Specific Standards of Accreditation for Residency Programs in Plastic Surgery INTRODUCTION 2008 The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in Plastic Surgery. This document should be read in conjunction with the General Standards of Accreditation, the Objectives of Training and the Specialty Training Requirements in Plastic Surgery. STANDARD B1: ADMINISTRATIVE STRUCTURE There must be an appropriate administrative structure for each residency program. Please refer to Standard B1 in the General Standards of Accreditation for the interpretation of this standard. The Program Director must have RCPSC certification in Plastic Surgery or American Board certification in Plastic Surgery. In addition, the program director in Plastic Surgery must be a member of the university committee responsible for core surgery. STANDARD B2: GOALS AND OBJECTIVES There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The general goals and objectives for Plastic Surgery are outlined in the Objectives of Training and Specialty Training Requirements in Plastic Surgery. Based upon these general objectives each program is expected to develop rotation specific objectives suitable for that particular program, as noted in Standard B2 of the General Standards of Accreditation. STANDARD B3: STRUCTURE AND ORGANIZATION OF THE PROGRAM There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in the specialty. The structure and organization of each accredited program in Plastic Surgery must be consistent with the specialty training requirements as outlined in the Objectives of Training and the Specialty Training Requirements in Plastic Surgery. In addition to offering the components noted in the specialty training requirements, all accredited programs in Plastic Surgery should offer community-based learning experiences. This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright 2009 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission. Please forward a copy of the final product to the Office of Education, attn: Associate Director. Written permission from the Royal College is required for all other uses. For further information regarding intellectual property, please contact: documents@royalcollege.ca. For questions regarding the use of this document, please contact: accred@royalcollege.ca. Page 1 of 6
Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience. Each resident should keep a validated record of all operative procedures in which he or she has participated either as assistant or operating surgeon. STANDARD B4: RESOURCES There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the Royal College specialty training requirements. In those cases where a university has sufficient resources to provide most of the training in Plastic Surgery but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to Plastic Surgery. 1. Teaching Faculty There must be a sufficient number of qualified teaching staff to provide appropriate teaching and supervision of residents. Within the faculty there should be clinicians who are expertly and actively involved in Plastic Surgery of the hands, trunk including breast, reconstructive surgery of the trunk, trauma to the face and craniofacial bones, microsurgery and aesthetic surgery. Faculty must also be involved in research and undergraduate teaching as well as postgraduate education. 2. Number and Variety of Patients There should be patients representing all areas of Plastic Surgery with an adequate number of operative procedures to educate each resident in the safe conduct of all aspects of the procedure and of patient management. This includes: a. Congenital deformities, including those of the lip and palate, ear, eyelids, neck, hand, trunk, extremities and craniofacial maxillofacial regions. b. Traumatic deformities including bone and soft tissue wound management, reconstruction of the head, neck, face, hand, trunk and extremities, grafts of various tissues, management of acute burns and burn reconstruction and facial nerve palsy. c. Esthetic surgery including facial rejuvenation, body contouring, skin resurfacing, and esthetic breast surgery must be provided. The psychological components of esthetic plastic surgery should be included. d. Microsurgery, including free tissue transfers, peripheral nerve surgery and reimplantation of digits and extremities. e. Tumour surgery, including excision and repair of benign and malignant neoplasms of skin and soft tissue. Exposure to surgery and reconstruction of head and neck Page 2 of 6
malignancies is highly desirable. Instruction in interdisciplinary oncology should be provided, in order that the respective roles of surgery, radiotherapy, chemotherapy and immunotherapy may be clearly understood. f. Hand Surgery. A specific program for all aspects of surgery of the hand must be available either within the program, or if necessary, by arrangement with other programs or institutions. g. Breast Surgery. There should be exposure to all aspects of reconstructive and esthetic breast surgery. 3. Clinical Services Specific to Plastic Surgery a. Inpatient There must be sufficient hospital inpatients (both children and adults) to permit evaluation, treatment, follow-up and rehabilitation. b. Ambulatory Inpatient and outpatient clinical services should be sufficiently integrated, in order to provide continuity of observation of patients. Organized clinics or other facilities must provide opportunities for pre-admission investigation and post-discharge follow-up of patients. c. Community Based Learning Experiences Training in free standing surgery centres and private offices may be included in the residency program to supplement those areas that are being de-emphasized in active treatment hospitals. Community-based electives or those based in another university may be used for areas of special interest. d. Surgical Services There must be adequate operating room time and appropriate facilities to provide graded surgical responsibility for residents in the program, as well as a balanced exposure to all aspects of Plastic Surgery. e. Consultation The program must provide residents with the opportunity to obtain experience in the provision of a consultant service in Plastic Surgery to primary care physicians and other specialists. f. Pediatric Plastic Surgery There must be an organized teaching service for the Plastic Surgery of infants and children under the direction of qualified teachers, with all appropriate supporting staff and facilities. There must be close association with a pediatric service, including subspecialty units. The teaching service must provide experience in the diagnosis and management of all congenital deformities relevant to plastic surgeons, in particular cleft lip and cleft palate, hand surgery, and all forms of trauma and reconstructive surgery of children. Page 3 of 6
g. Trauma There must be adequate numbers of patients available to provide each resident with an extensive training in the recognition and management of injuries. The range of trauma should include all types of burns and other injuries. Experience in major trauma is essential, including participation in the initial management of multiple injuries as part of an interdisciplinary team. The program must also provide for training in post-traumatic reconstructive surgery, with full facilities for rehabilitation in a setting organized for teaching. It is particularly important that close relationships exist with other branches of medicine and surgery concerned with the management of trauma. 4. Supporting Services - Clinical, Diagnostic, Technical a. Liaison with Other Specialties and Subspecialties There must be active teaching services in Orthopedic Surgery, General Surgery, Neurosurgery, Pediatric General Surgery, Ophthalmology, Otolaryngology, Vascular Surgery, Anesthesiology, Dermatology, Pathology, and rehabilitation. b. Clinical i. Intensive Care Unit and Burn Unit There must be access to an intensive care unit and a unit that specifically deals with burns. Training in intensive care of the critically injured must be provided for all residents. Units organized for teaching are required to provide experience in the broad field of supportive care of critically ill and injured patients. Intensive care units admitting major and multiple trauma must be organized to ensure that residents in Plastic Surgery assume major responsibility under appropriate supervision. ii. Emergency Training There must be access to an active emergency department optimally with a trauma centre designation with active participation of the plastic surgical service. An active emergency department is essential, organized so as to provide instruction for residents in the initial management of all types of emergencies related to the specialty. Each resident must be assured of adequate training in the management of emergencies from the initial acceptance of responsibility to definitive surgical care. In addition, experience in providing a consultative service under emergency conditions is essential. iii. Rehabilitation Services There must be access to rehabilitation services staffed by professional staff in physical medicine, psychology, social work, physiotherapy and occupational medicine and therapy. Page 4 of 6
c Diagnostic and Technical i. All aspects of diagnostic imaging including radiology, CT, ultrasound, MRI, and nuclear medicine must be readily available for Plastic Surgery patients. ii. Facilities should include a technical skills centre and/or microsurgery laboratory and a facility for anatomical dissections. iii. Instruction should be available in the safe and appropriate use of endoscopic surgery, suction-assisted lipectomy, laser surgery and skeletal plating and fixation systems. STANDARD B5: CLINICAL, ACADEMIC AND SCHOLARLY CONTENT OF THE PROGRAM The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfill all of the CanMEDS Roles of the specialist. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside, in clinics or in the community, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Please refer to Standard B5 in the General Standards of Accreditation, the Objectives of Training, the Specialty Training Requirements in Plastic Surgery and the CanMEDS Framework for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS Roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below. 1. Medical Expert 2. Communicator 3. Collaborator 4. Manager In addition to the General Standards of Accreditation, the following requirement applies. The program must help residents develop their time management skills through directed readings, role modeling, and if possible seminars with time management experts. 5. Health Advocate In addition to the General Standards of Accreditation, the following requirement applies. Page 5 of 6
Non-confrontational approaches to advocating healthier life styles should be taught to and be seen to be applied by residents in their interactions with patients 6. Scholar 7. Professional STANDARD B6: EVALUATION OF RESIDENT PERFORMANCE There must be mechanisms in place to ensure the systematic collection and interpretation of evaluation data on each resident enrolled in the program. Results of resident evaluations, e.g. results of the yearly Canadian Plastic Surgery in-service examination, and surgical logs, must be considered in the formal review of resident performance. Please refer to Standard B6 in the General Standards of Accreditation for the interpretation of this standard. Adopted by Council - 98 04 Revised 05 06 29 Revised Education Committee 06 11 16 Revised SSRC June 2008 Page 6 of 6