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Electives - Plastic Surgery

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ACE  - Plastic Surgery Preceptorship A. I.

Elective Number: 2608

Rotation Supervisor: Dr. David B. Drake

Designated Signer: Freda McClung; Old Medical School, North wing, room 4711; 924-1234, fm3s@virginia.edu

Duration: Maximum 4 weeks, Minimum 2 weeks

Available: Rotations 3, 4, 5, 6, 7, 8, 9, 10, 11

Report to: Dr. Drake

Time to Report: 7:15 am

Place to Report: OPSC in Battle building

Typical day: 6:00 am - 6:00 pm

A pager is required for this rotation but is not supplied by the department

Attendance: A student may not take time off during an ACE.

Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Number of students per rotation: 1

Course Description: This Plastic Surgery rotation entails exposure to all aspects of Plastic Surgery. Clinic exposure, operative experience both inpatient and outpatient, and inpatient patient management are aspects of the rotation. During your rotation you will be evaluated regarding your patient care, medical knowledge, practiced based learning, interpersonal and communication skills, professionalism, and your ability to work with a multidisciplinary burn team and within the resources of a tertiary health care system. The following are basic science and clinical objectives for the rotation.

Basic Science Objectives
1. Study the molecular, biochemical, and physiologic basis of wound healing.

2. Review the detailed anatomy of the upper extremity and hand, the maxillofacial area, and facial soft tissues.

3. Study the basic physiology of free tissue grafts and pedicle tissue transfer including the classifications of flaps and appropriate related nomenclature. Review pathophysiology and indications for hyperbaric oxygen therapy.

4. Participate in anatomy review and plastic surgery flap dissection (cadaver) workshop sessions.

5. Study the physiology of tissue transfer including concepts related to flap failure and salvage, the delay phenomena, repercussion injury and no-reflow phenomena.

6. Study concepts of flap design, geometry and flap movement

7. Study the use of biomaterials in plastic surgery as well as grafting of such tissues as fat and cartilage, and their biochemical properties

8. Explore the psychologic concepts of body image and its relation to reconstructive and aesthetic surgery.

9. Review the physiological ramifications of burns and burn surgery.

Clinical Objectives

1. Demonstrate an understanding of the analysis of specific patient problems addressing loss of form and function.

2. The student will become aware of the Plastic Surgeon’s role in the multidisciplinary (or “team”) approach to:
a. major tumor surgery
b. management of difficult wounds and patient rehabilitation
c. prioritization of reconstructive surgery in the polytrauma patient
d. burn resuscitation and surgery
e. hand surgery
f. breast oncology and reconstruction

3. The student will understand basic techniques for handling of soft tissue including wound management and debridement and soft tissue repair.

4. The student will study surgical and nonsurgical management of skin lesions including skin cancers and premalignant lesions.

5. Demonstrate further understanding of:
a. staging and prioritization of procedures in complex reconstructive cases
b. improved ability to suggest and weight viable options for reconstruction of major defects
c. “donor site” morbidity

6. Obtain an understanding of the criteria for replantation surgery and extremity revascularization, as well as the basic preparation of the patient and the severed part for surgery or transfer.

7. The student will learn to perform a comprehensive examination of the hand and upper extremity.

8. The student will order and interpret appropriate imaging studies for hand trauma.

9. The student will monitor routine postoperative care for plastic surgery patients, both pediatric and adult.

10. The student will monitor postoperative circulation and viability in major flaps and free tissue transfers, and demonstrate knowledge of the early complications of these procedures.

11. The student will apply basic concepts of pressure management and wound care for large body surface wounds and defects.

12. The student will be expected to assist in:
a. major soft tissue reconstructive procedures
b. microvascular free tissue transfer
c. management of hand trauma
d. evaluate patients for possible hyperbaric oxygen therapy, discuss indications and contraindications

Relative to the six competencies, the educational goals of the service are as follows:

Practice-based Learning and Improvement
1. Review outcomes of Plastic Surgery patients with attending staff and fellows to discuss optimal strategies for improving current outcomes
2. Modify treatment protocols as indicated based on outcomes results of patients while on the service
3. Participate in daily rounds with the Plastic Surgery team in order to receive feedback and make appropriate changes in clinical performance based on feedback.

Interpersonal and Communication Skills
1. The service will require the student to communicate effectively to the supervising attending or fellow as well as the nursing and support staff to efficiently and optimally care for the Plastic Surgery patient.
2. Communication skills will be assessed by having the student effectively communicate with both teams to understand priorities and efficiently work as an integral part of both teams
3. Interpersonal skills will be strengthened through the appropriate interactions with family and patients on the Burn and Wound Care Center, as well as the interactions with the multi-discipline staff of the unit.
4. Written and verbal communication skills will be improved and more organized through reporting patient progress to supervising staff.
5. Communication with the patient’s family will improve the skills of interpersonal interaction and verbal communication of medical facts to the lay public

Professionalism
1. The student will be appropriately responsible to the ethical and behavioral issues involved in the care of patients with life-threatening injuries
2. Issues of patient confidentiality will be strictly respected
3. Demeanor and behavior will be consistent with the accepted professional behavior of a physician.

Systems-Based Practice
1. Due to the need for integration of a multi-discipline team for the care of the burn-injured patient, the student will learn his/her appropriate place within the team structure, and adopt appropriate interactive behavior and consultation within elements of the team
2. Patient protocols for burn-injured patients will be followed and an understanding of appropriate integration of many members of the health care team for burn-injured patients

Communication with consulting services will be on a daily or ongoing fashion as appropriate and directed.

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