1+5

[ghatz]

Wouldn't that be nice? If all PRS programs were 1+5 instead of 3+3? I was talking to a friend of mine in Canada and they do 1+4 which is even sweeter... **sigh**

Do you guys think 3+3 would make one more prepared or a better surgeon though? I doubt it would..

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[ItalianPlastics]

Wouldn't that be nice? If all PRS programs were 1+5 instead of 3+3? I was talking to a friend of mine in Canada and they do 1+4 which is even sweeter... **sigh**

Do you guys think 3+3 would make one more prepared or a better surgeon though? I doubt it would..

3 yrs of gen surg would definitely NOT make a better plastic surgeon!! the approach and focus is completely different....just as anyone who's done the independent model!!

And, there are a few 1+5 and 2+4 programs out there, you just have to look for them...

 

[ghatz]

3 yrs of gen surg would definitely NOT make a better plastic surgeon!! the approach and focus is completely different....just as anyone who's done the independent model!!

And, there are a few 1+5 and 2+4 programs out there, you just have to look for them...

I know that JHU/Maryland was supposed to go to a 1+5 model but I am not sure if that has actually happened.. Are you aware of others?

 

[ItalianPlastics]

UMich is basically a 1+5 (With a research year) as is Pitt

Georgetown and USF are 1.5+4.5

Wake is 2+4

I think UCI had a pretty good curriculum, but I don't really remember for sure.

Some programs list their curriculum online. You just have to search for it.

 

[maxheadroom]

Michigan is 1+5?? Really?? Last that I knew, they were still doing some General Surgery during their PGY-4 year!!

 

[igap]

Michigan is 1+5?? Really?? Last that I knew, they were still doing some General Surgery during their PGY-4 year!!

There is no general surgery in the pgy-4 year. There are 2 months of general surgery in the pgy-3 year and plastics from there on out. Actually, if you don't count the 2 months of trauma/burn, there's a total of 11 months of general surgery in the entire 7 year residency.

 

[ItalianPlastics]

There is no general surgery in the pgy-4 year. There are 2 months of general surgery in the pgy-3 year and plastics from there on out. Actually, if you don't count the 2 months of trauma/burn, there's a total of 11 months of general surgery in the entire 7 year residency.

http://surgery-graphics.med.umich.edu/~keithsm/plastic-new/education/residented.shtml

 

[PRS2009]

I know that JHU/Maryland was supposed to go to a 1+5 model but I am not sure if that has actually happened.. Are you aware of others?

JHU/maryland is now 1+5.

 

[maxheadroom]

Looks like Michigan has changed since I've talked to them. Glad to hear it. They used to spend half of their 4th year on Trauma/Burns. Yuck.

 

[skiz knot]

As more programs go to a model of 1-2 + whatever, more are certainly to follow in order to stay "desireable" to the best candidates. In my opinion that would be detrimental to PRS as a whole as there will be less spots available from those from other disciplines. The great thing about PRS is that people who have varying backgrounds (gsurg, ENT, ortho, etc) have all contributed immensely to the field as a whole. Without continued input from these other specialties, it could stifle innovation and decrease overall knowledge base in the field of PRS.

 

[ItalianPlastics]

Looks like Michigan has changed since I've talked to them. Glad to hear it. They used to spend half of their 4th year on Trauma/Burns. Yuck.

UMich has completely dropped doing any trauma in the 4th year. replaced it with more plastics, elective, and oculoplastics.

... In my opinion that would be detrimental to PRS as a whole...

I very strongly disagree. Why should you spend 3+ years in the abdomen to then never EVER open it up again? Why should you do laparoscopic or liver surgery (unless there's a liver flap I've never heard of...)

...as there will be less spots available from those from other disciplines. The great thing about PRS is that people who have varying backgrounds (gsurg, ENT, ortho, etc) have all contributed immensely to the field as a whole. Without continued input from these other specialties, it could stifle innovation and decrease overall knowledge base in the field of PRS.

I don't mean to sound insensitive, but people from those specialties should have done plastics if that's what they want to do. No one criticizes the other surgery specialties for just doing the gen surg intern year and then working solely in their respective fields, I don't see why plastics should be any different. It just makes more sense--the best way to learn plastic surgery is...doing plastics surgery! While rotating on other services might be theoretically interesting, it doesn't necessarily make you a better plastic surgeon (esp as when being off service means being relegated to floor/scut work and not necessarily performing the surgeries which defeats the purpose)

 

[droliver]

I very strongly disagree. Why should you spend 3+ years in the abdomen to then never EVER open it up again? Why should you do laparoscopic or liver surgery (unless there's a liver flap I've never heard of...)

....the best way to learn plastic surgery is...doing plastics surgery! While rotating on other services might be theoretically interesting, it doesn't necessarily make you a better plastic surgeon (esp as when being off service means being relegated to floor/scut work and not necessarily performing the surgeries which defeats the purpose)

I'm assuming this comment is from someone who isn't a practicing plastic surgeon or you'd know how foolish that statement is.

Plastic Surgery and general surgery have tremendous overlap, and many of the operations you perform in plastic surgery in vascular procedures, breast surgery, abdominal wall surgery, and burns/wound care are variations of traditional procedures. Particularly in oncology and reconstructive surgery, the perspective you gain from a general surgery experience is something lost in the integrated model.

As to who would ever have to "open up the abdomen" as a plastic surgeon, I would say ME for instance, who has had to do extensive intraperitoneal adhesiolysis procedures doing redo incisional ventral hernia repairs twice in the last week.

 

[maxheadroom]

As to who would ever have to "open up the abdomen" as a plastic surgeon, I would say ME for instance, who has had to do extensive intraperitoneal adhesiolysis procedures doing redo incisional ventral hernia repairs twice in the last week.

Surprise, Max disagrees with Ollie about training models . . .

In general, I like the fact that there are many routes to Plastics. (I think) John Persing wrote a nice editorial for the ABPS newsletter a couple of years ago in which he argued that Plastics benefits from having multiple perspectives in our specialty and I agree. The guys that I know who've trained in Ortho and ENT before Plastics bring some very different and useful experiences.

Ollie likes the way that he trained (as a fully trained General Surgeon). I like how I trained (as an Integrated resident). This is a common argument in lots of Plastics circles. From what I've heard about the movements within AACPS (in particular), the RRC, and the ABPS, there is a movement to spend more time in Plastics and less time in other disciplines, especially Gen Surg. Lots of this is due to the growing breadth of the field of Plastics and the perceived need for more intensive training in Plastics instead of other disciplines (hence all models transitioning to a mandated 3 years of Plastics instead of 2 years).

I feel comfortable in the abdomen, but I will never enter it without a General Surgeon being involved. I don't want to manage GI tract issues and (God forbid) a bowel injury that results in something like a fistula. Kudos to Ollie and his pals who are willing to do an LOA when they do a VHR. Maybe they're saving Blue Cross some money by doing it on their own, but I do those cases with a General Surgeon who gets the bowel free before I close. I think that's more reflective of the current practice in most places, but I have limited experience.

 

[rongeur]

Maybe they're saving Blue Cross some money by doing it on their own, but I do those cases with a General Surgeon who gets the bowel free before I close. I think that's more reflective of the current practice in most places, but I have limited experience.

That's how it is at my institution too. Even the GS boarded guys who could blast through adhesions won't touch it because it's a turf issue. Just like there's general surgeons who could do their own separations of parts, but they give them to plastics.

There's obviously value in spending time on anything. Residents would learn something if they spent a month on ob gyn. But the question is which month is actually going to give the most bang for the buck, and every other surgical specialty has decided that means maximizing the amount of time in that specialty. I think the main reason plastics isn't like those yet is because they're under the GS umbrella and GS doesn't want to lose the free manpower. Note that at places where plastics is a department they're usually minimal general surgery time.

 

[igap]

I very strongly disagree. Why should you spend 3+ years in the abdomen to then never EVER open it up again? Why should you do laparoscopic or liver surgery (unless there's a liver flap I've never heard of...)

I don't know at what stage in your training you are in, but this statement seems odd to me.

I train at a high volume academic center, and we get worked pretty hard. I spend a great deal of time doing replants, and perforator flaps, and craniofacial surgery. I can guarantee that I will never do a replant in my practice. I will also probably not do esoteric hand reanimation operations, and quite possibly (despite my sdn name) not do too many perforator flaps. I will never do craniosynostosis surgeries.

What will I do? All manner of reconstruction, hand soft tissue and fractures (we get outstanding hand training where I train), etc.

My point is, there is a ton of stuff in my plastic surgery residency I have to learn, but will never do. Does that mean these experiences are not worthwhile to have as your logic seems to suggest? I say no. I learn from every case I do, and every patient I manage.

General surgery has a ton of overlap with plastic surgery. Is a component separation any different because a plastic surgeon did it versus a general surgeon? There is more to general surgery than laparoscopy, and liver surgery. There is breast, soft tissue, vascular, etc. Plastic surgery is not the only field that covers a wide spectrum of operations and disease entities.

I marvel at the fact that plastic surgery encomapasses such a wide spectrum of surgical disease. In response to the statement "I don't mean to sound insensitive, but people from those specialties should have done plastics if that's what they want to do", I would say that the roots of plastic surgery reach into almost every surgical specialty because of a rich history of contributions from individuals with diverse training backgrounds. The notion that plastic surgery is somehow separate from all of the other fields is counterproductive to the evolution of the field. Kinda brings the analogy to mind of the establishment American looking down on recent immigrants. What makes plastic surgery so cool is that it is the surgical melting pot specialty, and the field is only as strong as the people in it. As such we ought to be open and accepting of all different backgrounds and perspectives.

 

[ItalianPlastics]

I'm not at all undermining the great things about our specialty that have come about through the different specialties. I think I wrote it down in the wrong way...I was just saying that I don't think that anything has been lost by focusing more on plastic surgery rather than requiring completing another training specialty and then applying for plastic surgery. The most important factor that swung me into plastics was the breadth of the field and the variety of the cases that we do. I didn't mean to step on any toes, and I know people who have done the traditional route are usually very grateful for the training they have received.

So, if you know you want to do plastics from med school, I don't think that you necessarily lose anything and I think you gain much more experience going straight into plastic surgery. Even on my general surgery rotations, I usually was trying to think about what I could take away for my future plastic surgery practice. I was reading as much PRS as I could and attending their conferences whenever possible. In this way, I think the integrated pathway is more complete as you have 6-7 years of being (in theory, if not always in practice) a plastic surgeon rather than the 2, well...now 3 years in the traditional route.