University of Louisville

Transcription

1 University f Luisville Plastic Surgery Residency Training Manual Educatinal Prgrams, Plicies, and Guidelines fr Prgressin and Graduatin 1

2 PREFACE THE OATH OF HIPPOCRATES Table f Cntents 1. INTRODUCTION AND ACADEMIC MISSION OF THE PROGRAM EDUCATIONAL PROGRAM: THE TEACHING PHILOSOPHY, ACGME CORE COMPETENCIES, AND SPECIALTY GOALS GENERAL OBJECTIVES AND RESIDENT EVALUATION PARAMETERS (COMMON TO ALL CLINICAL SERVICES) CLINICAL COMPONENTS OF THE FIELD OF PLASTIC SURGERY THE CLINICAL SERVICES: THE EDUCATIONAL GOALS AND EVALUATION PARAMETERS FOR EACH ROTATION EDUCATIONAL CONFERENCES AND ROUNDS ETHICS CURRICULUM MEDICAL LEGAL CURRICULUM SOCIOECONOMICS & PRACTICE MANAGEMENT EDUCATION ANNUAL SYMPOSIA AND VISITING PROFESSORS KEEPING THE PLASTIC SURGERY OPERATIVE LOG (PSOL) BASIC SCIENCE EDUCATION AND RESEARCH EXPERIENCE ETHICS, HONESTY AND CONDUCT TEACHING RESPONSIBILITIES SERVICE ROTATION SCHEDULE DUTY HOURS LIMITATIONS CALL RESPONSIBILITY FACULTY SUPERVISION AND RESIDENT OPERATING ROOM STAFFING THE MEDICAL RECORD MEDICAL RECORD DOCUMENTATION FOR MEDICARE COMPLIANCE ACCURATE BILLING PROTOCOL TRANSITION OF CARE HIPAA COMPLIANCE

3 24. TIME OFF POLICY OVERSEAS HUMANITARIAN MISSIONS OUTSIDE EMPLOYMENT ROLE OF THE PLASTIC SURGERY RESIDENT IN THE EDUCATION OF THE UNDERGRADUATE MEDICAL STUDENT ONGOING COMMITTEES ONGOING EVALUATIONS RESIDENT PERFORMANCE EVALUATION GUIDELINES FOR ADVANCEMENT AND PROGRAM COMPLETION IN SERVICE EXAMINATION RESIDENT GRIEVANCES DISCIPLINARY ACTIONS AND GROUNDS FOR DISMISSAL POLICY ON RESIDENT RECUITMENT APPLICATION FOR EXAMINATION BY THE AMERICAN BOARD OF PLASTIC SURGERY STRESS AND FATIGUE IN THE WORKPLACE PERSONAL AND UPFRONT GUIDE TO THE APPENDICES CONFIRMATION OF UNDERSTANDING ATTACHMENT 1: BLOCK ROTATION AND DESCRIPTION OF SERVICES ATTACHMENT 2: PRINCIPLES OF MEDICAL ETHICS *Manual riginally prepared by Grdn Tbin, M.D. Updated by Bradn Wilhelmi, M.D. and Larry Flrman, M.D. in Frmatting cnverted by Andrea Sinclair in

4 PREFACE Oath f Hippcrates Frm HIPPOCRATIC WRITINGS, translated by J. Chadwick and W. N. Mann, Penguin Bks, I swear by Apll the healer, by Aesculapius, by Hygeia (health) and all the pwers f healing, and call t witness all the gds and gddesses that I may keep this Oath, and prmise t the best f my ability and judgment: I will pay the same respect t my master in the science (arts) as I d t my parents, and share my life with him and pay all my debts t him. I will regard his sns as my brthers and teach them the science, if they desire t learn it, withut fee r cntract. I will hand n precepts, lectures, and all ther learning t my sns, t thse f my master, and t thse pupils duly apprenticed and swrn, and t nne ther. I will use my pwer t help the sick t the best f my ability and judgment; I will abstain frm harming r wrngding any man by it. I will nt give a fatal draught (drugs) t anyne if I am asked, nr will I suggest any such thing. Neither will I give a wman means t prcure an abrtin. I will be chaste and religius in my life and in my practice. I will nt cut, even fr the stne, but I will leave such prcedures t the practitiners f that craft. Whenever I g int a huse, I will g t help the sick, and never with the intentin f ding harm r injury. I will nt abuse my psitin t indulge in sexual cntacts with the bdies f wmen r f men, whether they be freemen r slaves. Whatever I see r hear, prfessinally r privately, which ught nt t be divulged, I will keep secret and tell n ne. If, therefre, I bserve this Oath and d nt vilate it, may I prsper bth in my life and in my prfessin, earning gd repute amng all men fr all time. If I transgress and frswear this Oath, may my lt be therwise. 4

5 1. INTRODUCTION AND ACADEMIC MISSION OF THE PROGRAM A. Welcme On behalf f the full time academic faculty and the cmmunity vlunteer faculty, we welcme yu t the University f Luisville Plastic Surgery Residency Training Prgram. This is an independent mdel three year prgram. As such, it fllws prir graduate surgical training that has taught yu the fundamental ACGME cre cmpetencies and basic surgical skills. Therefre, ur prgram is designed t build upn and further enhance these cre cmpetencies and surgical skills, and t teach the art, principles and skills specific t Plastic and Recnstructive Surgery. The perative and clinical experience available t yu in this prgram is renwned fr being exceptinally diverse and challenging. We apprach this experience systematically, with analytic lgic and evidence based medical principles, in rder t give yu the finest set f general cmpetencies and surgical skills fr independent practice in Plastic Surgery thrughut yur career. If diligently pursued and fully utilized, this experience will prepare yu well fr a rewarding lifetime career f excellent patient care. It will als prepare yu well fr certificatin by the American Bard f Plastic Surgery, which is an essential credential f yur career, and which shuld be achieved at the earliest pssible time. B. Academic Missin The missin f the University f Luisville Plastic Surgery Residency Prgram is t train surgens wh are cmpassinate and skillful in patient care; wh use schlarly principles t maintain and apply mastery f the knwledge f their discipline; wh use gd science and analytical lgic in effective surgical prblem slving and utcme review; wh are careful and safe in their applicatin f judgment and technique; wh cntinuusly imprve their cmmunicatins, care and care delivery systems; wh stand ut as impeccable examples f ethical and prfessinal cnduct, and wh becme Bard certified and leaders in their prfessin and cmmunities. C. Guidelines In rder t maximize yur experience in this prgram and t facilitate smth day t day peratinal prcedures, guidelines are clearly utlined fr yu in the fllwing pages. These guidelines are intended t instill a prgram f intellectual challenge and active learning and t prvide yu with an unambiguus understanding f yur bligatins, respnsibilities, and educatinal pprtunities during yur training perid. 5

6 D. Manuals This manual is a supplement t the Department f Surgery Huse Staff Manual and The University f Luisville Resident Plicies and Prcedures Manual. Yu are prvided these dcuments alng with this manual and must als review them t fully understand yur respnsibilities. E. Attestatin If any element f this dcument fr Plastic Surgery Residents, the Surgery Department Manual r the University Manual is unclear, cntact the Prgram Directr fr clarificatin f plicy. When yu are finished reading this dcument yu will be required t sign the attestatin frm at the end. 2. EDUCATIONAL PROGRAM: THE TEACHING PHILOSOPHY, ACGME CORE COMPETENCIES, AND SPECIALTY GOALS A. Teaching Philsphy f this Prgram Fr each f yu, this is a secnd residency. Therefre, we expect prgressin beynd the basic cmpetencies and skills that yu have learned t date t substantially mre advanced levels, analgus t prgressin frm undergraduate t graduate schl. As such, ur educatinal philsphy emphasizes rapid acquisitin f advanced learning methds, develpment f keen cgnitive and analytic skills, refinement f surgical techniques (e.g. micrsurgery, gentle handling f tissues, meticulus attentin t detail), and advanced applicatins f ACGME Cre Cmpetencies. The key elements and gals f ur educatinal philsphy are listed belw, and presented thereafter in greater detail. These key elements are: Gal 1: Prgressin in the ACGME Cre Cmpetencies and their applicatins t the specialty f Plastic Surgery. Gal 2: Insistence n active learning (in cntrast t passive) and engagement in a variety f learning experiences and settings. Interactive cnferences and the Scratic Methd are used extensively. 6

7 Gal 3: Use f analytic lgic, the scientific methd and evidence based medicine in patient prblem analysis and slutin design. Gal 4: Rapid prgressin t independent judgment and practice by insisting that the resident always be challenged and always first take the lead in prblem analysis, literature use, slutin design, judgment and technical executin, with faculty critique at the cnclusin. Gal 5: Encuraging a diversity f technical and cgnitive experience by teaching encunters with a brad array f full time and vlunteer faculty, and asking residents t critically analyze and ratinally select amng differences in appraches and techniques. B. Explanatin f the Gals Gal 1: Prgressin in the ACGME Cre Cmpetencies. A primary bligatin that yu accept in becming a physician and surgen is t master the general cmpetencies f medical practice and the specific skills f yur discipline, and t maintain that mastery thrughut a lifetime f patient care. T this end, the University f Luisville Plastic Surgery Residency Prgram incrprates and emphasizes the six ACGME cre cmpetencies in ur training, ur evaluatin prcess and ur gals fr the utcme f yur experience here. We expect yu t cme with basic cmpetencies and t further refine them here. These six cmpetencies are as fllws: 1. Patient Care that is cmpassinate, apprpriate, and effective fr the treatment f health prblems and the prmtin f health. 2. Medical Knwledge abut established and evlving bimedical, clinical and cgnate sciences (e.g. epidemilgical and scial behaviral) and the applicatin f this knwledge t patient care. 3. Practice Based Learning and Imprvement that invlves investigatin and evaluatin f their wn patient care, appraisal, and assimilatin f scientific evidence, and imprvements in patient care. 4. Interpersnal and Cmmunicatin Skills that result in effective infrmatin exchange and teaming with patients, their families, and ther health prfessinals. 7

8 5. Prfessinalism, as manifested thrugh a cmmitment t carrying ut prfessinal respnsibilities, adherence t ethical principles, and sensitivity t a diverse patient ppulatin. 6. Systems Based Practice, as manifested by actins that demnstrate an awareness f a respnsiveness t the larger cntext and system f health care and the ability t effectively call n system resurces t prvide care that is f ptimal value. We pursue these six ACGME cmpetencies diligently thrugh all cmpnents f ur educatinal prgram and patient encunters. The ACGME cre cmpetencies are emphasized in the UfL Huse Staff Orientatin, and then built upn in ur Plastic Surgery Resident Orientatin. These cre cmpetencies are then re enfrced thrugh ur weekly ACGME Cre Cmpetency Cnference (Plastic Surgery Grand Runds Cnferences) and interactin with faculty in surgical care plan frmulatins fr each individual patient. Gal 2: Engagement and Active Learning. This prgram fcuses n active (versus passive) learning and cntinuusly challenges the intellectual skills f the resident. Thus, residents are given the encuragement and skills t cnstantly questin and verify the validity and scientific accuracy f the infrmatin they are given in lectures, cnferences and literature. Each judgment, diagnsis, and selectin f technique r design is expected t be lgically justified. Participatin rather than bservatin is required. The purpse is t develp a mre analytic prcess that upgrades the quality f medical knwledge and ultimately the quality f medical care that results. A welcme side effect is an enhanced acquisitin and retentin f infrmatin fr Bard and ther examinatin prcesses. Gal 3: Use f Analytic lgic, the scientific methd and evidence based medicine. Our philsphy emphasizes the analysis f practice principles and treatment f individual patient prblems using lgical prcesses, such as deductive reasning, inductive reasning, the scientific methd and evidence based medicine. Fr example, the scientific methd wuld translate int terms f clinical medicine as fllws: bservatin=disease r defrmity; hypthesis=differential diagnsis r suspected cnditin cause; hypthesis testing=prblem analysis, medical wrkup and data analysis; cnclusin=diagnsis and the treatment r recnstructive prcedure derived lgically frm the cnclusin. 8

9 A classic methd used in Plastic Surgery fr lgical design f recnstructive prcedures is t frmally analyze the missing elements f a defect needing recnstructin, and t surgically restre r replace like with like r with the mst similar. Furthermre, we expect the resident t generate a hierarchy f appraches and slutins and the rank rder t be defended by lgic and evidence based citatins (e.g., the recnstructive ladder ). Our apprach requires that the resident be the first t g thrugh this prcess, with critique by faculty t fllw, rather than the reverse rder. This causes judgment and analytic skills t grw mst rapidly, and thus best prepare residents t smthly make the transitin int independent practice. The ability t access the scientific literature f ur discipline, and t analyze it critically fr acceptance r rejectin, is essential t the best quality patient care and t lifelng learning. We emphasize literature use and analysis and evidence based medicine/evidence based practice (EBM/EBP) in each clinical challenge. EBM/EBP principles are learned early in ur ACGME Cre Cmpetency Cnference and practiced in each patient care plan frmulatin and each literature analyses sessin f Jurnal Club and cnference presentatins. Gal 4: Accelerated Prgressin t Independent Practice. Our educatinal prgram is specifically designed t accelerate prgressin t independence in judgment and practice. We fster this by challenging the resident t be the first t evaluate the patient, analyze the prblem, derive the diagnses, make the judgments and design the slutin. Only then is the faculty critique and input given rather than in the reverse rder as dne in many prgrams. In additin, we strive t prvide graduated respnsibility based n prgressive acquisitin f knwledge, prgressively increasing judgment challenges and prgressive refinement f technical skills. Requiring residents t take the intellectual lead in prblem analysis and slutin design and presenting increasing challenging judgment decisins with expectatins f increasingly skilled perfrmance requires a great degree f interactin between the attending faculty and the resident. The faculty must cnstantly encurage and require resident analytic thinking in surgical prblem slving, resident applicatin f the scientific methd f data analysis, and resident use f a sund physilgic and evidential basis fr surgical practice, all in keeping with the values incrprated in the cre cmpetencies. Optimal grwth f technical skills in rapid fashin is als achieved by an analgus prcess by encuraging the resident t take the lead as a supervised primary surgen, rather than an bserver. The resident is given prgressive technical respnsibility under faculty supervisin r rapidly as perfrmance allws. The senir residents are expected t have prgressed further than the junir residents, but all are encuraged 9

10 t prgress as rapidly and fully as their capabilities permit. Our Micrsurgery Labratry and Fresh Tissue Dissectin and Practice Labratry substantially serve the grwth f advanced technical skills. By the final semester f the senir year, if nt sner, each resident is expected t have matured sufficiently in judgment, knwledge and technical skill s as t be ready fr independent practice and fr the Bard certificatin examinatins. Gal 5: Optimal Use f Our Diversity f Experience. This prgram has been blessed with a rich amunt f clinical material that spans the entire spectrum f the field and gives in depth challenges f great cmplexity. We als have an exceptinally large number f cmplex cases that require interactin with ther specialties which prvides valuable experience in interdisciplinary case management. Our full time faculty is supplemented by a large, active vlunteer cmmunity faculty wh welcme resident teaching and wh participate actively. This prvides a diversity f technical and cgnitive appraches t prblem slving and technical executin. We use this diversity by insisting that the residents critically analyze the alternative appraches they encunter in rder t lgically chse the best and mst apprpriate cgnitive appraches and technical prcedures fr each patient. The residents are cntinually challenged t lgically justify these chices and defend them with basic anatmic and physilgic ratinale and evidence based practice. C. The UfL ACGME Cre Cmpetency Orientatin The UfL Graduate Medical Educatin Office hlds a full day f rientatin in the ACGME Cre Cmpetencies during the huse staff rientatin prcess that is mandatry fr all incming huse staff. Then, ur Plastic Surgery Residency Orientatin emphasizes the ACGME Cmpetencies and their applicatin t ur specialty. This rientatin is mandatry fr all residents and staff each year. D. ACGME Cre Cmpetency Cnference In rder t enhance ACGME cmpetencies in ur curriculum and t adapt them mst accurately t plastic surgery, an ACGME Cre Cmpetency cnference is held each week (Wednesday). During each sessin, a 10

11 Plastic Surgery tpic representing an imprtant aspect f every cmpetency is presented and discussed in rtatin. This cnference schedule is psted in the Divisin ffices. E. ACGME Cre Cmpetencies in Each Patient Encunter This prgram requires that each new patient r new prblem in an established patient be first analyzed by the resident in perspective f the relevant ACGME cmpetencies, and a slutin utlined that is als in perspective f the ACGME cmpetencies and evidence based practice. This analysis and prpsed slutin is then presented t the attending (r the Patient Care Plan Cnference) and discussed with the same rientatin t ACGME cmpetencies and evidence based practice principles. F. ACGME Cre Cmpetencies in the Clinical Rtatins We have adpted the gals f the curriculum utlined by the American Cuncil f Academic Plastic Surgens (ACAPS), and administered by the Accreditatin Cuncil fr Graduate Medical Educatin (ACGME). This Milestne Prject identifies the knwledge and skill sets t be acquired during each clinical rtatin. These are t be reviewed by each resident at the time f each rtatin change and midway thrugh each rtatin. The ACAPS has rganized these Milestnes alng lines f the ACGME Cre Cmpetencies (Sectin 5: The Clinical Services). G. ACGME Cre Cmpetencies in the Evaluatin Prcess Evaluatin f resident perfrmance and prgress is dne in perspective f the ACGME cre cmpetencies. Beginning July 2017, this will be perfrmed with a standardized prcess unifrm t all University f Luisville Residency prgrams called MedHub. This cmputer driven system will be explained t yu in great detail. 11

12 3. GENERAL OBJECTIVES AND RESIDENT EVALUATION PARAMETERS (COMMON TO ALL CLINICAL SERVICES) Fundamental skills that are essential bjectives cmmn t all clinical rtatins als becme majr cmpnents f the resident perfrmance evaluatin prcess. These skills and evaluatin parameters are as fllws: A. Patient Care 1. Residents must shw prficiency in btaining, dcumenting, and cmmunicating an accurate medical histry. 2. Residents must shw prficiency in perfrming, dcumenting and cmmunicating an accurate physical examinatin. 3. Residents must shw prficiency in judicius selectin f labratry and imaging studies that are mst relevant and specific t the diagnstic wrkup prcess. 4. Residents must shw prficiency in integratin and analysis f the histry, physical findings, labratry, and imaging data in prducing an accurate diagnsis and patient prblem list. 5. Residents must dcument a cmprehensive care plan, including prgress mnitring and fllw up. 6. Residents must respnd t the psych scial aspect f the illness r injury, including disfigurement and functinal limitatins. 7. Residents must prmte health educatin fr preventin f disease and injury. 8. Residents must demnstrate cmmitment t their rle as patient advcate, grwing int their rle as activists fr health equity. B. Medical Knwledge and Applicatin t Patient Care 1. Residents must develp a cmprehensive and scientifically accurate medical knwledge base thrugh advanced literature searches and analysis, plus ther scientific inquiry methds. 12

13 2. Residents must develp skill in selectin and use f evidence based medicine frm texts and jurnal articles selected by effective library and internet search techniques. 3. Residents must supply knwledge f scientific study design and apprpriate statistical methds t the appraisal f medical studies and ther infrmatin relevant t the diagnstic and therapeutic needs f the patient. 4. Residents must use Infrmatin Technlgy t manage and rganize infrmatin, t enhance their educatin. 5. Residents must apprpriately select the medical knwledge set relevant t the patient s cnditin and prblems. 6. Residents must develp skill in integrating medical knwledge with clinical data and diagnstic prcedures t refine the diagnsis, and prblem list and management plan. 7. Residents must develp skills in applicatin f medical knwledge t managing cmplex prblems, such as multiple injuries and c mrbid cnditins, with lgical priritizatin f therapeutic gals and interventins. C. Practice Based Learning and Imprvement 1. Residents must develp habits f cntinually analyzing practice experience and cnverting this t imprvements in care. 2. Residents must develp an penness and eagerness t seek and accept feedback frm faculty, peers, and patients. 3. Residents must prepare a prtfli develped arund cases presented in the weekly Indicatin and Care Plan Cnferences that prvide evidence f learning and shws the prcesses used. This will include PwerPint summaries f presentatins, jurnal articles, r internet searches demnstrating additinal infrmatin surces and readings and any crrespndence frm faculty, staff, r patients. D. Interpersnal and Cmmunicatin Skills 1. Residents must cmmunicate clearly and accurately t patients and their families, and cnfirm understanding f key cncepts. 13

14 2. Residents must cmmunicate clearly and effective with ther health prfessinals. 3. Residents medical recrds must be cmpleted, timely and legibly. 4. Residents must wrk effectively in team settings. 5. Residents must develp refined listening skills. 6. Residents must facilitate educatin f students, staff, therapists, patients and their families. E. Prfessinalism 1. Residents must develp prfessinal attitudes shwing: a. reliability and punctuality; b. ethics and integrity; c. initiative and leadership. 2. Resident must shw cperative attitudes that prmte teamwrk and mutual respect; 3. Residents must accept respnsibility fr their actins and their cnsequences. 4. Residents must develp humanistic qualities that include: a. establishment f ethically sund patient relatinships; b. demnstratins f cmpassin, sensitivity, and respect fr the dignity f patients and their families; c. and sensitivity and respect t age, culture, disabilities, ethnicity, gender and sexual rientatin. 5. Residents must respect patient cnfidentiality in all settings and meticulusly cnfrm t HIPAA guidelines. F. System Based Practice 1. Residents must demnstrate a thrugh understanding f the systems influencing the delivery f care t their patients, and integrate their practice apprpriately within the larger care systems. 2. Residents must fully evaluate the risks/benefits, limitatins, and cst f available resurces used in their practices. 14

15 3. Residents shuld imprve the system f care by thughtful analysis and advcacy fr bth incremental and innvative imprvement in care prvisin. 4. CLINICAL COMPONENTS OF THE FIELD OF PLASTIC SURGERY We cver the brad field f plastic surgery in a balanced, cmprehensive fashin. The 12 cmpnents f the Plastic Surgery field, as designated by the Plastic Surgery Residency Review Cmmittee (RRC), are each addressed in ur designated reading prgram, in the tpic rtatin f ur cnference schedule (Appendix 7, 8), in ur clinical rtatins (Attachment 2 f this Manual), and in the descriptin f clinical rtatins that fllws (Sectin 5). Within each f the 12 cmpnents f the Plastic Surgery field, specific knwledge and skill gals have been utlined by the American Cuncil f Academic Plastic Surgery, and published as the Plastic Surgery Curriculum (PSC) (Appendix 1). Yu are advised t review these PSC cmpnents and skill gals at the beginning and mid pint f each clinical rtatin. These 12 areas cmprise the basic clinical arenas f the specialty, and the designated gals within each arena must be mastered ver the length f the prgram. Yur experience must be reflected in yur Plastic Surgery Operative Lg (PSOL) with depth and balance in all areas. These 12 areas are as fllws: 1. Cngenital defects f the head and neck, including clefts f the lip and palate, and cranifacial surgery. 2. Neplasms f the head and neck, including the rpharynx, and training in apprpriate endscpy. 3. Cranimaxillfacial trauma, including fractures. 4. Aesthetic (csmetic) surgery f the head and neck, trunk, and extremities. 5. Plastic surgery f the breast. 6. Surgery f the hand/upper extremities. 7. Plastic surgery f the lwer extremities. 8. Plastic surgery f cngenital and acquired defects f the trunk and genitalia. 9. Burn management, acute and recnstructive. 10. Micrsurgical techniques applicable t plastic surgery. 11. Recnstructin by tissue transfer, including flaps and grafts. 12. Surgery f benign and malignant lesins f the skin and sft tissues. 15

16 5. THE CLINICAL SERVICES: THE EDUCATIONAL GOALS AND EVALUATION PARAMETERS FOR EACH ROTATION The 12 areas f plastic surgery are cvered by the service rtatins f ur hspitals. There are specific educatinal gals fr each rtatin f the residency. These include the general gals stated abve as well as mre specific gals f acquiring the knwledge and skills f the clinical fcus f each rtatin. Each hspital in ur prgram makes a unique and substantial cntributin t these gals. Each majr rtatin is described belw, alng with the relevant milestnes and evaluatin parameters frm the Plastic Surgery Curriculum (PSC) f the American Cuncil f Academic Plastic Surgens and backgrund readings. The PSC utline f milestnes (Appendix 1) is distributed alng with the Plastic Surgery Residency Training Manual annually. It is als accessible n line. Yu must review the gals listed belw and the related sectins f the PSC at the beginning f the prgram, and again at the midpint f each rtatin. The backgrund readings shuld be cmpleted by the beginning f each rtatin in the first year. They are selected frm the current textbk, Grabb and Smith Plastic Surgery. By the secnd year f the plastic surgery residency, residents are expected t have prgressed frm textbks t peer reviewed jurnal and review articles. Additinally, the ACGME has designed a Milestne Prject t prvide a framewrk fr assessment f the develpment f the resident in key dimensins f the elements f physician cmpetency. The Milestnes are designed t use in semi annual review f resident perfrmance and reprting t the ACGME. Milestnes are knwledge, skills, attitudes, and ther attributes fr each f the ACGME cmpetencies rganized in a develpmental framewrk frm less t mre advanced. They are descriptrs and targets fr resident perfrmance as a resident mves frm entry int residency thrugh graduatin. The Review Cmmittee will examine milestne perfrmance data fr each resident t determine whether they are prgressing verall. The Milestne levels are designed t best describe a resident s current perfrmance and attributes. Milestnes are arranged int numbered levels. Tracking frm Level 1 t Level 5 is synnymus with mving frm nvice t expert. These levels d nt crrespnd with pst graduate year f educatin. Selectin f a level implies that the resident substantially demnstrates the milestnes in that level, as well as thse in lwer levels. 16

17 Level 1: The resident demnstrates milestnes expected f an incming resident. Level 2: The resident is advancing and demnstrates additinal milestnes, but is nt yet perfrming at a mid residency level. Level 3: The resident cntinues t advance and demnstrate additinal milestnes, cnsistently including the majrity f milestnes targeted fr residency. Level 4: The resident has advanced s that he r she nw substantially demnstrates the milestnes targeted fr residency. This level is designed as the graduatin target. Level 5: The resident has advanced beynd perfrmance targets set fr residency and is demnstrating aspiratinal gals which might describe the perfrmance f smene wh has been in practice fr several years. It is expected that nly a few exceptinal residents will reach this level. THE UNIVERSITY OF LOUISVILLE HOSPITAL ROTATION The UfL Hspital rtatin has a brad clinical base with a cncentratin f trauma, burn, and critical care experience. The Hspital is designated as a Level I Trauma Center, and it huses ur adult burn unit. Thus, the clinical gals f this rtatin are t becme skilled in the fllwing principles and techniques: critical care; trauma and burn resuscitatin; maxillfacial trauma, extremity trauma, and general trauma surgery; burn care, grafting, and recnstructin; majr flap and micrvascular recnstructins. These clinical gals are supprted by several weekly bedside teaching runds. These include Plastic Surgery Service runds, with the University attending, interdisciplinary Burn Service runds, and multidisciplinary trauma runds, invlving all services participating in trauma care. The multi disciplinary structure f this service als serves the gal f develping skills in effective interdisciplinary relatinships fr care f critically ill patients, which is present t a degree fund in few ther prgrams. In additin, the University f Luisville Hspital rtatin serves the gal f enhancing prgress tward independent judgment and respnsibility, as it is a resident run service, with the faculty serving in supervisry rles as attending cnsultants and teaching first assistants. The University clinics serve the gal f develping 17

18 skills in pre and pst perative care and in nn perative management f apprpriate cnditins. The Outpatient Clinic prvides prgressive respnsibilities and cntinuity fr Plastic Surgery residents. This clinic gives ur residents the experience and respnsibility fr being the primary plastic surgen fr the patient in the cntext f apprpriately supervised care. Increased respnsibility and autnmy are encuraged in prgressing PGY levels. Safe pprtunities fr independent activity are prvided. Supervisin by attending surgens is always present at the clinics. Dr. Jshua H. Ch will prvide verall supervisin at the University Hspital. He is cmplemented by all faculty when the needs arise. University Hspital Level 1 (PGY 6) Gals The fundamental ability t diagnse patients medical cnditins and initiate a treatment plan will be achieved at this level. The resident will be respnsible fr Patient Care with the University Ward Service patients and peratins specifically fr patients that will be fllwing up at the ACB. The resident s primary respnsibilities will be t University patients admitted thrugh ER as traumas r that have been preperatively seen thrugh the ACB. The resident is expected t evaluate and treat patients with the supervisin f the faculty fr their level f training using their apprpriate level f Medical Knwledge. The resident is expected t demnstrate Practice Based Learning and Imprvement fr their level f training and experience as deemed apprpriate by the attending supervising. The resident is expected t utilize effective Interpersnal and Cmmunicatins Skills in wrking with patients, families and ther health prfessinals. Prfessinalism shuld be adhered t in perfrming duties ethically and sensitively with this diverse patient ppulatin. Residents shuld apply System Based Practice principles in caring fr these patients thrugh effectively using system resurces in prviding ptimal care. University Hspital Level 2 (PGY 7) Gals The main bjective fr residents t develp n this rtatin will be t demnstrate the ability t devise an apprpriate treatment plan. The resident will be respnsible fr prviding Patient Care t ACB initiated r University Plastic Surgery trauma patients. The resident is expected t evaluate and treat patients with the supervisin f the faculty fr their level f training using their apprpriate level f Medical Knwledge. The resident is expected t demnstrate Practice Based Learning and Imprvement fr their level f training and experience as deemed apprpriate by the attending supervising. The resident is expected t utilize effective 18

19 Interpersnal and Cmmunicatins Skills in wrking with patients, families and ther health prfessinals apprpriate fr their level. Prfessinalism shuld be adhered t in perfrming duties ethically and sensitively with this diverse patient ppulatin. The resident shuld apply System Based Practice principles in caring fr these patients thrugh effectively using system resurces in prviding ptimal care fr their level f experience. University Hspital Level 3 (PGY 8) Gals In the last year, the resident is expected t demnstrate superir perative skills t at the level t safely teach ther residents thrugh cmplex cases. The resident will als be expected t prvide Patient Care fr all ACB initiated and University Trauma initiated patients that are admitted t the hspital. The resident is expected t evaluate and treat patients with the supervisin f the faculty fr their level f training using their apprpriate level f Medical Knwledge. The resident is expected t demnstrate Practice Based Learning and Imprvement fr their level f training and experience as deemed apprpriate by the attending supervising. The resident is expected t utilize effective Interpersnal and Cmmunicatins Skills in wrking with patients, families and ther health prfessinals. Prfessinalism shuld be adhered t in perfrming duties ethically and sensitively with this diverse patient ppulatin. The resident shuld apply System Based Practice principles in caring fr these patients thrugh effectively using system resurces in prviding ptimal care by striving t practice cst effective measures. Backgrund Reading: Negligan/Mathes Plastic Surgery; Selected Readings In Plastic Surgery HAND AND UPPER EXTREMITY ROTATION This rtatin is dne with U f L Hand Surgery at Jewish, University and Children s Hspitals. The primary gal that this rtatin serves is mastering the principles f management, surgery and therapy f hand and upper extremity disrders in adults and children. It als prvides a strng digit and extremity replantatin experience and reinfrces the gals f strengthening micrsurgical experience. This rtatin is supplemented by weekly cnferences that cvers all areas f hand surgery and by several annual sympsia in anatmy, internal fixatin and ther relevant tpics. Dr. Bradn Wilhelmi is charged with the Hand Service. 19

20 Hand Level 1 (PGY 6) Gals The fcus f this rtatin is t demnstrate the ability t recgnize and manage pst perative prblems. The resident will take hand call weekly and see all hand patients admitted t Plastic Surgery with hand cnditins. With regard t Patient Care, the resident is expected t develp and execute a prper patient care plan. In demnstrating Medical Knwledge the resident is expected t prepare and have knwledge f perative prcedures apprpriate fr treated patients. The resident will demnstrate Practice Based Learning thrugh participatin in the educatin f patients, family and junir learners. Interpersnal and Cmmunicatin Skills will be develped and demnstrated by cunseling and educating these patients and their families in an understandable and respectful manner. Prfessinalism shuld be exhibited by cnsistently demnstrating ethical behavir and recgnizing ethical issues in these patients. System Based Learning will be achieved thrugh recgnizing basic elements needed t establish a practice (staffing, insurance, and accreditatin). Hand Level 2 (PGY 7) Gals The emphasis f this rtatin will be n hw t manage multiple patients and surgical cnsultatins. Patient Care will be assessed by yur demnstratin f apprpriate manual dexterity fr training level. This will be taught and stressed during the rtatin. Medical Knwledge will be develped by use f cllateral reading in preparing fr cases. Practice Based Learning will be determined by bserving and develping the resident s ability t critique persnal practice utcmes. Interpersnal and Cmmunicatin Skills refined and evaluated thrugh the residents cmmunicatin with members f the health care team skills. Prfessinalism will be taught t extend the residents patient management skills t demnstrate cmpassin and sensitivity twards thers. System Based Practice will be taught t the resident at this level thrugh develping the use f tls (checklists, briefings) t prevent adverse events. Hand Level 3 (PGY 8) Gals The verall bjective f this will be t help the resident independently perfrm rutine prcedures in the care f the hand surgical patient. Patient Care will be assessed by the residents ability t demnstrate a superir manual dexterity and apprpriate ecnmy f mtin in the perating theatre. Medical Knwledge will be assessed thrugh ne s ability t demnstrate knwledge base in the clinical setting and perating rm fr their level. Practice Based Learning will be assessed by the resident s ability t discuss n ging research in the 20

21 field f hand surgery. Interpersnal and Cmmunicatin Skills will be develped thrugh managing transitins f care and ptimizing cmmunicatins acrss systems. Prfessinalism will be emphasized thrugh striving t maintain ne s persnal health and wellness. System Based Practice is addressed thrugh discussin f csteffectiveness in patient care in the hand surgery field (managing length f stay, perative efficiency, etc.). Backgrund Reading: Green s Operative Hand Surgery; Neligan/Mathes Plastic Surgery. THE ADULT RECONSTRUCTIVE ROTATION The adult recnstructive service at Jewish and Nrtn Hspitals prvides a rich and diverse expsure t all areas f adult plastic surgery, and serves gals f develping general recnstructive judgment and skills. The thracic and cardivascular service at Jewish Hspital prvides challenging thracic recnstructins and prvides the gals f develping bth recnstructive skills and critical care management. This rtatin als includes a large transplant service and serves the gals f develping skills and knwledge in difficult wund prblems as well as basic transplantatin bilgy. The adult nclgic service at the Nrtn Hspital Cancer Center and the Brwn Cancer Center serves the gal f enhancing judgment and experience in breast recnstructin, head and neck nclgic recnstructin, gyneclgic nclgic recnstructin, and rthpedic nclgic recnstructin. Dr. Terry McCurry and Dr. Grdn Tbin mentr and direct this service. Recnstructin Level 1 (PGY 6) Gals The verall fcus f this rtatin will be t develp the ability t recgnize and manage pst perative prblems. In this rtatin, the resident will wrk under the directin f Dr. Tbin and Dr. McCurry. Patient Care will be stressed t have the ability t develp and execute patient care plan. Medical Knwledge will be develped thrugh the resident s ability t prepare and knwledge f perative prcedures fr recnstructive patients. Practice Based Learning will be emphasized by having the resident participate in the educatin f patients, families and junir learners. Interpersnal and Cmmunicatins Skills will be enhanced thrugh bservatin f cunseling and educating patients and their families in an understandable and respectful manner. Prfessinalism will be develped by the resident wh will be expected t cnsistently demnstrate ethical behavir and recgnize ethical issues in recnstructive patients. System Based Practice will be enhanced thrugh teaching basic elements needed t establish a practice (staffing, insurance and accreditatin). 21

22 Recnstructin Level 2 (PGY 7) Gals The emphasis f this rtatin will be n develping the ability t manage multiple patients and surgical cnsultatins. In this rtatin the resident will wrk under the directin f Dr. Tbin and Dr. McCurry. Patient Care will be develped by teaching the resident t have apprpriate manual dexterity and technical efficiency. Medical Knwledge will be stressed thrugh prviding resurces fr cllateral reading t prepare fr recnstructive cases. Practice Based Learning gals will help the resident t develp a better ability t critique persnal practice utcmes in the utpatient setting. Interpersnal and Cmmunicatin Skills will be refined thrugh cmmunicating with the members f the health care team effectively. Prfessinalism requirements will stress perfrming clinical and administrative respnsibilities in a timely manner. System Based Practice will be demnstrated by bserving the residents ability t cnsistently utilize tls t prevent adverse events such as checklists, briefings, smart phne. Recnstructive Level 3 (PGY 8) Gals The thrust f this rtatin is fr the resident t demnstrate the ability t independently perfrm rutine prcedures in the care f the surgical patient. In this rtatin, the resident will wrk under the directin f Dr. Tbin and Dr. McCurry. Patient Care will be demnstrated by the residents ability t independently manage multiple patients and surgical cnsultatins. Medical Knwledge will be assessed as demnstrated in practice in the clinical setting. Practice Based Learning will be reinfrced thrugh attentin t demnstratin and cmmitment t life lng learning and self imprvement. Interpersnal and Cmmunicatin Skills will be enhanced thrugh the ability t manage transitins f care and ptimizing cmmunicatin acrss systems. Prfessinalism will be develped thrugh demnstratin f cnsistent cmmitment t cntinuity f patient care. System Based Practice will be encuraged thrugh discussins n cst effectiveness (Managing length f stay, perative efficiency) in the recnstructive patient. Backgrund Reading: Neligan/Mathes Plastic Surgery; Selected Readings in Plastic Surgery. THE VETERANS AFFAIRS MEDICAL CENTER ROTATION This resident run rtatin is based in a large Veterans Affairs Medical Center Hspital ten minutes frm the main campus. Its primarily missin serves the gals f acquiring experience in head and neck nclgy and recnstructin, cutaneus malignancy nclgy and recnstructin, and management f neurlgical injury 22

23 cmplicatins, such as decubitus ulcers. In additin, this rtatin serves the imprtant gal f develping independent judgment and respnsibility; bth the service and its clinics are resident run with a full time plastic surgen attending serving in a supervisry rle. Dr. Mrtn Kasdan is charged with all plastic surgery services at the VAMC thrugh 12/2018. VAMC Level 1 (PGY 6) Gals On this rtatin, the main gal will be t learn hw t develp the ability t diagnse cnditins and execute patient care plan. The VAMC Plastic Surgery rtatin is under the directin f Dr. Kasdan. Patient Care will develp the ability t recgnize and manage pst perative prblems. Medical Knwledge will be achieved thrugh the preparatin fr perative prcedures. Practice Based Learning is attained thugh the participatin in the educatin f patients, families and junir learners. Interpersnal and Cmmunicatin Skills will be encuraged by having residents cunsel and educate patients and their families in an understandable and respectful manner. Prfessinalism is cnsistently encuraged allwing the resident t demnstrate ethical behavir and recgnize ethical issues in practice. System Based Practice is ptimized thugh learning hw t recgnize basic elements (staffing, insurance, accreditatin) needed t establish a practice frm Dr. Kasdan extensive clinical experience. VAMC Level 2 (PGY 7) Gals This rtatin will emphasize develpment f manual dexterity fr training level. The VAMC Plastic Surgery rtatin is under the directin f Dr. Kasdan. Patient Care will invlve independent management f multiple patients and surgical cnsultatins. Medical Knwledge will be hned in preparatin and knwledge f perative prcedures. Practice Based Learning is develped thrugh participatin in the educatin f patients, families and junir learners. Interpersnal and Cmmunicatin Skills are refined thrugh cunselling and educating patients and their families in an understandable and respectful manner. Prfessinalism is develped thrugh cnsistent mentring under Dr. Kasdan demnstrating ethical behavir and reinfrcing ethical issues in practice. System Based Practice will be utlined cnsistently using tls t prevent adverse events. 23

24 VAMC Level 3 (PGY 8) Gals The thrust f this rtatin will be develping independence t perfrm prcedures in the care f the plastic surgical patient. The VAMC Plastic Surgery rtatin is under the directin f Dr. Kasdan. Patient care will invlve demnstrating the ability t imprve perative skills thrugh ecnmy f technique. Medical Knwledge will be attained thrugh applicatin f knwledge base in the clinical setting with Dr. Kasdan. Practice Based Learning is btained thrugh cmmitment t life lng learning and self imprvement under Dr. Kasdan s mentrship. Interpersnal and Cmmunicatin Skills are refined by using ability t manage transitin f care and ptimizing cmmunicatin acrss systems and in sign uts. Prfessinalism is advanced thrugh demnstratin f cnsistent cmmitment t cntinuity f patient care. System Based Practice will be addressed thrugh cnsistently practicing cst effective care as taught by Dr. Kasdan. Backgrund Reading: Neligan/Mathes Plastic Surgery. HEAD AND NECK ROTATION An in depth head and neck experience is available. This is a rtatin at the University Hspital, Nrtn Hspital and Ksair Children s Hspital under the mentrship and directin f Dr. Jarrd Little. The primary gal f this rtatin is t learn the principals f head and neck anatmy, nclgy, trauma and recnstructin. This rtatin prvides a very diverse expsure t head and neck plastic surgery and ther plastic surgery. The gal f learning, evaluatin and pre and pst perative care f the head and neck patient is served by the experience f taking care f these specialized patients at a variety f hspitals t intensively teach these specialized skills. Residents will learn a multidisciplinary apprach t the management f these cmplex patients frm the perspective f an tlarynglgy trained plastic surgen. Head and Neck Level 1 (PGY 6) Gals The emphasis f this rtatin will be n ability t recgnize and manage pst perative prblems. The Head and Neck rtatin will be primarily at Nrtn Hspital under the directin f Dr. Little. Patient Care will be develped thrugh the ability t execute a patient care plan. Medical Knwledge will be achieved preparatin and develpment f perative plan and prcedures. Practice Based Learning will be learned thrugh participatin in the educatin f patients and their families. Interpersnal and Cmmunicatin Skills will be btained thrugh cunseling patients and their families in an understandable and respectful manner. 24

25 Prfessinalism will be expected and taught cnsistently expecting prper ethical behavir and recgnitin f ethical issues in practice. System Based Practice will be reviewed t emphasize the basic elements needed t establish a practice. Head and Neck Level 2 (PGY 7) Gals The thrust f this rtatin will be t learn hw t independently manage multiple patients and surgical cnsultatins. The Head and Neck rtatin will be primarily at Nrtn Hspital under the directin f Dr. Little. The resident will be expected t develp the apprpriate manual dexterity fr level. Medical Knwledge will be facilitating t prviding cllateral reading fr head and neck patients and peratins. Practice Based Learning will be develped by teaching the resident the ability t critique persnal practice utcmes. Interpersnal and Cmmunicatin Skills will stress effective cmmunicatin with members n the health care team. Prfessinalism will be refined by demnstratin f cmpassin and sensitivity twards the head and neck patients. System Based Practice will be established thrugh cnsistent use f tls (checklists, briefings) t prevent adverse events. Head and Neck Level 3 (PGY 8) Gals The verall bjective f this rtatin will be t have the resident be able t independently perfrm rutine prcedure in the care f the surgical patient. The Head and Neck rtatin will be primarily at Nrtn Hspital under the directin f Dr. Little. Patient Care will emphasize management f multiple patients and surgical cnsultatins. Medical Knwledge allw fr demnstratin f knwledge base in the clinical setting. Practice Based Learning will be develped thrugh teaching cmmitment t life lng learning and selfcmmitment. Interpersnal and Cmmunicatin Skills will be enhanced thrugh management f transitin f care and ptimizing cmmunicatin acrss systems. Prfessinalism will be taught and btained thrugh mnitring wn persnal health and wellness. System Based Practice will be attended by striving t achieve and teach cst effective care. Backgrund Reading: Grabb and Smith s Plastic Surgery; Neligan/Mathes Plastic Surgery 25

26 INTERDISCIPLINARY SUBSPECIALTY TRAINING OPPORTUNITIES The majr rtatins listed abve prvide the majr clinical experiences fr ur prgram and serves the gals f develping the specialty knwledge and skills assciated with the specific patient ppulatins and educatinal experiences f each hspital. In additin, within these majr rtatins certain multidisciplinary subspecialty gals and in depth experiences are incrprated. The Divisin f Plastic and Recnstructive Surgery supprts this interdisciplinary apprach t shared educatinal prgrams in rder t fulfill the gals f prviding experiences that utilize specialized skills held r shared by ther disciplines. Shrt Elective Rtatins Level 3 (PGY 8) Gals Residents will have an pprtunity t select electives as suggested by the RRC in the abve areas. During these third level rtatins the residents will be able t further refine their knwledge base and skills in their selected rtatin. The resident is expected t cntinue t advance their Patient Care skills and perative technique when apprpriate. They will have an pprtunity t further their Medical Knwledge n that specific elective thrugh cllateral reading and preparatin fr cases. Practice Based Learning will be addressed varying n rtatin and specialty. Interpersnal and Cmmunicatin Skills will have an pprtunity t flurish in wrking within a new team and system. The resident will still be expected t demnstrate apprpriate Prfessinalism as a representative f the University f Luisville Plastic Surgery prgram. These super specialty electives will prvide the resident with a multitude f practice mdels t help develp practice management strategies with staffing, insurance, and accreditatin. Oculplastic Surgery An in depth Oculplastic experience is available. This is prvided primarily by Dr. Duglas Gssman, a skilled culplastic surgen and Plastic Surgery vlunteer faculty member. His backgrund is in the discipline f phthalmlgy, with previus training in neursurgery. He wrks clsely with the University full time and vlunteer plastic surgery faculty in majr recnstructins f rbital trauma, cranial base nclgic resectins, and cranifacial peratins, as well as prviding experience in cngenital ptsis and ther rbital recnstructins, nt cmmn t mst plastic surgery prgrams. Backgrund Reading: Grabb and Smith s Plastic Surgery 26