Plastic Surgery Resident Responsibilities

The specific clinical areas listed in the program requirements consist of the congenital defects of the head and neck including cleft lips and palate and craniofacial surgery, neoplasms of the head & neck include oral pharynx and education.
Craniomaxillofacial trauma, aesthetic surgery, plastic surgery of the breast, surgery of the hand and upper extremities, plastic surgery of the lower extremities, plastic surgery of congenital and acquired defects of the trunk and genitalia, burn management, acute and reconstructive, microsurgical techniques applicable to plastic surgery, reconstructive by tissue transfer including flaps and grafts and surgery of benign and malignant lesions of the skin and soft tissues. The congenital defects of the head & neck including lips and palates and craniofacial surgery experience are gained in two venues.
We have a congenital head & neck anomalies clinic that is held on a first two Monday afternoon of each month. This clinic is a multi-disciplinary clinic that has other sub-specialties such as orthodontics, oral surgery, ENT, genetics, speech therapy as well as a representative from the Division for Specialized Care for Children.

All of the residents are expected to attend this clinic and their other responsibilities are waved. The clinic will see a number of cleft lip and palate patients both in the acute and chronic setting.

Residents gain experience in the evaluation, pre-operative assessment and post-operative assessment of these patients in this clinic. Other clinics assessed here include any congenital head & neck anomaly, include Apron syndrome, Treachers Collins, Saetler-Shotzer to name a few. The overall management of the patients is reviewed in a conference subsequent to the clinic so that all of the disciplines can coordinate timing of the various elements of the patients care. Over the last number of years the number of cleft lip & palate and secondary procedures performed on cleft lip & palate patients has decreased.

In order to keep the appropriate numbers for the resident surgical experience, we have recently sent the residents to the Chicago Children's Hospital under the guidance of Dr. Bruce Bauer and pediatric plastic surgeon. At this institute, the residents gain further experience with cleft lips & palates and other congenital disorders in pediatric plastic surgery.. Residents in their fifth year of training will spend six-weeks in Chicago getting experience in this field.

Residents obtain experience with neoplasm of the head & neck and oral pharynx through the regular rotations with each of the attendings. Minor basal cell, squamous cell, and melanomas on the head & neck region are evaluated and treated by each of the attendings. The latest PSOL data collection illustrates the numbers obtained by the residents in this field. Complex craniofacial tumor management is done more often in conjunction with otolaryngology.

The resection of the tumor is performed by the otolaryngology service and the reconstruction with various local, regional flaps, or free tissue transfers are performed by the plastic surgery service most notably by Dr's. Wilhelmi, Neumeister, Russell and Brown with their microsurgical expertise. Each of the rotations with the attendings provide experience with aesthetic surgery, the head & neck, surgery of the breast, and plastic surgery of congenital, acquired defects of the trunk and urogential system.
Each of the plastic surgeons are involved in resident training. Dr's Neumeister, Wilhelmi, Brown & Russell have a further expertise in hand and upper extremity. The residents that rotate through these services obtain an enormous amount of hand and upper extremity experience. All of the residents obtain their experience with craniomaxillofacial trauma including fractures through the on call schedule. Craniomaxillofacial trauma is divided between Oral Surgery, Plastic Surgery and Otolaryngology services.

The residents are expected to take part in the pre-operative, intra-operative and post-operative care of patients with craniomaxillofacial trauma with oral surgeons and plastic surgeons. Call schedule for craniomaxillofacial surgery is such that every other day plastic surgery sees this trauma and on the off days otolaryngology sees this trauma. Oral surgery is responsible for all mandible fractures. Plastic surgery and otolaryngology are responsible for all fractures of the face above the mandible.
Residents are responsible for the assessment of patients pre-operatively in the clinics. All clinics are supervised by the attending surgeon who reviews the pre-operative assessment and evaluates each patient with the resident.

The post-operative care is managed in a similar fashion. All procedures are performed in attendance with the faculty or community surgeons and direct guidance and supervision is provided by the attending surgeon present during the case. Cases that are seen in the emergency room by the residents or on the wards in the post-operative period are supervised by the responsible attending. The attendings are expected to discuss ward patients with the residents on a daily basis.

The residents have a graduated experience with progressive patient management responsibilities. The more junior residents are mentored and supervised by the chief and senior residents as well as the attendings. Off-service residents are mentored and supervised in a similar fashion. Although in attendance through each of the procedures, the chief residents acts either as the primary surgeons or the assistant for the junior residents and it is through this means that the graduated experience is obtained. A greater responsibility of patient management and patient care is given to the residents as they progress though the years of training. The residents progress in this fashion is evaluated in the bi-annual formal evaluation by all of the faculty to make sure that the resident is progressing in an appropriate fashion.

Residents in all training programs of SIU School of Medicine are required to assume the following responsibilities:

1. Develop a personal program of self-study and professional growth with guidance from the teaching staff.
2. Participate in effective, and compassionate patient care, under supervision, commensurate with his/her level of ability and responsibility.
3. Participate fully in the education and scholarly activities of their program including the teaching and supervising of medical students and residents of a more junior level.
4. Participate in institutional programs and activities involving the medical staff and adhere to established practices, procedures, and policies of the institution.
5. Participate in institutional committees and councils, especially those that relate to patient care review activities.
6. Participate in evaluation of the quality of education provided by the program.
7. Develop an understanding of how to apply cost containment measures in the provision of patient care.

Additional responsibilities specific to the plastic surgery residency program include the following:

a. Complete medical records in an accurate and timely fashion with special reference to the dictation of operative reports.
b. Accurately and promptly report the operative experience (case records) using the ACGME web based format.
(This is the greatest importance to the ultimate qualifications of the resident for Board Certification and to the accreditation of the program by the Residency Review Committee.)
c. Attend on a regular basis Surgical Grand Rounds.
d. Attend all Core Curriculum, Journal Club, Morbidity and Mortality, Combined Hand, Photo, Conferences and any additional educational conferences provided. Participate fully in the teaching rounds and other educational activities.
e. Establish and maintain a program of self-study appropriate to individual needs.
f. Protect oneself and ones' patients by consistently and conscientiously observing universal precautions and other infection control measures, including any required immunization against hepatitis B. Consider inoculations for influenza in the fall of each year.
g. Participate annually in the PSEF Plastic Surgery In-Service Examination.