Aesthetics Training in Plastic Surgery: A Systematic Review on the Implementation and Perceived Educational Value of Resident Aesthetic Clinics
Jonlin Chen, BS, Erica Lee, BS, Leen el Eter, BS, Carisa Cooney, MPH, Kristen Broderick, MD.
Johns Hopkins School of Medicine, Baltimore, MD, USA.
BACKGROUND Resident aesthetic clinics (RACs) have emerged as means to provide plastic surgery residents with aesthetic surgery training. The implementation of a successful RAC can be challenging given the changing demands for aesthetic services, need for financial stability, and evolving requirements of the ACGME’s Next Accreditation System. Several studies have reported that RACs improve resident training while offering successful patient outcomes, but few have evaluated the link between clinic structure and perceived educational value. This systematic review sought to identify best practices in existing RACs to maximize sustainability and educational value for residents.
METHODS A literature search was conducted through PubMed, Embase, and Web of Science to identify all articles published before April 2020 that reported the use of RACs in plastic surgery residency training. Articles written in English that included information on RAC structure and educational value were included in the analysis. Clinic structure (e.g. volume, location, cost, clinic operations) and perceived educational value (e.g. resident satisfaction, confidence in procedures) were assessed.
RESULTS Of 1199 identified publications, 11 met inclusion criteria: 4 multi-institutional national survey studies, 3 single-site retrospective chart reviews, and 4 single-site studies combining resident surveys and retrospective chart reviews. Of the single-site studies, RACs were located in a range of city sizes from smaller populations (e.g. Winston-Salem, NC) to larger populations (e.g. Philadelphia, PA). Graduating chief resident size ranged 1-6 residents/year. Annual patient volume ranged 25-160 patients/year. Annual case volume ranged 22-80.5 cases/year, with the majority being breast and abdomen cases. Clinics were staffed by full-time faculty (100%), adjunct faculty (16.7%), and community faculty (33.3%). Clinic operations and procedure set-up varied according to several resident factors: hours in clinic (0.5 vs. 1.0 days/week for final 1-2 years versus throughout training), postgraduate year (junior versus senior), and autonomy (attending as assistant, two chief residents, or resident as assistant). Multi-site studies reported residents perceived RACs having positive effects on their training, with greater confidence in performing breast and body contouring procedures than facial cosmetic procedures. Critical challenges included financial viability, continuity of care, and maintaining positive relationships with community plastic surgeons.
CONCLUSIONS RACs are increasingly important for providing plastic surgery residents with aesthetic training. Implementation variables including patient and case volume, degree of resident autonomy, and clinic staffing are critical determinants of the sustainability and value of RACs. By better understanding RAC practice patterns, programs can best identify implementation methods that will fit their training paradigm and culture.
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