dedicated educators and play a vital role in the educational program, especially in the areas of aesthetic surgery, elective hand surgery, general reconstruction, and outpatient surgery.
Hunter Wessells, MD is the Chair of the Department of Urology and is an adjunct faculty member of the Division of Plastic Surgery. He and Dr. Friedrich collaborate on urologic reconstruction at Harborview Medical Center.
Dr. Jeffrey Scott is a hospital-based plastic surgeon at Providence-Everett medical center. He completed his Plastic Surgery training here at the University of Washington. He is involved with clinical education of junior plastic surgery residents when they rotate to Everett.>
3. Faculty scholarly activities.
As noted above, all of the full-time academic faculty members are university-based and fully committed to the educational program of this residency. None of the full time faculty members have private practices. All of their clinical activities, including inpatient and outpatient, clinics, and O.R. are centered on resident education. Each faculty has an area of clinical and scientific expertise and many are nationally or internationally-renowned experts in their fields, representing all of the clinical areas of plastic surgery, such that residents are learning from the experts in any given field. All have chosen to be part of the program because of their commitment to educating the next generation of leaders in the field. All of these faculty members are regularly involved in research and in national professional organizations. All of the faculty members actively participate in the various scholarly and didactic educational activities in the program, and as mentors to the residents in their research and scholarly activities.
D. Program Organization
1. Description of the program format.
This is a six-year integrated program that is entered by matching from medical school into the residency. The goal of the UW Plastic Surgery Residency is to train Plastic Surgeons in all four components of academic medicine: patient care, medical education, medical research and administration. The program is currently accredited for three residents per year.
During the Private practice and VA rotation during the 5th year of training, research time is allotted for each resident. This time, though brief, allows the residents to gain an important insight into research and provides them a valuable education in how to properly evaluate research and scientific contributions. The opportunities at the University of Washington to learn to do and to do research are excellent. The clinical and basic science faculty members are outstanding and the University is the top ranked public institution in NIH support, and consistently in the top few of all institutions nationwide. At the completion of this program, it is expected that the resident will have an understanding of sound and relevant research and will be capable of designing and executing case reports, case series reports, prospective clinical protocols, and applied surgical laboratory studies.
The program utilizes four University affiliated hospitals and two private offices. The hospitals include the University of Washington Medical Center (UWMC), Harborview Medical Center (HMC), the Veteran's Administration Puget Sound Health Care System (VAPSHCS), and Seattle Children's Hospital (SCH). These institutions represent the only Level 1 trauma center, only major children’s hospital, only academic VA hospital, and only university-based tertiary referral hospital for a 5-state region (Washington, Alaska, Montana, Idaho, and Wyoming) representing 1/4 of the U.S. land mass. The clinical experience for our residents, therefore, is outstanding, and in our opinion, unparalleled. The private plastic surgery office with which we have had a relationship since the inception of the residency is that of Drs. David Barker, Patricia Briscoe, Jonathan Hutter, and Wallace Chang. These physicians admit patients to Valley Medical Center (VMC) and Overlake Medical Center. Our Second year residents complete a rotation with The Everett Clinic in a community general surgery practice. One of our past Plastic Surgery graduates is on staff at The Everett Clinic practicing plastic surgery, bolstering our affiliation and its opportunities. The University of Washington Burn Center is located at Harborview Medical Center and is intimately involved in the residency. In addition, the plastic surgery residency is an integral part of the UW Hand Surgery Institute that is coordinated between the Division of Plastic Surgery and the Department of Orthopaedics.
The University of Washington Medical Center, located on the campus of the University of Washington and contiguous with the School of Medicine, is a 450-bed teaching hospital. It is a tertiary referral center for WWAMI (Washington, Wyoming, Alaska, Montana and Idaho). In addition to the main UW Medical Center Campus, the UW Medical Center also includes clinic and operating room facilities approximately 1 mile northwest of the main campus and a clinic in Bellevue, a city located across Lake Washington approximate 2 miles from the main campus.
Harborview Medical Center is located approximately three miles from the University of Washington campus. It is a 413-bed hospital owned by King County and operated under a management contract by the University of Washington, School of Medicine. It is the primary Seattle metropolitan receiving hospital for trauma and emergency medicine and surgery as well as a health resource for urban and inner-city inhabitants. It is the only Level I Trauma Center and Burn Center for the five-state WWAMI region.
The Veteran's Administration Puget Sound Health Care System is a Dean's Committee Hospital, and all of the medical staff are UW faculty members. The 450-bed hospital opened in 1985. It is located approximately five miles from Harborview and includes a Spinal Cord Injury Center.
Seattle Children’s Hospital is a 250-bed hospital with a substantial referral base throughout the WWAMI region. It includes a well-developed and very busy craniofacial program and is located approximately two miles from the University of Washington Medical Center.
The office of Drs. Barker, Briscoe, Hutter, and Chang is one of the premier private practices in the metropolitan area and is located in Renton, Washington, adjacent to Valley Medical Center, approximately twenty miles from the University. Their practice is quite general, including most aspects of Plastic Surgery. These physicians see approximately 9000 outpatient visits annually and admit approximately 250 patients to Valley Medical Center.
The Everett Clinic is a community multispecialty group approximately 45 minutes north of Seattle. Residents rotate here in their second year, and gain valuable general and plastic surgery experience.
The University of Washington Burn Center is located at Harborview Medical Center and is one of the largest in the country. It admits over 700 acute burn patients per year, and is one of the original burn centers that focused on early excision and grafting of acute burns. In addition, most of the patients are followed long term in the Burn Center, undergoing secondary reconstruction. Plastic surgery residents participate in both the acute and reconstructive care of burn patients during both the first three and final three years of training.
The University of Washington Hand Surgery Institute manages all hand surgery for all of the medical centers and consists of hand surgery attendings, residents, and fellows from both Plastic Surgery and Orthopaedics, working together in shared clinics, on-call responsibilities, teaching conferences, and many procedures involving faculty, fellows and residents from diverse training backgrounds and primary specialties. As an integral member of this service, the Plastic Surgery Resident gains a broad, diverse, and comprehensive exposure to hand surgery that is available in very few other Plastic Surgery programs.
2. Educational goals and objectives for resident assignments to each of the participating institutions.
The goals and objectives for the various rotations and components of the residency program are appended to this section and are distributed to the residents at the beginning of the program.
3. Resident responsibilities when assigned to the plastic surgery service.
These are described in detail for every rotation in the documents attached to this section.
Since all Plastic Surgery services except Children’s Hospital are well supported with in-house Surgery residents and since it is a goal of the program to keep Surgery residents intimately involved, it is possible and desirable for the Plastic Surgery residents to work at two hospitals on some of the rotations, though on any given day of the week, the resident is generally at just one institution.
The current practice of Plastic Surgery at each of the hospitals and the private office of the Renton group provides exposure to general Plastic Surgery. In addition, the practice at each provides unique clinical exposure. Plastic Surgeons at the University of Washington Medical Center are involved primarily in aesthetic, breast, and truncal surgery. Clinical care at Harborview includes maxillofacial trauma, hand surgery, reconstruction of lower extremities and the trunk, burns, and microsurgery. The practice at the VAPSHCS is very general and includes head and neck cancer reconstruction, hand surgery, and most aspects of Plastic Surgery except pediatric surgery and trauma. Activities at Children’s' include congenital anomalies of the head and neck and other aspects of pediatric Plastic Surgery. The practice of Drs. Barker, Briscoe, Hutter, and Chang includes aesthetic, maxillofacial and hand trauma, and microsurgery.
Years 1 through 3 in our integrated Plastic Surgery residency are designed to build a solid foundation of surgical technique and care. Plastic Surgery is truly the last general surgery practice. Trainees will require a broad spectrum of knowledge gathered from access to all of our surgical teams. Residents will work alongside both General Surgery residents and other specialty residents covering all aspects of patient care and methodology necessary to succeed in our specialty. These rotations are not only designed to implement the operative experience the American Board of Plastic Surgery outlines but also to give trainees the tools to succeed as a well-rounded plastic surgeon.
While the first 3 years of training are crucial in building the surgical knowledge foundation, it is also important to begin Plastic Surgery training concurrently. In year 1 plastic surgery residents rotate at the University Hospital with our reconstruction team. Trainees learn the fundamentals of evaluation and hone manual skills utilized by plastic surgeons. Also in the first year, integrated plastic surgery residents work at Harborview on the coordinated Burn/Plastic Surgery service. This combined service has been in existence since the Division was founded by Dr. Engrav in 1977 and is an excellent collaborative experience. Finally, first year residents also participate in the Seattle VA Vascular/Plastic Surgery team with good exposure to a variety of both simple and complex plastic surgery cases.
In year 2, plastic surgery residents are assigned to a 6-week oral surgery and orthopedic surgery block working alongside Oral/Maxillofacial surgeons and Orthopaedic surgeons at Harborview. This rotation serves as a good foundation for the Hand/Craniofacial rotation in year 4. Residents also complete an otolaryngology/head and neck surgery rotation at the UWMC. This rotation actually includes a significant amount of head and neck microsurgical reconstruction. Also in year 2 are rotations with Thoracic and Vascular Surgery divisions in our department as well as an Anesthesia rotation.
In year 3, residents participate in a Ophthalmology and Dermatology block for 6 weeks. These departments are great resources to our plastic surgeons and further solidify the plastic surgery education experience. Also in year 3 is a rotation to the Everett Clinic, one of our community surgery practices. Finally, 3rd year residents rotate at Children’s Hospital on the surgery service, which is a good introduction to care of the pediatric plastic surgery patient.
The rotations for the final three years of plastic surgery training are months in duration rather than weeks to give our residents time to develop a more longitudinal relationship with both faculty and patients. These experiences are as follows:
• Harborview Burns and General Reconstruction
• Harborview Hand & Craniofacial
• University of Washington Medical Center
• VA Puget Sound/ Research
• Community Plastic Surgery (Renton Practice with Drs. Barker, Briscoe, Chang, and Hutter)/ Research
• UW Medical Center/Pediatric Hand and Plastic Surgery (Children’s Hospital)
• Pediatric Plastic Surgery (Children’s Hospital)
• Harborview Hand & Craniofacial
• University of Washington Medical Center
Every effort has been made to minimize scheduling conflicts and to allow time for nonclinical activities, as well as to minimize covering more than one institution on a given day of the week. The schedules at the various institutions have been carefully integrated. In addition, since each service is staffed with Surgery housestaff as well as Plastic Surgery housestaff, the Plastic Surgery resident has some flexibility.
The fourth year resident spends 2 months at Harborview Burns/Reconstructive Surgery twice a year, 2 months on the Harborview Hand/Craniofacial service twice a year and 2 months at the University of Washington Medical Center twice a year. The resident is exposed to general Plastic Surgery and trauma and will become familiar with the principles and techniques of wound care, grafts, flaps, microsurgery, and trauma. As the resident's knowledge and technical skills mature, the educational needs of the surgery housestaff are integrated into clinical activities so as to provide the educational objectives of both. This is accomplished by a case distribution that directs more complex procedures to the Plastic Surgery resident and standard wound care, grafts and flaps to the Surgery housestaff. Further, as his/her abilities increase, the resident is allowed more independent clinical activity, but always functions with the supervision and participation of the faculty.
In the fifth year, the residents rotate on the VA service, the Renton Plastic Surgery service and on a combined UWMC/Children’s rotation. Given the clinical schedules at the VA and in Renton, there is ample time for residents to participate in a research project. This research time extends over 8 of the 12 months of the second year. While there is not sufficient time for a resident to conceive, initiate and ultimately complete a sophisticated project of their own, there are several opportunities to complete a basic science or clinical research project with one of the core plastic surgery or other University faculty. During the UWMC/Children’s rotation the resident spends a part of the week participating in microvascular surgery cases at the UWMC and in craniofacial and pediatric hand clinic and surgery cases at Children’s Hospital. During, the Renton rotation, the house officer participates in the practice of a four-physician group that includes the broad spectrum of Plastic Surgery—including both reconstructive and aesthetic cases. These physicians supervise the resident who carries out those procedures and makes those decisions in keeping with his/her level of development.
In the sixth year, the Chief resident again spends 4 months on the Harborview Hand/Craniofacial service, the University of Washington Medical Center service and 4 months at Children’s hospital doing pediatric plastic surgery. On these services, the house officer will be exposed to the clinical activities of those institutions, i.e. aesthetic, breast and pediatric Plastic Surgery, as well as advanced aspects of general reconstruction, head and neck reconstruction, hand, and microsurgery. The resident becomes more familiar and facile with the principles and techniques of all aspects of Plastic Surgery. As he/she develops in these areas, the resident assumes greater responsibility and independence but is always working with the supervision and participation of the faculty. It is expected that the chief resident will take an increasingly greater role in the evaluation of patients, formulation of treatment plan and operative cases commensurate with the advanced level of training. When the third year resident is on the UWMC/SCH rotation, they also have a special “resident-oriented” cosmetic clinic at UWMC that is staffed and supervised by faculty, but allows the resident to assume greater responsibility in the preoperative, operative, and postoperative care of these patients. In addition, the resident participates actively in the education of the Surgery housestaff, assisting them in procedures of wound care, grafts and flaps at these institutions.
Continuity of care is achieved at all of the institutions through resident participation in the various clinics. There are no “private” or “resident” clinics. Faculty and residents will usually participate in all clinics together.
During all three final years and on all rotations the educational philosophy is the same. It is same as that of the Department of Surgery, which prescribes a “wide latitude in intellectual inquiry but very close supervision of specific patient care with gradual assumption of clinical decision-making and operative responsibility.” Two training methods are fundamental to this philosophy, one for cognitive activities and one for technical matters. The first is that in all cognitive activities the resident is required to “make a plan” prior to discussing the problem with the attending. Attendings do not dictate diagnostic or therapeutic plans. The resident “makes a plan” which is then discussed with the attending and together a combined plan is made. This method of “making a plan” and then defending it against the critique of the attending physician trains the resident and permits him to assume increasing levels of independence. It is the goal that at the completion of his/her training the resident will have made sufficient independent decisions (under faculty supervision) that he/she can easily assume the position of an independent physician. This philosophy holds for all patients on the wards, in the clinics, pre- and postoperatively, and throughout the program. There are no “private” cases in which this philosophy does not apply. Regarding technical skills, the resident is expected to master the less complex procedures before proceeding to the more complex. Furthermore, he/she is expected to first assist until he/she understands the principles and methods, at which time the resident becomes the operating surgeon with faculty supervision, and eventually moves to teaching others. In virtually all instances there is an attending in the operating room. However, as the residents experience grows, the attending plays an increasingly supervisory role.
Regular, scheduled participation during every week in the clinics, i.e. the pre- and postoperative care of patients, is mandatory and is an integral part of every rotation. In the clinic setting, the resident usually sees the patient first, performs an evaluation, formulates a plan, then discusses the findings and plan with the attending, who then examines the patient with the resident and modifies/implements the plan.
4. Resident responsibilities when assigned to other services.
Residents are expected to serve as a member of the team on other services, without distinction as to their standing as Plastic Surgery residents. The goals and objectives for these services are identical for the Plastic Surgery residents and other residents.
5. Resident assignments outside the United States.
Residents are not assigned outside the United States.
6. Didactic component.
The didactic component is planned and modified at the beginning of each year in a meeting that includes all of the faculty and residents of the program. The structure and schedule of the plastic surgery didactic program is attached to this section and encompasses all required sections IA and V B&C of the program requirements over a 3-year period. Implementation is coordinated by the program director along with the administrative Chief Resident (the three switch after each rotation). Attendance by faculty and residents is mandatory and attendance is documented. All faculty and all residents participate at one point or another throughout the year. Visiting faculty participate in giving lectures 1-2 times per year.
Ethics, professionalism, systems based practice and the optimal conduct of an interdisciplinary medical team, as well as medicolegal issues are regularly discussed on rounds and at the Wednesday morning conferences. The M&M conferences are actually termed “M&M&X” with the “X” representing cases involving ethics, professionalism, systems based practice and the optimal orchestration of a complex, integrated interdisciplinary medical team, as well as medicolegal issues- potential or real.
In addition to the main Wednesday morning 0630-0815 plastic surgery teaching conference and the preceding evening teaching conferences, the following are also part of the didactic curriculum:
6:30 Hand Conference HMC- Ortho/PS
7:00 Children’s Hospital Craniofacial Conference
10:00 HMC Wound Rounds
12:00 HMC Burn/Plastic Surgery Teaching Rounds
6:30 Hand Conference (HMC)
7:30 Burn Teaching Conference (HMC)
10:00 HMC Wound Rounds
6:30-8:00 Division-wide Plastic Surgery Conference
11:00 HMC Wound Rounds
10:00 HMC Wound Rounds
12:00 HMC Burn/Plastic Surgery Teaching Rounds
7:00: UWMC Pre-operative Teaching Conference
10:00 HMC Wound Rounds
The subspecialty (hand and craniofacial) conferences are attended by the resident(s) rotating on that service, with the exception of the Tuesday morning hand lecture series, which is attended by all residents. The Divisional conferences are held at Harborview Medical Center and are attended by all Plastic Surgery residents. The Divisional conferences include preoperative case discussion, M&M (statistics are recorded), Selected Readings reviews, literature reviews, topic oriented resident questioning, and formal presentations by faculty, residents, and students. During the preoperative discussions the residents present the cases, including history, physical exam, analysis and plan. During the M&M conferences the residents present the cases and then all participate in the discussion. The Selected Reading reviews are presented by the residents, as are the literature reviews. In all conferences the faculty comment and lead the discussions. The topic oriented resident questioning sessions are based on regular, monthly evening teaching sessions, held by one of the faculty. In addition, there is a series of four lectures on basics of clinical and laboratory research as well as periodic research presentations from the fifth year residents.
7. Resident scholarly activity.
Residents are taught to understand and apply the scientific method to clinical medicine throughout the training program. This includes reviews of journal articles as part of the didactic program, presentation of topics based on the literature, and participation with the faculty in clinical and basic science research. Each resident completes one clinical research study during his/her three year training and one grant application is recommended (one manuscript is required for successful completion of the program). Some residents generate and prepare their own clinical and surgical laboratory research ideas and complete the studies during their final three years. Others assume responsibility for studies partially underway.
The clinical studies are conducted with the faculty of the Division of Plastic Surgery. The topics are those related to the practices of the faculty of the Division. Prior to the start of the second year of plastic surgery training, residents are required to submit to the program director a research plan for the year and a faculty research mentor.
As noted previously, because of the program’s commitment to fostering the development of future academic plastic surgeons, there is dedicated research time during the VA and Renton community plastic surgery rotations during the fifth year. This research rotation, though brief, allows the residents to gain an important insight into research and provides them a valuable education in how to properly evaluate research and scientific contributions. The opportunities at the University of Washington to learn to do and to do research are excellent. The laboratory studies are generally conducted with a faculty person of the Division of Plastic Surgery utilizing laboratory space and equipment of the Department of Surgery and the Division of Plastic Surgery. Such studies are prepared during the first year, executed during the second, and completed during the third. With this experience, UW plastic surgery residents have won the resident research award at the national Plastic Surgery Research Council meeting more than any other program.
E. Program Policies
As noted previously, during all six years and on all rotations the educational philosophy is the same, i.e. “wide latitude in intellectual inquiry but very close supervision of specific patient care with gradual assumption of clinical decision-making and operative responsibility.” Two training methods are fundamental to this philosophy, one for cognitive activities and one for technical matters. The first is that in all cognitive activities the resident is required to “make a plan” prior to discussing the problem with the attending. Attendings do not dictate diagnostic or therapeutic plans. The resident “makes a plan” which is then discussed with the attending and together a combined plan is made. This method of “making a plan” and then defending it against the critique of the attending physician trains the resident and permits him to assume increasing levels of independence. It is the goal that at the completion of his/her training the resident will have made sufficient independent decisions (under faculty supervision) that he/she can easily assume the position of an independent physician. This philosophy holds for all patients on the wards, in the clinics, pre- and postoperatively, and throughout the program. There are no “private” cases in which this philosophy does not apply. Regarding technical skills, the resident is expected to master the less complex procedures before proceeding to the more complex. Furthermore, he/she is expected to first assist until he/she understands the principles and methods, at which time the resident becomes the operating surgeon with faculty supervision, and eventually moves to teaching others. In virtually all instances there is an attending in the operating room. However, as the residents experience grows, the attending plays an increasingly supervisory role.
Residents will evaluate and treat patients in the emergency rooms and on the wards of the hospitals where they are on call and will involve the faculty depending on the severity, complexity, and urgency of the problem. Some minor procedures such as laceration repairs, fracture reductions, extensor tendon repairs, incision and drainage, amputation revisions, etc. can be performed by the resident without supervision, once they have achieved competence under supervision. At all times an attending is assigned, available, and ultimately responsible, however.
In the clinic setting, the resident usually sees the patient first, performs an evaluation, formulates a plan, then discusses the findings and plan with the attending, who then examines the patient with the resident and modifies/implements the plan.
2. Duty Hours
The program director monitors compliance with the resident duty hours requirements by having the residents keep a running log of their daily, weekly, and monthly duty hours and submitting them weekly to the program coordinator via the Med Hub on-line system. These are presented, reviewed, and discussed by all faculty and residents monthly at the Wednesday morning conference. The residents are clearly instructed to notify faculty at any time when they are approaching any of the duty hours limits. The schedule is arranged such that there is always a backup resident available.
1. Resident evaluation
Each resident is evaluated every rotation by all faculty members on their current rotation with online evaluation forms that are based on the core competencies, as well as face-to face interviews with the residents during the last week of their rotation. In addition, each resident receives a “mid-rotation” face to face evaluation with the appropriate service chief to monitor progress and identify areas for improvement for the remainder of the rotation. Any problems are discussed directly with the resident and are discussed amongst the faculty and remedial/corrective action is taken. In addition, each year the residents take the Plastic Surgery In-Service Training Exam. The results of this exam are not be used to determine promotion but rather as another measure of progress.
Every six months, each resident meets with the program director and associate program director to review his/her progress in the program. During these meetings, resident case logs are reviewed, rotation evaluations are reviewed and there is discussion of the resident’s career plans. In addition, the residents are given an opportunity to discuss issues with the program structure and conduct.
2. Faculty evaluation by the program director and residents.
Each resident confidentially evaluates faculty with online evaluations every rotation. Confidentiality is achieved through the blinded online evaluation system via MedHub. Any documented difficulties are addressed and plans promptly made to correct the problem. In addition, the program director meets with the residents face-to-face every six months to receive feedback regarding the faculty. The division chief also meets annually with the junior faculty and biannually with the senior faculty to discuss academic performance. Teaching performance is part of this evaluation.
3. Program evaluation.
Each resident confidentially evaluates each rotation with online evaluations in MedHub. Confidentiality is achieved through the blinded online evaluation system. These are discussed with the faculty at regular faculty meetings and improvements are discussed and implemented. In addition, the program director meets with the residents face-to-face every six months to receive feedback regarding the program and to discuss potential changes to the educational program to improve it. In addition, the educational, research, and clinical aspects of the program are discussed in a meeting with all residents and faculty 1-2 times per year. A number of improvements have come from the combination of these evaluations, including reassignment of residents within the overall rotation structure to improve workflow, allow better continuity of care, and facilitate emergency coverage so that it does not disrupt key educational activities. Redeployment to different activities within the same service and changing the structure of backup coverage in certain cases has also resulted in an improved educational experience. In addition, time is taken at the beginning of Wednesday conference to discuss any problems with the current residency operation and to make necessary interim adjustments.
Modified November 2011 - MDH