ABOUT THE PLASTIC SURGERY RESIDENCY PROGRAM
Integrated residents will have a broad training in plastic surgery, general surgery, ENT, orthopedics, ophthalmology, dermatology, burn surgery, and others during their first three years. The curriculum during the final three years consists of rotations at the University of Utah Hospital (including the Huntsman Cancer Hospital), Primary Children’s Hospital, and The Salt Lake VA Medical Center. Progressive responsibility is provided to the residents as they proceed through the rotations. This increasing responsibility is reflected in the proportion of cases, as surgeon, increasing each year. It is also reflected in their increased knowledge and technical competence expectations.
The clinical rotations consist rotations at the University of Utah Medical Center, VA Medical Center and Primary Children's Hospital. The rotations at the University of Utah and the VA Medical Center provide broad exposure to all facets of adult plastic surgery, including hand surgery, aesthetic surgery, and reconstructive surgery. They generally consist of three operative days and two clinic days per week.
The children's hospital rotation provides broad exposure to pediatric plastic and reconstructive surgery as well as cleft care and craniofacial surgery. This rotation has three or four operative days and one or two clinic days per week. The University of Utah and Primary Children's Hospital are the regional referral centers for the Intermountain West. The closest medical centers are in Denver, Colorado, and Sacramento, California. The VA Medical Center is likewise the regional referral center for the veterans' medical system.
Currently we are matching with three residents per year in the integrated program and one in the independent program. The prerequisites for entrance into the independent program are those established by the American Board of Plastic Surgery. Independent applicants apply and match through the San Francisco Match. Integrated applicants apply through ERAS and match through NRMP.
PROGRAM INFORMATION
On all plastic surgery services, residents are involved in the pre-operative, intra-operative, and post-operative care of patients. Residents are involved in clinics at all of the hospitals, thus gaining pre- and post-operative experience. The residents will see patients both independently and with the attending physicians in the clinics. Discussions are held when appropriate to maximize the educational experience for the resident. Faculty attend all surgical cases. The resident assumes a level of responsibility appropriate to his or her knowledge and capabilities.
At each institution, the residents are responsible for making daily rounds on the patients before the beginning of the clinic or operative schedule.
Senior residents also participate in their own resident cosmetic clinic where they evaluate patients for cosmetic procedures. After developing an operative plan, they present each case to a faculty member who will serve as the primary staff and advisor for the resident cosmetic case.
While at Primary Children's Hospital, the residents spend one to two days per week in the general plastic surgery clinic and cleft clinic. The remaining days are spent in the operating room learning a range of pediatric surgical techniques, including cleft lip/palate repair and cranial vault remodeling.
While at the VA Medical Center, clinics are held two days a week and the remaining days are spent in the operating room. Residents also staff a procedure clinic where they are able to gain experience in minor surgeries performed under local anesthesia.
All significant decisions and especially those regarding operative intervention are made in conjunction with the attending staff. Surgery is performed on an inpatient and outpatient basis in all of these facilities. The University Outpatient Clinic is only available for outpatient surgical care. The clinics at University Hospital and the adjacent Huntsman Cancer Hospital also have small procedure rooms appropriate for performing procedures under strictly local anesthesia.
In their rotations at the affiliated institutions, the residents gain a broad exposure to all facets of plastic surgery and to each of the specific clinical areas described in the plastic surgery operative log. University Hospital and Primary Children’s Hospital provide the bulk of the exposure to trauma. They are both level one trauma centers. This includes both hand and maxillofacial trauma. A significant amount of adult reconstruction in breast, upper and lower extremity, and trunk are encountered at these facilities. The majority of the microvascular procedures are also performed at these facilities.
The VA Medical Center provides the residents with a very broad experience in facial skin cancers and their reconstruction, hand surgery, and head and neck cancer surgery. Primary Children's Hospital provides a broad and inclusive range of pediatric plastic surgical, craniofacial, and congenital hand patients. Pediatric maxillofacial trauma is also provided at Primary Children’s. The teaching program is centered at the University of Utah and is coordinated by the full time faculty. Faculty at Primary Children's and the VA Medical Center add variety and a different perspective to the resident teaching. Weekly conferences consist of grand rounds (including local and national speakers), resident didactic conference covering the main topics in plastic surgery, case conference discussing the weeks interesting cases, hand conference, and a general review conference oriented towards studying for the in-service test and board examinations
WEEKLY CONFERENCES
The University of Utah Division of Plastic Surgery holds weekly conferences that provide both didactic and interactive learning opportunities for the residents and students. The series of rounds and conferences have been developed to assure residents in the program are educated in the broad scope of plastic surgery.
- Tuesday Night Conference is a seminar style conference that covers the entire core curriculum in plastic surgery over an 18-month cycle. A brief didactic presentation of the topic is followed by discussion and questions and answers involving residents and faculty. This is followed by a Case Presentation Conference, which is led by a faculty member, and cases are presented and discussed in an oral boards style. This is also an opportunity for residents and attendings to present challenging upcoming cases and discuss indications and approaches.
- Wednesday Morning Grand Rounds include didactic lectures of a wide range of topics in relevant to plastic surgery. Presentations are given by faculty, local plastic surgeons, and members of other divisions and departments. Additionally, visiting professors are invited several times per year with a dinner the evening before and a half or full day of lectures that includes a grand rounds presentation.
- Every other month we hold a Morbidity and Mortality Conference on Wednesday mornings.
- Thursday Morning Conference alternates between Hand Conference and In-Service Review. Review of questions follows a pre-set curriculum. Quarterly the conference is replaced with a mock in-service exam.
JOURNAL CLUB
Journal Club is held every other month at faculty member's home or choice of venue. Selected papers from the primary plastic surgery journals are reviewed and critically discussed over dinner.
Academic Funds
- All residents will receive $2,500 at the beginning of their residency for academic purposes. These funds will be used to help defray costs for surgical loupes, a tablet or textbook purchases during residency. These funds may be used for career building conferences or workshops. These funds can also be used to reimburse costs associated with USMLE Step 3.
- Additionally, the Division of Plastic Surgery will cover the cost of membership to the ASPS Resident Forum for all residents. This gives residents’ access to ASPS Education Network (formerly PSEN), a subscription to Plastic and Reconstructive Surgery, and subscription to Plastic Surgery News, registration for the ASPS annual meeting, as well as other benefits found on the ASPS website.
- Residents are given two coats at the beginning of residency and then are able to purchase one more per year, if needed. If residents need/want more than one additional per year, that additional one will come out of their academic fund.
Call Room
- The Division of Plastic Surgery has a call room in Area E of the University of Utah Hospital, lower level, room B106. EVS will clean and change linens daily Monday-Friday. The door code is 2435# In addition to the designated call room, residents have an office space in the HELIX building, a room with a sleep chair in HELIX room 4S135 as well as an additional shared wellness room with a bed for napping and overnight purposes in HELIX room 4S117.
- Should a resident feel too fatigued to safely return home and the resident elect to go home. The Division of Plastic Surgery will reimburse the resident for the cost of the ride from the hospital to their home
Foreign Surgical Mission
- Residents are encouraged to attend a surgical mission trip during their last 3 years of plastic surgery training. Senior residents will be given priority to participate. If the senior resident is unable to go or has previously gone, then the next senior resident will be eligible. Residents may attend a trip in conjunction with a University of Utah faculty member or through a separate established program (ie. Op Smile).
- We have two established trips through the Division of Plastic Surgery. One trip to Guatemala, under the direction of the craniofacial team, is focused on pediatric disorders, primarily cleft lip and palate. The second trip to Ghana, under the direction of Dr. Brad Rockwell, is focused on hand and trauma care in an underserved region. Residents also have access to the University of Utah Center for Global Surgery who can assist in identifying trips to other regions.
- Residents will be allowed to have 7 days for travel on a surgical mission trip during their final 3 years. If a resident requires any additional time for the trip or if a resident plans to attend more than one 7 day trip, he/she will be required to use vacation time. The fees for the trip (travel, food/lodging) will come from either division funds (Ghana and Guatemala), the faculty member with whom they are traveling, the resident, or the organization they are traveling with.
Gender Affirming Surgery
- The Division of Plastic Surgery performs Gender Affirming Surgery (GAS) as part of the University of Utah’s Transgender Health Program. The surgeries offered include masculinizing chest surgery, breast augmentation, vaginoplasty, metoidioplasty, phalloplasty, body contouring, and facial feminization. During a number of your rotations, specifically with Dr. Cori Agarwal, Dr. Courtney Crombie, Dr. Isak Goodwin, Dr. Dana Johns, and Dr. Erinn Kim you will be caring for these patients. If you are not planning to participate in these surgeries, please discuss this with the Program Director know and they will rearrange your operative schedule accordingly. You will still be expected to care for the patients before and after surgery
In-Service Policy
- Every resident will take the Plastic Surgery In-Service exam each spring. Residents are expected to score above the 35th percentile compared to PGY level peers in the same training track. If a resident does not meet this minimum requirement the resident informal remediation will take place. The resident will be required to meet with the program director and devise a plan for improvement. The resident will then be required to take a full make up exam four months later to show that the plan has worked. If the following year the resident is still unable to score above the 35th percentile then formal remediation will occur. If the resident fails to meet the minimum of 35th percentile three years in a row, the resident will be put on academic probation. In addition, if the resident scores below the 35th percentile in their 4th and/or 5th year of training they will not be allowed to attend a foreign trip that following year
- In the final three years of training, for each year that a resident scores in the 80th percentile or higher, compared to PGY level peers in the same training track, the Division of Plastic Surgery will contribute 20% of the written board examination fee to the resident.
- The night before the exam, all residents will be excused from clinical duties starting at 8:00 pm. The microsurgery fellow will take call on the night of the in-service exam. On the day of the exam, the Division APCs will carry the residents’ pagers and manage or refer all calls appropriately.
Performance Standards
- Residents are sent the goals and objectives for each rotation prior to the rotation starting. Those goals and objectives are reviewed with them during the rotation. Resident performance is based on whether the resident meets the criteria outlined in goals and objectives for that rotation.
Clinical Evaluation
- For each rotation, the resident has an evaluation completed by the faculty member they interact with. In addition, residents are evaluated by administrative staff and nursing staff throughout the year.
- These evaluations are completed electronically and are compiled by the Medhub system.
- The program director has access to these evaluations and any significant issues identified are addressed with the resident.
- The resident also has access to these evaluations and has the ability to question the validity if he/she disagrees with it. Significant issues that require formal intervention because of disagreement will be managed though the Program Director’s office.
- More details regarding this are in the Standards of Performance and Evaluation Policy.
In-Service Exam
- The In-Service Exam is used as part of the overall evaluation of the resident. It is a mandatory exam. Every resident is expected to score above the 50th percentile. Residents who score below the 35th percentile will be placed into a remediation program.
- More details regarding this are in the In-Service Policy.
Semi-Annual Evaluations
- Residents will have their performance evaluated semi-annually by the Plastic Surgery Clinical Competency Committee. The PS CCC will discuss each resident based on milestones and a report of the resident’s performance will be generated.
- These reports will be discussed with each resident.
- The program director and associate program director meet with each resident individually semi-annually to discuss all of their evaluations, other performance factors, and review the residents individual learning plan.
- More details regarding this are in the Standards of Performance and Evaluation Policy.
Addressing Performance Issues
- The Graduate Medical Education Committee has a policy section available for review. More details and the steps regarding this are in the GME Institutional policies.
Yearly Evaluations
- Every resident will have a yearly evaluation done prior to last day of February. This is similar to semi-annual evaluations and all of the issues addressed above can be implemented.
- Additionally, this is a retention meeting. Each resident will either be retained in the program or his/her contract will not be renewed.
- A contract non-renewal does not have to be preceded by a Letter of Concern or by Probation.
- The resident will be notified as to the reason for the contract non-renewal.
- More details regarding this are in the Standards of Performance and Evaluation Policy.
ROTATION INFORMATION
The goal of each rotation is to provide satisfactory clinical material and educational supervision to allow residents to make appropriate preoperative assessment, become proficient in intraoperative technique, and learn appropriate postoperative care in both inpatient and outpatient settings. Ethical and moral principles as well as billing procedures are discussed on all rotations. For the integrated program, rotations in the first two years will provide residents with a broad training in general surgical principles. Rotations will include general surgery, ENT, orthopedics, ophthalmology, dermatology, burn and plastic surgery. The final four years will be focused on plastic surgery and rotations will be as listed below.
University of Utah Medical Center
- During this rotation, the residents are exposed to a wide variety of clinical cases. Cases are performed in both the outpatient and inpatient setting. They are expected to learn head and neck, trunk, and extremity anatomy with an emphasis on hand anatomy. Clinical areas stressed on this rotation are head and neck trauma, breast reconstruction and aesthetic breast surgery, hand surgery, including elective and traumatic reconstruction and post-operative therapy, pressure sore care, extremity reconstruction, cutaneous malignancies, microsurgery, and aesthetic surgery.
- Residents should learn appropriate anatomy, be able to diagnose properly, become technically proficient in surgical care, know the various options for treatment, and learn appropriate post-operative care. During this rotation, resuscitative and surgical burn care should be learned.
Primary Children's Medical Center
- This rotation provides a complete education in congenital, craniofacial, and pediatric plastic surgery. The objectives are diagnosis and treatment of congenital and craniofacial disorders as well as care for pediatric diseases stressing aesthetics, fracture management, and tissue coverage. Residents should learn how to communicate with both the patient and the family members. Diagnosis and treatment of congenital hand anomalies should be learned.
Veteran's Administration Medical Center
- Residents have a dedicated VA rotation. A broad spectrum of procedures and disease are encountered during this rotation. Head and neck anatomy and disease and treatment should also be learned. Otherwise, objectives are the same as for the University of Utah Medical Center rotation.
STRUCTURE
Clinical and Educational work hours are defined as time spent on all clinical and educational activities related to the residency or fellowship program. This includes patient care, administrative duties related to patient care, provision for transfer of patient care, time spent in-house during call activities, time spent on patient care activities while on at-home call, moonlighting activities (moonlighting is not allowed)., and scheduled educational activities such as conferences. Work hours do not include reading and preparation time spent away from the duty site.
A. Maximum Hours of Clinical and Educational Work per Week
- Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting (moonlighting is not allowed).
B. Mandatory Time Free of Clinical Work and Education
- Programs must design an effective program structure that is configured to provide residents with educational opportunities, as well as reasonable opportunities for rest and personal well-being.
- Residents should have eight hours off between scheduled clinical work and educational periods. In certain circumstances, residents may choose to stay to care for their patients or return to the hospital with fewer than eight hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements.
- Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
- Residents must be scheduled for a minimum of one day in seven free of clinical work and required education, when averaged over four weeks. At-home call cannot be assigned on these free days.
C. Maximum Clinical Work and Education Period Length
- Clinical and education work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.
- Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. Additional patient care responsibilities must not be assigned to a resident during this time.
D. Clinical and Educational Work Hour Exceptions
- After handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances:
- To continue to provide care to a single severely ill or unstable patient.
- Humanistic attention to the needs of a patient or family, or
- To attend unique educational events.
- These additional hours of care or education will be counted toward the 80-hour weekly limit.
E. Moonlighting
- The Division of Plastic Surgery prohibits moonlighting.
F. In-House Night Float
- Night float must occur within the context of the 80-hour and one day-off-in-seven requirements.
G. Residents must not have more than four consecutive weeks of night float assignment, and night float must not exceed one month per year. ( Maximum In-House On-Call Frequency
H. Residents must be scheduled for in-house call no more frequently than every third night (when averaged over a four-week period). The Division of Plastic Surgery does not have in house call outside of night float. At-Home Call
- Time spent on patient care activities by residents on at-home call must count toward the 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks.
- At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.
- Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient care must be included in the 80-hour maximum weekly limit.
Failure to comply with these any of the above rules will result in the following:
- First offense will result in informal remediation
- Second offense will result in formal remediation
- Third offense will result in probation (final warning)
- Fourth offense will result in non-renewal of contract or dismissal
Senior residents have the opportunity to participate in their own resident cosmetic clinic. Residents will meet with patients for an initial consultation to discuss the patient's concerns, take pre-operative photographs for surgical planning, and discuss estimated fees for the surgery. Each case will then be presented to a faculty member, who will serve as the primary staff and advisor. Residents perform the procedure, and then meet with the patient for a follow-up consultation to ensure professional and quality post-operative care.
Procedures and Treatments: The clinic offers a wide variety of procedures that involve both non-surgical (Botox and fillers) and surgical methods, using the most up-to-date techniques.
Face: Reconstructive
- Eyelid lift (Blepharoplasty)
- Brow lift
- Ear pinning (Otoplasty)
- Nose job (Rhinoplasty)
Face: Cosmetic
- Botox
- Facelift, mid-facelift & necklift
- Fillers & fat injections
- Laser facial resurfacing
Breast:
- Breast augmentation
- Breast lift (mastoplexy)
- Breast reduction
- Gynecomastia
Body Contouring
- Tummy tuck (Abdominoplasty)
- Arm tuck (Brachioplasty)
- Liposuction
- Lower body lift (Circumferential abdominoplasty)
- Labiaplasty
- Thigh lift
PROGRAM APPLICATION
Independent applicants apply and match through the San Francisco Match. Integrated applicants apply through PSCA and match through NRMP.
CONNECT WITH US
Program Director
Program Coordinator
Kallie Handy, C-TAGME
Email: kallie.handy@hsc.utah.edu
Phone: 801-581-8419
