Commentary on: Plastic Surgery Resident-Run Cosmetic Clinics: A Survey of Current Practices

Commentary on: Plastic Surgery Resident-Run Cosmetic Clinics: A Survey of Current Practices In their survey study, Ingargiola et al describe the current state of affairs of resident cosmetic clinics (RCC) through the perspective of program directors.1 Specifically, structure, procedures offered, finances, and perceived benefit of the clinic were examined. Nearly 75% of program directors responded to the survey and around 60% of respondents endorsed having a RCC. While one may view the cup as more than half full, the reality is that around 40% of programs continue to not have a RCC. This has not changed much over the period of time that such clinics have been studied in the plastic surgery literature. Indeed, a RCC is by no means the only venue or modality for resident aesthetic surgery education. Currently, no RCC experience is sufficient for achieving the required minimums in aesthetic procedures to graduate from an accredited training program. But, the absence of a RCC at 40% of programs, begs the question of what barriers exist that may prevent them from having a RCC? If the goal of aesthetic surgery education is to improve learning opportunities for residents to be prepared to enter clinical practice, there needs to be less variability in residents’ access to such clinics. We and others have described experiences with a RCC and its safety and outcomes.2,3 Others have also published on this topic in our prestigious Journal, highlighting the importance of resident aesthetic education in our field.4 Barriers have been looked at in the past and include a lack of institutional support, liability concerns, lack of trained aesthetic surgery faculty, and most concerning of all, perceived lack of educational value on the part of program directors.3 We would like to congratulate the 60% of programs that have seen the educational value of such a clinic to complement their aesthetic surgery education. This involves on the part of the institution not only emotional and philosophical investment, but also financial investment. However, if disparities and variability in aesthetic surgery education are to be reduced, as a field, we need to examine programs who seem be doing things better and apply those to programs that need help. Having 100% of programs with a RCC is not the ultimate goal or final benchmark of success. But, with the perceived benefits of such a clinic being well known, it is a start to standardizing components of resident aesthetic education.4 From our assessment of the present study and the literature on resident aesthetic education, there are a few take-home messages that can help elevate the standard of education across programs: Programs must acknowledge a commitment to aesthetic surgery education similar to that of other subspecialities of plastic surgery as highlighted by the American Council of Graduate Medical Education (ACGME) changes to aesthetic surgery minimums. This requires full time or part time aesthetic surgery faculty who are committed to the mission of training the next generation of leaders in plastic surgery. This also requires trained aesthetic surgeons to “give back” and invest their time and effort in educating trainees. A dedicated aesthetic surgery experience that includes a resident cosmetic clinic is one way to improve aesthetic education. Such a clinic allows for graduated clinical responsibility with evaluation, diagnosis, treatment, management of complications, and critical appraisal of outcomes. Other modalities like attendance at ASAPS-endorsed meetings, use of the RADAR application, hosting ASAPS traveling professors and online educational modules are other invaluable ways to enhance education. Residents will benefit from exposure to nonsurgical aesthetic procedures. This includes exposure to neurotoxin, fillers, laser, and nonsurgical body contouring. The principles learned from these treatment modalities can complement learning in other areas such as congenital anomalies and burn reconstruction, for example. There is a financial cost to the institutions that support such a clinic. This includes physical space, possible advertising, opportunity cost on the part of the supervising surgeon, and administrative costs to provide quotes, nursing care and counseling. A business plan and model can help programs that do not have one better delineate how such a RCC would fit within their division or department. More transparency on the economics of such clinics would potentially help reduce the economic barriers to establishing a RCC. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Ingargiola MJ , Burbano FM , Yao A , et al. Plastic surgery resident-run cosmetic clinics: a survey of current practices . Aesthet Surg J . 2018 . doi: 10.1093/asj/sjy065 . [Epub ahead of print] 2. Qureshi AA , Parikh RP , Myckatyn TM , Tenenbaum MM . Resident cosmetic clinic: practice patterns, safety, and outcomes at an academic plastic surgery institution . Aesthet Surg J . 2016 ; 36 ( 9 ): NP273 - NP280 . Google Scholar CrossRef Search ADS PubMed 3. Koulaxouzidis G , Momeni A , Simunovic F , Lampert F , Bannasch H , Stark GB . Aesthetic surgery performed by plastic surgery residents: an analysis of safety and patient satisfaction . Ann Plast Surg . 2014 ; 73 ( 6 ): 696 - 700 . Google Scholar CrossRef Search ADS PubMed 4. Weissler JM , Carney MJ , Yan C , Percec I . The value of a resident aesthetic clinic: a 7-year institutional review and survey of the chief resident experience . Aesthet Surg J . 2017 ; 37 ( 10 ): 1188 - 1198 . Google Scholar CrossRef Search ADS PubMed © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Aesthetic Surgery Journal Oxford University Press

Commentary on: Plastic Surgery Resident-Run Cosmetic Clinics: A Survey of Current Practices

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Publisher
Mosby Inc.
Copyright
© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com
ISSN
1090-820X
eISSN
1527-330X
D.O.I.
10.1093/asj/sjy072
Publisher site
See Article on Publisher Site

Abstract

In their survey study, Ingargiola et al describe the current state of affairs of resident cosmetic clinics (RCC) through the perspective of program directors.1 Specifically, structure, procedures offered, finances, and perceived benefit of the clinic were examined. Nearly 75% of program directors responded to the survey and around 60% of respondents endorsed having a RCC. While one may view the cup as more than half full, the reality is that around 40% of programs continue to not have a RCC. This has not changed much over the period of time that such clinics have been studied in the plastic surgery literature. Indeed, a RCC is by no means the only venue or modality for resident aesthetic surgery education. Currently, no RCC experience is sufficient for achieving the required minimums in aesthetic procedures to graduate from an accredited training program. But, the absence of a RCC at 40% of programs, begs the question of what barriers exist that may prevent them from having a RCC? If the goal of aesthetic surgery education is to improve learning opportunities for residents to be prepared to enter clinical practice, there needs to be less variability in residents’ access to such clinics. We and others have described experiences with a RCC and its safety and outcomes.2,3 Others have also published on this topic in our prestigious Journal, highlighting the importance of resident aesthetic education in our field.4 Barriers have been looked at in the past and include a lack of institutional support, liability concerns, lack of trained aesthetic surgery faculty, and most concerning of all, perceived lack of educational value on the part of program directors.3 We would like to congratulate the 60% of programs that have seen the educational value of such a clinic to complement their aesthetic surgery education. This involves on the part of the institution not only emotional and philosophical investment, but also financial investment. However, if disparities and variability in aesthetic surgery education are to be reduced, as a field, we need to examine programs who seem be doing things better and apply those to programs that need help. Having 100% of programs with a RCC is not the ultimate goal or final benchmark of success. But, with the perceived benefits of such a clinic being well known, it is a start to standardizing components of resident aesthetic education.4 From our assessment of the present study and the literature on resident aesthetic education, there are a few take-home messages that can help elevate the standard of education across programs: Programs must acknowledge a commitment to aesthetic surgery education similar to that of other subspecialities of plastic surgery as highlighted by the American Council of Graduate Medical Education (ACGME) changes to aesthetic surgery minimums. This requires full time or part time aesthetic surgery faculty who are committed to the mission of training the next generation of leaders in plastic surgery. This also requires trained aesthetic surgeons to “give back” and invest their time and effort in educating trainees. A dedicated aesthetic surgery experience that includes a resident cosmetic clinic is one way to improve aesthetic education. Such a clinic allows for graduated clinical responsibility with evaluation, diagnosis, treatment, management of complications, and critical appraisal of outcomes. Other modalities like attendance at ASAPS-endorsed meetings, use of the RADAR application, hosting ASAPS traveling professors and online educational modules are other invaluable ways to enhance education. Residents will benefit from exposure to nonsurgical aesthetic procedures. This includes exposure to neurotoxin, fillers, laser, and nonsurgical body contouring. The principles learned from these treatment modalities can complement learning in other areas such as congenital anomalies and burn reconstruction, for example. There is a financial cost to the institutions that support such a clinic. This includes physical space, possible advertising, opportunity cost on the part of the supervising surgeon, and administrative costs to provide quotes, nursing care and counseling. A business plan and model can help programs that do not have one better delineate how such a RCC would fit within their division or department. More transparency on the economics of such clinics would potentially help reduce the economic barriers to establishing a RCC. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Ingargiola MJ , Burbano FM , Yao A , et al. Plastic surgery resident-run cosmetic clinics: a survey of current practices . Aesthet Surg J . 2018 . doi: 10.1093/asj/sjy065 . [Epub ahead of print] 2. Qureshi AA , Parikh RP , Myckatyn TM , Tenenbaum MM . Resident cosmetic clinic: practice patterns, safety, and outcomes at an academic plastic surgery institution . Aesthet Surg J . 2016 ; 36 ( 9 ): NP273 - NP280 . Google Scholar CrossRef Search ADS PubMed 3. Koulaxouzidis G , Momeni A , Simunovic F , Lampert F , Bannasch H , Stark GB . Aesthetic surgery performed by plastic surgery residents: an analysis of safety and patient satisfaction . Ann Plast Surg . 2014 ; 73 ( 6 ): 696 - 700 . Google Scholar CrossRef Search ADS PubMed 4. Weissler JM , Carney MJ , Yan C , Percec I . The value of a resident aesthetic clinic: a 7-year institutional review and survey of the chief resident experience . Aesthet Surg J . 2017 ; 37 ( 10 ): 1188 - 1198 . Google Scholar CrossRef Search ADS PubMed © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Aesthetic Surgery JournalOxford University Press

Published: May 14, 2018

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