Overview of Rotation Educational Objectives

PGY-3-4Section of Plastic SurgeryOverview for PGY-3, 4 and 5Apart from two blocks of electives, the entire PGY-3 and PGY-4 years are spent on plastic surgeryrotation at the three adult hospitals and the Children’s Hospital. The past years have seen a shifttowards more time being spent at the Peter Lougheed Centre (PLC), Rockyview General Hospital (RGH),and Alberta Children’s Hospital (ACH). Although the residents still spend more at the Foothills MedicalCentre (FMC) than any other site.Through these rotations, residents obtain exposure to the domains of hand, trunk, lower extremity,craniofacial, breast, head and neck, burn, paediatric, aesthetic and microsurgery. Although certain siteswill have a concentration of expertise in a certain field, we feel strict compartmentalization of theresidency into brief rotations with a narrow focus is less effective that a broad, longitudinal exposure.PGY-5The PHY-5 year consists of rotations at the adult and paediatric sites a swell as a cosmetic surgeryrotation.The emphasis on this chief year is to prepare the resident to become a competent staff surgeon and topass the fellowship program in Plastic Surgery. The resident takes primarily second call during the yearwithin a 6-week period prior to the exams in the spring during which the resident has no on-callresponsibilities.The chief resident is responsible for running the services, including organizing the resident rounds.During the months leading up to the exam, many of the duties are shared with the PGY-4 residents.

Rotation Specific ObjectivesPlastic Surgery ResidentsPGY-3, 4 and 5The residents PGY 3 – 5 years consist of rotations at the three adult hospitals (FMC, PLC,and RGH), the ACH, private surgical centres, and elective time.At these sites, the residents gain exposure to the broad spectrum of plastic surgerydisciplines, including hand surgery, burn surgery, breast surgery, craniofacial surgery,microsurgery, head and neck reconstruction, cosmetic surgery, and pediatric surgery.Our program is one of a small number of Canadian Residency Training Program allowsthis breadth of exposure.Because the residents will see a variety of subspecialty surgery at each rotation,assigning rotation specific objectives is somewhat arbitrary; For example, residents willsee hand surgery and breast surgery at each adult site they rotate through as these arestaples of almost every plastic surgeon’s practice.Although this makes designating rotation specific objectives more difficult, we feel thisbroad exposure over several years is the best way to become expert in the diversespecialty of plastic surgery.With this in mind, the following objectives are not “all-inclusive”, but rather reflectpractices with the tendency for certain subspecialties to be more prevalent at each site.1

Foothills Medical Centre (FMC)The residents spend more time at the Foothills Medical Centre than any other site. Theyhave rotations in their R1, R3, R4, R5 years.The majority of the resident’s exposure to multi-trauma, burn surgery, craniofacialsurgery, head and neck reconstruction, and microsurgery is obtained at the FoothillsMedical Centre.Rockyview General Hospital (RGH)The Rockyview General Hospital offers an exposure to more of a community-type plasticsurgical practice. Although complex, multidisciplinary procedures are not uncommon,the emphasis is on elective surgery of the hand and breast and body contouring, andaesthetic facial surgery.Peter Lougheed Centre (PLC)The Peter Lougheed Centre has increasingly become the focal point for reconstructionof the upper and lower extremity. In addition, surgery of the breast, body contouring,and aesthetic surgery are represented.Alberta Children’s Hospital (ACH)The Alberta Children’s Hospital isPrivate ClinicsA concentrated exposure to aesthetic surgery is obtained during the resident’s finalyear.2

Rotation Educational ObjectivesFoothills Medical Centre - Burn UnitMEDICAL EXPERTKnowledgeThe physician shall attain a working knowledge of …..PGY- 3-41. Pathophysiology of the burn wound2. Mechanism of development of burn shock3. Understanding of resuscitation of burn shock4. Understanding of complications of fluid resuscitation including limb andabdominal compartment syndrome, pulmonary edema, and airway compromise.5. Indications for airway protection/prophylactic intubation of a burn patient, andthe pathophysiology and clinical management of smoke inhalation injury, COpoisoning, and HCN poisoning.6. Understanding of indications escharotomy for both trunk and the limbs.7. Understanding of indications for and approach to surgical decision makingsurrounding early excision and closure of the burn wound, for both minor andmajor injuries.8. Understanding of the role of nutritional support and metabolic alterations in theburn patient.9. Understanding of the role and use of topical antimicrobials and dressings forburn wounds.10. Understanding of complications and management of complications associatedwith significant burn injury, specifically sepsis and ARDS.11. Understanding of ventilation modalities for burn patients including protectiveconventional ventilation, high-frequency percussive ventilation, and highfrequencyoscillatory ventilation.12. Understanding of the indications for and use of skin substitutes.13. Understanding of approach to chemical and electrical burns, and specificconsiderations in these specialized burn injuries.14. Understanding of burn centre approach to management of severe exfoliativedisorders such as Toxic Epidermal Necrolysis.15. Understanding of the pathophysiology of scar and hypertrophic scar formation,and the modalities used in conjunction with the burn Rehabilitation Therapist tocontrol hypertrophic scar formation.16. Understanding of the rationale behind splinting in the burn patient, andknowledge of correct positioning and splinting for the burn patient in the acute,perioperative and late (rehabilitation) phases.17. Understanding of approach to analgesia in burn patients including opioid andnonopiod modalities.3

PGY-51. Understanding of the management of burns to the hand, including nonoperativemeasures (elevation, splinting, wound care, mobilization, analgesia),operative indications and techniques, and post-operative care.2. Understand management of burns to the face, ears and neck, including nonoperativemeasures, surgical approach/decision making surrounding excisionand closure, use of aesthetic units concept, post operative care.Clinical SkillsThe physician shall show competency with respect to…..PGY- 3-41. Performance of a thorough history from a burn patient including mechanism ofinjury, factors relevant to the airway and possibility of smoke inhalation injury,timing of injury, specialized considerations in chemical and electrical burns,considerations to pre-injury medical and socio-economic status and theirrelevance to the burn injury.2. Completion of thorough medical records and progress notes pertaining to 1, andcompletion of a burn diagram or Lund/Browder diagram.3. Completion of a thorough physical exam to include examination of the burnwound, diagnosing burn depth, examination of the airway, and the burnedextremities.4. Ability to approach all burn patients using the Advanced Burn Life Support (ABLS)approach to include a primary and secondary survey.5. Ability to complete admission orders for both minor and major burn injuries.6. Ability to function within the close working relationship of the burn team andwork effectively with nurses, PT, OT, social worker, nutritionist, pharmacist.PGY-51. Ability to council the patient and/or next of kin regarding the extent of apatient’s injury, probability of survival, potential complications, prognosis, andtreatment plan, in a professional and compassionate manner.Technical SkillsPGY- 3-41. Central venous and arterial line insertion in the burned patient.2. Escharotomy of the limbs, hands, thorax/abdomen.3. Naso and/or oro-gastric decompression and feeding tube insertion in the burnedpatient.4. Measurement of intra-abdominal pressure by bladder pressure measurement inthe burned patient.5. Use of blood conservation techniques for burn excision and graft harvestincluding epinephrine tumescence and use of tourniquets.6. Harvest of skin grafts with the power dermatome.7. Meshing of skin grafts.4

8. Application and fixation of both meshed and sheet autografts and allograft.PGY-51. Techniques and ability to position the burn patient in the operating roomincluding prone positioning, limb elevation, use of Steinman pins for limbelevation.2. Application of secure dressings and construction of the quilted dressing.3. Preparation, application, fixation and dressing of Integra artificial skin substitute.4. Excision and grafting of specialized areas specifically the hand, face, and eyelids.5. Basic release of burn contractures including transverse release, Z plasty, 4-flap Zplasty.6. Release/correction of burned eyelid ectropion.7. Tangential excision of the burn wound and ability to accurately determineadequacy of excision and viability of wound bed.8. Technique of fascial excision.COMMUNICATORPGY- 3-41. Develop rapport, trust and ethical relationships with burn patients andtheir families2. Accurately elicit and synthesize relevant information and perspectives ofpatient’s families, colleagues and other professionals3. Accurately convey relevant information and explanations to patients andfamily, colleagues and other professionals4. Develop a common understanding on issues, problems and plans withpatients and families, colleagues and other professionals to developed ashared plan of care5. Convey effective oral and written information about a medical encounter6. Obtain and synthesizes relevant history from patients and family7. Write a preliminary report on operations on chart8. Write clear progress notes, clinic notes and discharge summaries9. Is able to inform patients and families about their condition at anappropriate and understandable level, and in particular discuss complexissues surrounding the progress or deterioration of a critically ill burnpatient.10. Dictates concise and clear description of operation11. Writes clear and consultation notes and discharge summaries and clinicnotes12. Prepares and presents rounds in an organized manner, including AM unitrounds (Hand clinic, Burn clinic, Burn rounds) and weekly multidisciplinaryburn team rounds13. Participates actively in scheduled rounds5

PGY-51. Develop ability to discuss critical and life threatening illness and treatment andend-of life decisions with burn patient’s families2. Able to explain surgical interventions, options and expected morbidity andprognosis to patients and familiesCOLLABORATORPGY-3-41. Participate effectively and appropriately in an inter-professional healthcare team, especially the tight inter-workings of the burn care team andeffectively work with other health professionals to prevent, negotiate andresolve interpersonal conflict2. Works with ward, burn unit and operating room nurses to managepatients3. Appropriately identifies social, rehabilitative, dietetic concerns withpatients and consults appropriate allied health professionals4. Consults and works with medical specialists appropriatelyPGY-51. Assists allied health professionals through active participation theirtraining and educational roundsMANAGERPGY-3-41. Participate in activities that contribute to the effectiveness of theirhealthcare organizations and systems2. Manage their practice and career effectively3. Allocate finite healthcare resources appropriately4. Serve in administration and leadership roles as appropriate5. To level of training understand the importance of and mechanisms ofsafely utilize resources in a cost effective manner to benefit all patients6. Utilizes information technology to optimize learning7. Becomes practical and logical in the approach to clinical problem solvingPGY-51. Recommends practices to effectively utilize resources including theundertaking of standard of care proceduresHEALTH ADVOCATEPGY-3-46

PGY-51. Respond to individual patient health needs and issues as part of patientcare2. Respond to the health needs of the communities that they serve Identifythe determinants of health of the populations that they serve3. Promote the health of individuals4. Promote the health of individual patients, communities and populations5. Become familiar with the important determinants of health affectingplastic surgery patients such as smoking, obesity and other lifestyle andpreventative measures6. Understands the data supporting prevention of common burn injuriesespecially hot water scalds and grease fires7. Understands the value of outcomes research for surgical procedures8. Treats the individual as a whole person acknowledging, cultural, social,economic, family and personal influences on their psychosocial make-upand on their health and illness9. Assesses all patients for risk factors for a variety of plastic surgicalconditions and advises appropriate interventions10. Utilizes preventative measures correctly1. Understands the triage system of the surgical waitlist, it’s rationale,how patients are upgraded2. Participates in outcomes of research and assists in disseminatingresulting information3. Develops and supports constructive relationships with hospitaladministrators, regional, provincial and federal government agenciesand representatives4. Supports activity of local and national organizations promoting healthadvocacySCHOLARPGY-3-47

1. Maintain and enhance professional activities through ongoing learning2. Critically evaluate information and its sources and apply this appropriatelyto practice decisions3. Facilitate the learning of patients, families, students, residents, otherhealth professionals, the public, and others as appropriate4. Contribute to the creation, dissemination, application and translation ofnew medical knowledge and practices5. Recognizes gaps in knowledge and develops strategies to correct this byself directed reading and consulting with other professionals6. Contributes knowledge learned to service rounds7. Understands principles and practice of basic and applied research includingthe scientific method, design and conduct of clinical trials and criticalappraisal of literature and the use of statistics8. Reads around clinical cases9. Prepares and presents scheduled rounds10. Participates actively in scheduled morbidity and mortality and QualityAssurance conferences11. Actively participates in journal club12. Prepares and present clinical research papers at peer reviewedmeetings/publishes in medical literaturePGY-51. Participates effectively in teaching fellow professionals including juniorhouse staffPROFESSIONALPGY3-51. Demonstrates a commitment to their patients, profession and society throughethical practice2. Demonstrates a commitment to their patients, profession and society throughparticipation in profession-led regulation3. Demonstrates a commitment to physician health and sustainable practice4. Delivers care with integrity honesty and compassion5. Understands the professional, legal and ethical codes to which physicians arebound6. Exhibits appropriate personal and inter-personal professional behaviors and at alltimes functions professionally7. Is sensitive to and responds appropriately to different patients of different socialstatus, ethnic groups, age and gender8

Rotation Educational ObjectivesAlberta Children’s HospitalThe Plastic Surgery rotation at the Alberta Children’s Hospital is undertaken in the PGY-1, 3, 4 & 5 years. It is expected that the Plastic Surgery resident will be able tosuccessfully complete the Can Med Goals and Objectives as listed below regardless ofPGY status. The design of the rotation is to give the resident in plastic surgery in-depthexposure to all areas of pediatric plastic surgery but it is recognized that the residentmay not be exposed to all elements of these objectives. However at the conclusion ofthe rotation, the resident should demonstrate knowledge or competency in thefollowing:MEDICAL EXPERTGeneral Pediatric Plastic SurgeryPGY-1, 3 and 41. To acquire knowledge relating to the unique physiology and metabolism of thepediatric patient2. To become knowledgeable of skin lesions and conditions arising in the pediatricpopulation3. To understand the difference between malformations, deformations anddisruptions4. Knowledge of importance differences in mechanisms of trauma and woundhealing between children and adults.5. To be able to monitor appropriately the pediatric plastic surgery patientincluding appropriate choice of fluid and electrolyte replacement, drug and drugdosing, and blood product management and to be able to recommendappropriate analgesic medication.6. To be able to recognize soft tissue infections and initiate appropriate therapies.7. To be able to manage post-operative complications involving airway, bleeding,fever, dressings, etc.8. To be able to recognize and use appropriate adjunct services such as PT, OT,Social Work, Dietician etc.9. To gain knowledge and apply the use of regional anesthetic blocks and sedationin the pediatric population to effectively manage minor trauma in the ER10. To gain knowledge and expertise in the application of dressings in the pediatricpatient11. To be able to recommend an appropriate surgical approach and be familiar withnon-surgical alternatives12. To be aware of unique timing issues of surgical intervention in the pediatricplastic surgery patient9

PGY- 51. To acquire knowledge of the various congenital malformations, deformations,disruptions (syndromic and non-syndromic) affecting the face, hands, feet, trunkand genitalia2. To develop the special skills required to be able to communicate with pediatricpatients, parents and family3. To be knowledgeable and participate in standard microsurgical proceduresinvolving facial reanimation, free functioning muscle transfer, brachial plexusreconstruction, flap elevation and transfer.Pediatric Upper ExtremityA) GeneralPGY-1,3-51. Describe and illustrate the normal anatomy and its variations of the hand as itrelates to: vascular supply, nerve supply, flexor tendons, extensor tendons,bones, joints, skin, fascia and nails.2. Perform a thorough hand history investigating aspects of function, pain and bodyimage3. Perform a complete hand examination.B) FracturesPGY-1, 3 and 41. Understand unique aspects of pediatric hand fractures including the Salter-Harrisclassification system2. Demonstrate competence in local anesthesia and sedative techniques toperform closed reduction procedures3. Perform a closed reduction for a hand fracture4. List the complications and risks associated with hand fracturesPGY -51. Describe an algorithm for the management of pediatric hand fractures2. Perform an open reduction for a hand fracture3. Describe a corrective osteotomy for a mal-unionC) Extensor TendonsPGY-1, 3 and 41. Classify and describe the treatment for extensor tendon laceration2. Perform an extensor tendon repairPGY -51. Describe the abnormalities and their treatment associated with extensormechanism imbalance both for the digits and the thumb10

D) Flexor TendonsPGY-1, 3 and 41. Classify and describe the treatment for flexor tendon lacerations2. Describe flexor tendon healing3. Describe suture techniques and their rationalePGY -51. Describe post-operative regimens for flexor tendon healing2. Perform a flexor tendon repair3. Describe methods of flexor tendon reconstructionE) PIP/MCP joint repair and reconstructionPGY-1,3-51. Classify and describe PIP joint injuries2. Describe the treatment for PIP joint injuriesF) Fingertip/Nail bed injuriesPGY-1,3-51. Classify and describe fingertip and nail bed injuries in children2. Describe and perform treatment for fingertip and nail bed injuriesG) Obstetrical Brachial Plexus PalsyPGY-1, 3 and 41. Describe, illustrate and understand the normal anatomy and function of thebrachial plexus2. Establish the diagnosis and understand the pathophysiology of obstetricalbrachial plexus palsyPGY -51. Understand the treatment principles involved in the primary management ofobstetrical brachial plexus palsy (exploration and nerve graft reconstruction)2. Understand the treatment principles involved in the secondary management ofobstetrical brachial plexus palsy (tendon transfers, Botox® injection, etc.)H) Congenital Hand AnomaliesPGY-1, 3 and 41. Establish the diagnosis of common pediatric congenital hand anomalies such assyndactyly, polydactyly, hypo plastic thumb, trigger digit, overgrowth andundergrowth anomaliesPGY -51. Perform treatment for simple congenital hand anomalies such as polydactyly,syndactyly and trigger digit.2. Understand treatment philosophies for the management of complex congenitalhand anomalies such as hypo plastic thumb, radial and ulnar ray anomalies, etc.11

I) Traumatic/Ischemic InjuriesPGY-1, 3 and 41. Diagnosis and investigation of complex upper extremity trauma involving softtissue with possible nerve and or vascular injuriesPGY -51. Perform treatment of complex upper extremity injuries demonstratingknowledge of peripheral nerve and vascular microsurgical repair.12

PAEDIATRIC BURNSThe plastic surgery resident will be expected to achieve competency in all areas ofpediatric burn management including acute care, reconstruction and rehabilitationphases with emphasis on the following areas.PGY-1, 3 and 41. Pathophysiology of burn injury (scald, thermal, chemical, intravenousextravasation, electrical)2. Knowledge of causal agents3. Ability to determine burn wound depth, classification, body surface area4. Understanding of principles of initial acute burn care including transfer of burnpatients, A,B,C’s of trauma, intravenous fluid resuscitation, pain management,indications for escharotomies and intubation5. Pathophysiology of inhalation injury6. Burn wound sepsis - diagnosis, prevention and treatment7. Principles of nutritional support8. Wound care - dressings, debridement, local antimicrobial therapy, vacuumtherapy9. Principles of skin substitutes, artificial skin, allografts and cultured skin10. Rationale and indications behind different methods and techniques of primaryexcision and resurfacing11. Scar formation - conservative treatment including post-burn scar rehabilitationusing OT/PT services for splinting, compression.12. Understanding of philosophies, techniques and planning of secondary post-burnreconstruction.13. To be aware and to be able to manage aspects of burn care unique to pediatricpatients such as child abuse and neglect14. Tangential excision of a burn wound15. Harvest and application of skin grafts16. Post-operative wound care17. To understand and utilize appropriate ancillary support services in themanagement of the pediatric burn patient such as psychiatry, social work, OT, PTetc.PGY -51. To be able to assume the OR logistics for a major burn2. Understanding and familiarity with post-burn psychosocial issues in wider settingof family and community and to be able to integrate with available supportgroups13

PEDIATRIC CLEFT LIP AND PALATEPGY-1, 3 and 41. To understand normal embryologic development of the lip and palate2. To be able to describe the pathophysiology, embryology and anatomy of theunilateral and bilateral cleft lip and palate3. To be able to diagnose and classify clefts of the face including the lip and palateas well as Tessier craniofacial clefts4. To understand the functional issues facing the newborn baby with cleft lipand/or palate To be familiar with the etiology and genetics of cleft lip and palatedevelopment.5. To recognize and become familiar with the nutritional, airway, speech, growth,and psychosocial aspects of managing the cleft child.6. To understand the need for multidisciplinary approach to the management ofthe cleft childPGY -51. To be able to understand and discuss various treatment options for themanagement of cleft lip and cleft palate including the timing issues, potentialpitfalls, and post-operative care and to be able to draw various forms of surgicalrepair of cleft lip2. To understand the progression and sequence of care in the management of thecleft child and to be able to discuss the indications for surgical intervention in thecleft child3. To become familiar with the surgical techniques and to perform, undersupervision, standard surgical repairs involved in the management of a cleft childincluding closure of a cleft palate, pharyngeal flap, alveolar bone grafting.4. To become familiar with the surgical techniques and to participate in, undersupervision, cleft lip repair and cleft rhinoplasty5. To be able to recognize and deal with post-operative complications followingcleft lip/palate/pharyngoplasty/alveolar bone grafting/rhinoplasty procedures6. To understand the principles involved in the management of the cleft facialdeformity in the skeletally mature cleft patient involving a combined orthodonticand orthognathic surgical approachPEDIATRIC CRANIOMAXILLOFACIALPGY-1, 3 and 41. Describe and illustrate the anatomy of the pediatric craniofacial skeletonincluding the calvarium, cranial base, orbits, naso-orbital-ethmoid region, eyelidsand canthi, para-nasal sinuses, nose, zygoma, maxilla, mandible, TMJ, lips, ear,and facial nerve2. Describe normal occlusion and principles of re-establishing premorbid occlusion.3. Perform a comprehensive clinical assessment of the craniofacial region includingspecific evaluations of:a) Cranial vault deformity14

) Facial nerve functionc) Visual functiond) Jaw function and occlusione) Facial aesthetics4. Demonstrate an ability to read:a. Coronal, axial and 3D facial CT scansb. Facial x-raysc. Panorex5. To acquire knowledge of the various congenital malformations (syndromic andnon syndromic) affecting the craniofacial skeleton.6. To be able to diagnose and discuss treatment philosophies of the followingcongenital and acquired craniofacial conditions including but not limited tononsyndromic craniosynostosis, syndromic craniofacial dysostoses (Apert’s,Crouzon’s, Pfeiffer’s, Saethre-Chotzen syndromes), hemifacial microsomia,Treacher-Collins syndrome, Pierre Robin Sequence, vascular malformationspositional plagiocephaly, Tessier’s craniofacial clefts, hemifacial atrophy, bonetumours, soft tissue tumours, overgrowth and undergrowth conditions7. To have knowledge of the timing of congenital reconstructive procedures andbasic surgical principles involved.8. To understand the principles of elective orthognathic surgery and the basis ofcephalometric evaluation.9. To understand the mechanism of pediatric facial trauma, incidence of variousfractures, classification schema and unique aspects of dealing with the growingpediatric craniofacial skeleton including post-traumatic secondary deformities10. To be able to provide appropriate treatment options for the management ofpediatric facial trauma (bony and soft tissue) and secondary post-traumaticdeformities.11. To perform under supervision rigid fixation techniques of the craniofacialskeleton using titanium and bioresorbable fixation systems12. To understand the mechanism of bone healing in the pediatric craniofacialskeleton.15

PGY -51. Understand and perform the following surgical approaches and exposures:coronal, upper buccal sulcus, lower buccal sulcus, lower lid, upper lid incisionsforexposure of all areas of the facial skeleton2. Understand the basic principles and techniques of rigid fixation of thecraniofacial skeleton to use in congenital and traumatic conditions including thepitfalls and complications3. To be able to harvest bone graft from the iliac crest, rib and calvarium.4. To participate in, under supervision, standard craniofacial osteotomy proceduressuch as frontal-orbital osteotomies, Le Fort and mandibular osteotomiesCOMMUNICATORPGY-1, 3 and 41. Demonstrates effective establishment of therapeutic relationshipswith patients and their families2. Presents histories, physical findings and management plan toconsultants in an organized efficient and confident manner3. Obtains and synthesizes a relevant history from patients and family4. Demonstrates ability to contextualize relevant psychosocial,occupational and social consequences of plastic surgical disorders inpediatric patients5. Writes a preliminary report on operations on chart6. Writes clear progress notes, clinic notes and discharge summaries7. Is able to inform patients and families about their condition at anappropriate and understandable level8. Dictates concise and clear description of operations9. Writes clear and consultation notes and discharge summaries andclinic notes10. Prepares and presents rounds in an organized manner11. Participates actively in scheduled roundsPGY-51. Able to explain surgical interventions, options and expected morbidity andprognosis to patients and familiesCOLLABORATORPGY-1, 3-51. Demonstrates an understanding of the team structure of an in-patient service(house-staff team) and full-fill his/her role in this structure2. Demonstrates recognition and respect for the opinions and roles of otherteam members3. Recognizes the advantages for optimal patient care provided by aninterdisciplinary team4. Demonstrates collegial and professional relationships with other physicians,16

office and clerical support staff, operating room personnel and emergencyroom staff5. Recognizes the expertise and role of allied health professionals such asspeech language pathologists, audiologists, technicians, nurses and clericalstaff6. Participates in multidisciplinary clinics including cleft lip and palate, vascularbirthmark, burn clinicMANAGERPGY-1, 3-51. Keeps an up to date log of surgical procedures2. Utilizes resources effectively to balance patient care duties, learning needs,educational/teaching responsibilities and outside activities3. Appropriate to level of training understand the importance of andmechanisms of safely utilize resources in a cost effective manner to benefit allpatients4. Utilizes information technology to optimize learning5. Becomes practical and logical in the approach to clinical problem solving6. Recommends practices to effectively utilize resources including theundertaking of standard of care procedures7. Assists in organizing surgical care of the emergency inpatient patientsHEALTH ADVOCATEPGY-1, 3-51. Become familiar with the important determinants of health affecting plasticsurgery patients such as smoking, obesity and other lifestyle and preventativemeasures2. Understands the data supporting prevention of primary and secondary illnessand morbidity in plastic surgery patients3. Understands the triage system of the surgical waitlist, it’s rationale, howpatients are upgraded4. Understands the value of outcomes research for surgical procedures5. Treats the individual as a whole person acknowledging, cultural, social,economic, family and personal influences on their psychosocial make-up andon their health and illness6. Assesses all patients for risk factors for a variety of plastic surgical conditionsand advises appropriate interventions7. Utilizes preventative measures correctly8. Anticipates in research and assists in disseminating resulting informationSCHOLARPGY-1, 3-51. Recognizes gaps in knowledge and develops strategies to correct this by selfdirected reading and consulting with other professionals17

2. Contributes knowledge learned to service rounds3. Understands principles and practice of basic and applied research includingthe scientific method, design and conduct of clinical trials and criticalappraisal of literature and the use of statistics4. Reads around clinical cases5. Prepares and presents scheduled rounds6. Participates actively in scheduled morbidity and mortality and QualityAssurance conferences7. Actively participates in journal club8. Prepares and present clinical research papers at peer reviewedmeetings/publishes in medical literature9. Participates effectively in teaching fellow professionals including junior housestaffPROFESSIONALPGY-1, 3-51. Deliver highest quality care with integrity, honesty and compassion2. Exhibit appropriate professional and interpersonal behaviours3. Practice medicine and Plastic Surgery in an ethically responsible manner4. Recognize limitations and seek assistance as necessary5. Seek out and reflect on constructive criticism of performance6. Endeavor to develop an appropriate balance between personal andprofessional life to promote personal physical and mental health/well-beingas an essential to effective life long practice7. Is sensitive to and responds appropriately to different patients of differentsocial status, ethnic groups, age and gender18

Rotation Educational ObjectivesRockyview General HospitalMEDICAL EXPERTGeneral SkillsPGY- 3-51. Take a relevant, appropriately detailed history from a patient2. Perform a detailed and thorough physical examination3. Able to identify possible preoperative risk factors4. Appropriate use of diagnostic tests and investigations5. Diagnoses and recommends appropriate management of plastic surgicalproblems6. Performs techniques including gentle tissue handling, recognition of importantskin lines and landmarks, and understands the blood supply to the skin and othertissues7. Knowledge of different suture materials and wound closure techniques8. Recognizes and recommends appropriate alternative therapies9. Recognizes and recommends appropriate postoperative rehabilitation10. Able to recognize and manage postoperative complicationsSkin Pathology and Wound HealingPGY-3-51. Has an in depth knowledge of the embryology and anatomy of the skin2. Understands the principles and pathophysiology of wound healing3. Understands factors affecting scar formation and can recommend appropriatetreatment for both prevention and treatment of scars4. Has a knowledge of various clinical options to modify wound healing5. Has a knowledge of basic techniques for wound closure6. Has an in depth knowledge of various skin lesions, both benign and malignant7. Understands the surgical and appropriate adjuvant treatment regimens forvarious skin malignancies8. Understands the principles and can perform numerous local flaps9. Understands the pathophysiology of thermal injuries10. Is able to diagnose and appropriately treat burns and frostbite11. Is able to diagnose and appropriately treat injection and extravasation injuries12. Can proficiently perform the grafting of skin and other tissues13. Has knowledge regarding the pathophysiology and prevention of pressure sores14. Is able to recommend appropriate treatment for pressure sores, both from asurgical and non-surgical perspective15. Has knowledge regarding the pathophysiology of ulcers and diabetic footproblems19

16. Is able to recommend appropriate treatment for ulcers and diabetic footproblems17. Has a knowledge of various wound care regimens, dressings, and topicalantimicrobials18. Has knowledge regarding cellulitis and necrotizing infections of the soft tissues19. Is able to diagnose, properly investigate and recommend appropriate treatment,both surgical and non-surgical, for cellulitis and necrotizing infections of the softtissuesHand and Upper ExtremityPGY- 3-51. Has an in depth knowledge of the embryology and functional anatomy of thehand and upper extremity2. Is able to interpret radiologic investigations appropriately3. Understand the principles and executes microsurgical nerve repairs4. Understand the principles and executes tendon repairs5. Understand the principles and pathophysiology of Dupuytren’s disease6. Understand the principles of bone healing7. Is able to manage acute hand fractures, both closed and open reductions8. Understands the basics of extremity soft tissue injuries and soft tissue cover9. Recognizes and manages appropriately hand infections10. Understands conservative and surgical management of nerve compressionsyndromes11. Understands conservative and surgical management of tendon entrapmentsyndromes12. Has knowledge of the principles of tendon transfers13. Has knowledge of the management of acute and chronic fingertip injuries14. Understands the principles and management of hand arthropathies15. Is able to diagnose and recommend treatment for various hand tumorsAesthetic SurgeryPGY-3-51. Becomes familiar with the principles and ranges of aesthetic procedures2. Understands the concepts of appropriate patient selection3. Is able to carry out a proper physical examination of the aesthetic patient4. Is able to recommend an appropriate approach to rejuvenation, including bothsurgical and non-surgical options5. Has an understanding of the various implant materials, injectables, fillers,LASER’s, peels and muscular paralysis agents used in aesthetic rejuvenation6. Understands the risks, complications and principles of liposuction7. Is able to perform portions of various aesthetic procures under direct supervision20

Breast – GeneralPGY-3-51. Describe the embryology of the breast.2. Explain common congenital anomalies of the breast based on an understandingof the underlying embryology (axillary breast tissue, amastia, Poland’s syndrome,accessory nipple).3. Describe and illustrate the anatomy of the breast as it relates to: anatomiclocation, vascular supply, lymphatic supply, nerve supply, supporting structures.4. List the premalignant and malignant conditions that affect the breast anddescribe the treatment options available for each condition.5. List the genes that are involved in genetic screening for breast cancer and discussthe implications of a positive test as it relates to plastic surgery.6. Describe the current recommendations for mammography in the Province ofAlberta.7. Describe the diagnosis and treatment options for common benign conditions ofthe breast including fibroadenoma, fibrocystic disease, Mondor’s disease, ductalpapilloma.Breast ReductionPGY- 3 and 41. Perform a thorough consultation for a breast reduction to include a history,physical and development of a treatment plan.2. List the complications that would be discussed in an informed consent for abreast reduction procedure.3. Draw a Wise pattern for a breast reduction and describe variations in the patternto suit different breast sizes and shapes.4. List various options for infiltration in breast reduction surgery and discuss theadvantages of each.5. Describe a reasonable postoperative plan following breast reduction to include:hospitalization, dressings, wound management, follow up visits andmammography.PGY-51. Perform with assistance an inferior pedicle breast reduction.2. Perform with assistance a superior/superior lateral/superior medial breastreduction.3. Perform with assistance a free nipple graft breast reduction.4. Draw with assistance a vertical skin pattern breast reduction and perform abreast reduction using a limited skin excision approach.Breast liftPGY- 3 and 41. List the complications associated with a mastopexy that would be discussed in acomplete informed consent.21

2. Draw and describe the procedure for a peri-areolar mastopexy.3. Discuss the indications for a peri-areolar mastopexy.4. Draw and describe an inverted tear-drop mastopexy (vertical scar).5. Discuss the indications for an inverted tear-drop mastopexy.6. Draw and describe a Wise pattern mastopexy.7. Discuss the indications for a Wise pattern mastopexy.8. Provide a classification scheme for ptosis of the breast.PGY-51. Explain any modifications to a mastopexy that are or may be required whenperforming an augmentation at the same time as a mastopexy.Breast augmentationPGY-3 and 41. List the complications and risks associated with saline breast augmentation as itrelates to providing a full informed consent.2. List the complications and risks associated with silicone gel breast implantaugmentation as it relates to providing a full informed consent.3. List and explain the various breast implant options presently available for breastaugmentation surgery.4. Describe the components of a tubular breast deformity.5. Describe an acceptable treatment plan for a tubular breast deformity.PGY-51. Perform with assistance a subpectoral breast augmentation.2. Perform with assistance a subglandular breast augmentation.3. Perform with assistance a dual plane breast augmentation.4. Perform with assistance a breast augmentation through an inframammaryapproach.5. Perform with assistance a breast augmentation through a peri-areolar approach.6. Perform with assistance a breast augmentation through a trans-axillaryapproach.GynecomastiaPGY-3 and 41. List the complications and risks associated with male subcutaneous mastectomyas it relates to a full informed consent.2. Classify gynecomastia by etiology.3. Describe an appropriate work-up including history, physical and examination fora patient presenting with gynecomastia.PGY-51. Perform a subcutaneous mastectomy through a peri-areola incision.22

Post mastectomy breast reconstructionPGY-3 and 41. Describe the anatomy of the TRAM flap.2. Describe the variations of a TRAM flap: single pedicle, double pedicle, free TRAMDIEP, SIEP.3. Discuss the indications, contraindications, risks and complications associatedwith TRAM flap surgery.4. Discuss management of the abdominal wall in TRAM flap surgery.5. Discuss approaches to shaping the TRAM flap and demonstrate an ability toshape and reconstruct the breast using a TRAM flap procedure.6. Describe the anatomy of the latissimus dorsi flap and the extended latissimusdorsi flap for breast reconstruction.7. Discuss the selection of tissue expanders in post-mastectomy breastreconstruction.8. Discuss the selection of permanent breast prosthesis in post-mastectomy breastreconstruction.9. List the risks and complications associated with post-mastectomy breastreconstruction utilizing tissue expanders and implants.10. List options for nipple areola reconstruction and describe the advantages anddisadvantages of each approach.PGY-51. Perform a single pedicle TRAM flap.2. Perform a double pedicle TRAM flap.3. Perform a latissimus dorsi flap breast reconstruction with or without an implantor expander.4. Perform a two-stage immediate breast reconstruction with a tissue expanderand implant.5. Perform a two-stage delayed reconstruction with a tissue expander and implant.6. Perform areola reconstruction using tattooing and full thickness skin grafts.7. Perform with assistance nipple reconstruction utilizing local flaps, nipple sharingand labia grafts.Body ContouringPGY- 3 and 41. Describe the components of the tumescent solution.2. Describe what it meant by dry, super wet and tumescent liposuction.3. List the risks and complications associated with liposuction surgery as it relatesto a full informed consent.4. Provide appropriate guidelines for fluid resuscitation associated with super wetand tumescent liposuction.5. List the risks and complications associated with abdominoplasty surgery as itrelates to a full informed consent.23

6. Describe the indications for a full abdominoplasty, mini-abdominoplasty andliposuction of the abdomen.7. Discuss the indications for a circumferential body lift.8. Discuss the indications for a thigh lift.9. Discuss the various approaches to treating the upper arm includingbrachiaplasty, mini-brachiaplasty and liposuction.PGY-51. Perform liposuction surgery on areas to include abdomen, hips, thighs, kneesand buttocks.2. Perform a full abdominoplasty procedure including plication of the rectusmuscles.COMMUNICATORPGY-3-51. Develop rapport, trust and ethical relationships with burn patients and theirfamilies2. Develop ability to discuss critical and life threatening illness and treatment andend-of life decisions with burn patient’s families3. Accurately elicit and synthesize relevant information and perspectives of patient’sfamilies, colleagues and other professionals4. Accurately convey relevant information and explanations to patients and family,colleagues and other professionals5. Develop a common understanding on issues, problems and plans with patientsand families, colleagues and other professionals to developed a shared plan ofcare6. Convey effective oral and written information about a medical encounter7. Obtains and synthesizes relevant history from patients and family8. Writes a preliminary report on operations on chart9. Writes clear progress notes, clinic notes and discharge summaries10. Is able to inform patients and families about their condition at an appropriate andunderstandable level, and in particular discuss complex issues surrounding theprogress or deterioration of a critically ill burn patient.11. Dictates concise and clear description of operation12. Writes clear and consultation notes and discharge summaries and clinic notes13. Prepares and presents rounds in an organized manner, including AM unit rounds(Hand clinic, Burn clinic, Burn rounds) and weekly multi-disciplinary burn teamrounds14. Participates actively in scheduled rounds15. Able to explain surgical interventions, options and expected morbidity andprognosis to patients and families24

COLLABORATORPGY-3-51. Participate effectively and appropriately in an inter-professional health careteam, especially the tight inter-workings of the burn care team and effectivelywork with other health professionals to prevent, negotiate and resolveinterpersonal conflict2. Works with ward, burn unit and operating room nurses to manage patientsAppropriately3. Identifies social, rehabilitative, dietetic concerns with patients and consultsappropriate allied health professionals4. Consults and works with medical specialists appropriately5. Assists allied health professionals through active participation their training andeducational roundsMANAGERPGY -3-51. Participate in activities that contribute to the effectiveness of their healthcareorganizations and systems2. Manage their practice and career effectively3. Allocate finite healthcare resources appropriately4. Serve in administration and leadership roles as appropriate5. To level of training understand the importance of and mechanisms of safelyutilize resources in a cost effective manner to benefit all patients6. Utilizes information technology to optimize learning7. Becomes practical and logical in the approach to clinical problem solving8. Recommends practices to effectively utilize resources including the undertakingof standard of care procedures25

HEALTH ADVOCATEPGY-3 and 41. Respond to individual patient health needs and issues as part of patientcare2. Respond to the health needs of the communities that they serve Identifythe determinants of health of the populations that they serve3. Promote the health of individuals4. Promote the health of individual patients, communities and populations4. Become familiar with the important determinants of health affectingplastic5. surgery patients such as smoking, obesity and other lifestyle andpreventative measures6. Understands the triage system of the surgical waitlist, it’s rationale, howpatients are upgraded7. Understands the value of outcomes research for surgical procedures8. Treats the individual as a whole person acknowledging, cultural, social,9. economic, family and personal influences on their psychosocial make-upand on their health and illness10. Assesses all patients for risk factors for a variety of plastic surgicalconditions and advises appropriate interventions11. Utilizes preventative measures correctly12. Develops and supports constructive relationships with hospitaladministrators, regional, provincial and federal government agencies andrepresentativesPGY-51. Participates in outcomes research and assists in disseminating resultinginformation2. Supports activity of local and national organizations promoting healthadvocacySCHOLARPGY-3-51. Maintain and enhance professional activities through ongoing learning2. Critically evaluate information and its sources and apply this appropriately topractice decisions3. Facilitate the learning of patients, families, students, residents, other healthprofessionals, the public, and others as appropriate4. Contribute to the creation, dissemination, application and translation of newmedical knowledge and practices5. Recognizes gaps in knowledge and develops strategies to correct this by selfdirected reading and consulting with other professionals6. Contributes knowledge learned to service rounds7. Understands principles and practice of basic and applied research including thescientific method, design and conduct of clinical trials and critical appraisal of26

literature and the use of statistics8. Reads around clinical cases9. Prepares and presents scheduled rounds10. Participates actively in scheduled morbidity and mortality and Quality Assuranceconferences11. Actively participates in journal club12. Prepares and present clinical research papers at peer reviewed meetings/publishesin medical literature13. Participates effectively in teaching fellow professionals including junior housestaffPROFESSIONALPGY-3-51. Demonstrates a commitment to their patients, profession and society throughethical practice2. Demonstrates a commitment to their patients, profession and society throughparticipation in profession-led regulation3. Demonstrates a commitment to physician health and sustainable practice4. Delivers care with integrity honesty and compassion5. Understands the professional, legal and ethical codes to which physicians arebound6. Exhibits appropriate personal and inter-personal professional behaviors and at alltimes functions professionally7. Is sensitive to and responds appropriately to different patients of different socialstatus, ethnic groups, age and gender27

Rotation Educational ObjectivesPeter Lougheed CentreHand and Lower ExtremityClinical CompetenciesAssessment and Management of trauma patientsPGY-3-51. Obtain a medical history2. Perform a detailed physical examination3. Arrange the appropriate investigations4. Assess the findings to make a diagnosis5. Develop a treatment plan6. Initiate and carryout the treatment planMEDICAL EXPERTBasic sciencePGY-3 and 4• AnatomyFull understanding of the anatomy of the hand and wrist includingMuscles, tendons, skeleton and ligaments, major vessels• Anatomy of peripheral nerves in the entire upper extremity including thebrachial plexus.• Fracture, ligament, wound healingKnowledge of fracture healing issues specific to hand and wristIncluding fractures of scaphoid, metacarpals and phalanges, soft tissueinjuriesWrist ligaments• Nerve regeneration• Pathophysiology of arthritis in the handTrapeziometacarpal joint arthritisPGY-5Advanced collapse• rheumatoid arthritis of the hand and wrist• carpal instability and the pathomechanics of scapholunateClinical skillsPGY-3-5• Medical history and physical examinationCompetent hand examination including full neurological examination relevant tothe upper extremity• Interpretation of imaging studies28

-Interpretation of plain radiographs of the hand and wrist-Knowledge of indications for advanced imaging studies in the-Hand and wrist including MRI, CT and Ultrasonography• Diagnosis and clinical decision making-Understanding of the full spectrum of treatment options, including nonoperativetreatment, for common conditions affecting the hand and wrist-Development of a treatment plan, including therapy and other aftercare forcommon conditions affecting the hand and wrist• Pre-operative planning-Knowledge of appropriate instruments for hand and wrist surgery-Including internal fixation, intraoperative imaging.• Emergency management-Knowledge of the spectrum of care feasible in an emergency department setting-Knowledge of the evaluation and immediate care of patients with amputationsincluding care of the amputated part and preparation of patients withamputations for the operating roomTechnical skillsPGY- 3 and 4• Knowledge of surgical exposures in the hand and wrist• Knowledge of the use of internal fixation sets specific to care of injuries in the handand wrist including the mini-fragment and modular hand sets,• Knowledge of suturing techniques for flexor and extensor tendons• Knowledge of basic functions of the operating microscope• Skill in basic microsurgical procedures like digital nerve repair.PGY-5• Herbert and Accutrak screws.Diagnosis and treatment of soft tissue infectionPGY-3-51. Knowledge of the different types of bacteria and their effects2. Obtain a medical history3. Perform a detailed physical examination4. Arrange the appropriate investigations5. Assess the findings to make a diagnosis6. Develop a treatment plan7. Discuss the problem with the patient and obtain an informed consent8. Initiate and carryout the treatment plan29

Knowledge of specific issues in infectionHand infectionsFoot infectionsSpecific proceduresIncision and drainageWound debridementToe amputationForefoot amputationSkin graftSternal debridementDiagnosis and treatment of common skin lesionsPGY-3-51. Obtain a medical history2. Perform a detailed physical examination3. Arrange the appropriate investigations4. Assess the findings a make a diagnosis5. Develop a treatment plan6. Discuss the problem with the patient and obtain an informed consent7. Initiate and carryout the treatment planSpecific proceduresExcisional biopsyOther forms of biopsyExcision and Flap ReconstructionExcision and skin graftSentinel node biopsy and lymph node managementExcision of lesions and reconstruction of specialized structuresNoseEyelidEarLower Extremity Assessment and ReconstructionPGY-3-51. Obtain a medical history2. Perform a detailed physical examination3. Arrange the appropriate investigations4. Assess the findings a make a diagnosis5. Develop a treatment plan6. Discuss the problem with the patient and obtain an informed consent7. Initiate and carryout the treatment plan30

Specific proceduresCompartment releaseDiabetic foot ulcer managementVenous ulcer managementArterial ulcer managementSkin graftsMuscle flap reconstructionSkin graft reconstructionVac therapyRegional flap reconstructionFree flap reconstructionTreatment of osteomyelitisWound Assessment and TreatmentPGY-3-51. Obtain a medical history2. Perform a detailed physical examination3. Arrange the appropriate investigations4. Assess the findings a make a diagnosis5. Develop a treatment plan6. Discuss the problem with the patient and obtain an informed consent7. Initiate and carryout the treatment planSpecific proceduresExcision and reconstruction of pressure soresReconstruction of the abdominal wallReconstruction of surgical woundsSternumExtremitiesScalpHead and NeckTissue expansionBreast SurgeryPGY-1, 3-51. Obtain a medical history2. Perform a detailed physical examination3. Arrange the appropriate investigations4. Assess the findings a make a diagnosis5. Develop a treatment plan6. Discuss the problem with the patient and obtain an informed consent7. Initiate and carryout the treatment plan31

Specific proceduresBreast reductionBreast augmentationBreast reconstructionTissue expansionPedicled flap reconstructionFree flap reconstructionNipple reconstructionFacial Plastic SurgeryPGY-3-51. Obtain a medical history2. Perform a detailed physical examination3. Arrange the appropriate investigations4. Assess the findings a make a diagnosis5. Develop a treatment plan6. Discuss the problem with the patient and obtain an informed consent7. Initiate and carryout the treatment planOther AreasPGY-3-5Specific proceduresBlepharoplastyRhytidectomyUpper faceMidfaceLower faceTreatment of facial paralysisOtoplastyTraumatic ear reconstructionTraumatic facial deformityScar revision1. Obtain a medical history2. Perform a detailed physical examination3. Arrange the appropriate investigations4. Assess the findings and make a diagnosis5. Develop a treatment plan6. Discuss the problem with the patient and obtain an informed consent7. Initiate and carryout the treatment planSpecific proceduresLiposuctionSkin reduction surgery32

CollaboratorPGY- 3-5• Interaction with allied health workers• Understands role of hand therapists• Participates in prescribing physical therapy, splinting for hand, wrist patients• Interacts with home care services to co-ordinate outpatient care of patients inthe community• With social services to co-ordinate discharge and follow up, including outpatienttherapy works• Interaction with community physicians• Interacts and can advise community physicians in follow-up care of outpatientswith hand and wrist conditions• Works with social services to co-ordinate discharge and follow-up, includingcommunity hand therapyManagerPGY-3-5• Use Of Outpatient Surgery Services - understands role of outpatient surgery forhand/wrist patients including: indications, need for outpatient anaesthesiaconsultation and other medical workup, issues surrounding discharge and follow-up• Resource Utilization- understands the role of advanced imaging techniques inhand/wrist diagnoses including issues related to relative costs, informationgained, role of that information in further management- appropriate role of other ancillary investigations including electrodiagnostictesting, functional abilities evaluations, referral to other services like anesthesia,psychology• Canadian health care system - understands general principles WCB claims includingissues related to entitlement and resources available to injured workers.Health AdvocatePGY-3-5• Workplace Safety - has an understanding of workplace safety issues, role ofergonomic evaluation with respect to the hand and wrist eg. Use of computerkeypad and development of compressive neuropathy in the hand/wrist• Understands importance of diabetes, smoking, I.V. drug abuse with respect to handrurgery and direct patient to appropriate resources.33

Health ProfessionalPGY-3-5Scholar• Recognizes gaps in knowledge and develops strategies to correct these• Reads and prepares for scheduled clinical procedures• Acts as effective teacher for medial students, and other health care professionals• Develops knowledge of current literature/journals and participates in journal clubs• Understands principles of basic and clinical research including design and conduct ofclinical trials and critical appraisal of scientific literature• Takes an evidence-based approach to management problems• Accepts and acts on constructive feedbackProfessional• Recognizes limitations and seeks advice and consultation when needed• Exercises initiative within limits of knowledge and training• Discharges duties and assignments responsibly and in a timely and ethical manner• Reports facts accurately, including own errors• Maintains appropriate boundaries in work and learning situations• Show respect of diversity of race, age, gender, sexual orientation, disability,intelligence and socio-economic status34

Rotation Educational ObjectivesFoothills Medical CentreMEDICAL EXPERTThe resident will demonstrate knowledge, clinical skills and technical skills in the areaslisted below. The resident will demonstrate ability to access and apply relevantinformation to his or her clinical practice.Postmastectomy Breast ReconstructionPGY-3-51. The resident will be able to describe the anatomy of the anterior abdominal walland its relevance to breast reconstruction2. The resident will become familiar with the various flaps that can be harvestedfrom the abdominal wall for breast reconstruction3. The resident will become familiar with the flaps that can be harvested from thebuttock (S-GAP and I-GAP) for breast reconstruction4. The resident will learn the technique of accessing both internal mammary andthoracodorsal vessels in the chest5. The resident will learn the anatomy of the back, including the latissimus dorsiflap as well as the various perforator flaps such as T-DAP and intercostalsperforator flaps relevant to breast reconstruction6. The resident will learn how to select tissue expanders for postmastectomybreast reconstruction7. The resident will learn the selection of permanent breast prosthesis inpostmastectomy reconstruction8. The resident will learn the risks and complications associated withpostmastectomy breast reconstruction utilizing tissue expanders and implants9. The resident will become familiar with options for nipple reconstruction and willbe able to describe advantages and disadvantages of each approach10. The resident will learn to perform areola reconstruction using tattooingHead and NeckPGY-3-5The resident will become familiar with the intricacies of head and neck reconstructionincluding the following:1. Reconstruction of the tongue and floor of mouth using various flaps includingradial forearm and anterolateral thigh flap as well as DIEP flap2. Reconstruction of the pharangoesophagus using jejunum and tubed ALT flap3. Reconstruction of the maxilla using iliac crest and scapular flaps.4. The resident will become familiar with the fibular flap mandibular reconstruction5. Reconstruction of the scalp using latissimus dorsi free flaps and skin grafts6. The resident will become familiar with the performance of sentinel node biopsyof the head neck for melanoma7. The resident will become familiar with the performance of a neck dissection35

Extremity SarcomaPGY-3-51. The resident will become familiar with the various options for reconstructing theextremities. This will include the use of the fibular flap for various indications2. The resident will also become familiar with the choice of flaps for large softtissue defects3. The resident will become familiar with the effects of radiation and particularlywith its importance with regard to wound healingPelvic ReconstructionPGY-3-5The resident will become familiar with the role of various pedicle flaps in reconstructingthe pelvis. These will include the gracilis, the anterior lateral thigh, rectus femoris andthe V-RAM.Facial ReanimationPGY-3-5The resident will become familiar with the techniques used in facial reanimationincluding:1. Cross facial nerve graft2. Masseter nerve innervation of gracilis3. Free functioning gracilis transfer4. Depressor resection5. Static sling operations6. Gold weight insertion into upper eyelids7. Static sling operations for lower eyelidsTrunk and Lower Extremity ReconstructionPGY-3-51. Reconstruction of the infected sternotomy defect2. Management of extremity diabetic ulcers36

Rotation Educational ObjectivesFoothills Medical CentreMoh’s Rotation1. An approach to both benign/malignant, pigmented/non-pigmented lesions,with a solid understanding of all common, some important less-common skintumours and important mimics of BCCs, SCCs and MMs2. A good understanding of Mohs surgery via involvement in activities including:Mohs consults, determining appropriate margins for levels, taking levels,Mohs mapping and basic histology (normal skin, BCCs, SCCs and possiblyMMs)3. An understanding of important clinical and histological diagnostic features,staging, margins, indications for SLNBs and treatment options for MM4. Experience in reinforcing basic plastic surgery principles around head andneck local flaps including planning (reconstructive ladder) and executingplans for surgical repair5. An understanding of the role of a multi-disciplinary team and how such ateam functions/communicates in the treatment of lesions requiringadjunctive therapySkin CancersPGY-4The resident will become familiar with techniques involved in treating skin cancers.This will include:1. Use of medical treatment such as Efudex and Aldara2. Excisional techniques including local flaps and grafts. The resident will learn andperform these techniquesFACIAL SOFT TISSUE RECONSTRUCTIONGeneral PrinciplesPGY-41. Illustrate the ideal orientation of incisions on the face2. Illustrate aesthetic units of the face3. Describe the healing and outcome of a local skin flap, partial and full thicknessskin graft, composite graft4. Describe the physiology and clinical application of the delay phenomenon.5. Classify and illustrate local skin flaps6. Describe and illustrate regional axial pattern flaps in the head and neck37

7. Perform a full thickness skin graft reconstruction8. Perform a rhomboid flap reconstruction9. Perform an advancement flap reconstruction10. Perform a rotation flap reconstructionEyelid ReconstructionPGY-41. Discuss the principles of eyelid reconstruction2. Describe and classify techniques for upper lid reconstruction3. Perform a flap reconstruction of a lower lid defect4. Classify ectropion5. Describe a treatment plan for cicatritial ectropion6. Define medial canthal dystopia and describe the assessmentNose reconstructionPGY-41. Discuss the principles of nasal reconstruction2. Perform a flap reconstruction of a lower third nasal defect3. Perform a flap reconstruction of an upper two-thirds nasal defect4. Describe the use of a forehead flap in nasal reconstructionEar ReconstructionPGY-41. Describe and classify techniques for ear reconstruction2. Perform a reconstruction of a helical defectLip reconstructionPGY-41. Discuss the principles of lip reconstruction2. Describe and illustrate an Abbe flap3. Describe and illustrate a Karapandzyk flap4. Perform a lower lip defect reconstruction38

Rotation Educational ObjectivesFoothills Medical CentreAdult Craniofacial SurgeryGeneralPGY-3-41. Describe and illustrate the soft tissue and skeletal anatomy of the craniofacialregion.2. Describe normal occlusion and principles of re-establishing premorbid occlusion.3. Perform a comprehensive clinical assessment of the face, including specificevaluations of:a. Facial nerve functionb. Visual functionc. Jaw function and occlusion4. Demonstrate an ability to read:a. Coronal and axial face CT scansb. Facial X-raysc. Panorex5. Describe the normal healing of a fracture, of a free and a vascularized bone graftPGY-51. Perform the following surgical approaches and exposures:a. Coronalb. Lower lid transconjunctivalc. Mid-lower lidd. Upper and lower buccal sulcuse. External mandibularCraniofacial TraumaPGY-3-41. Describe the principles of (ABC’s) trauma management. Discuss specificmanagement of facial hemorrhage, compromised airway, patient with facialinjuries and associated c-spine or head injury.2. Describe the management of a patient with acute loss of vision3. Describe the management of a patient with facial fractures and CSF rhinorrhea.4. Perform repairs of facial soft tissue injuries. Describe principles5. Perform the following facial fracture procedures:a) Closed reduction nasal fractureb) Maxillo-mandibular fixation6. Discuss the management of condylar neck fractures7. List the indications for orbital fracture repair39

PGY-51. Perform the following facial fracture procedures:a) Open reduction and fixation frontal sinus fractureb) Open reduction and fixation zygoma fracturec) Repair orbital floor defectd) Open reduction and fixation nasoethmoid fracturee) Lateral canthoplastyf) Open reduction and fixation midface fractureg) Open reduction and fixation mandibular fractureCraniofacial: ElectiveCranial Vault DeformityPGY-3-51. Classify cranial vault defects2. List the materials available for cranioplasties and discuss the indications andcontraindications for eachOrbital DeformityPGY-3-51. Describe the clinical features and pathomechanics of enophthalmos, exophthalmos,hyperglobus and hypoglobus, vertical orbital dystopia.2. Describe the clinical features and pathomechanics of an enucleated orbit3. List the complications that would be discussed in an informed consent for an orbitalexploration4. Perform an orbital exploration5. Describe the surgical options for enophthalmos repair and the indications for eachAdult Cleft DeformityPGY-3-51. Describe the anatomy and clinical features of the nasal deformity associated withunilateral and bilateral clefts2. Describe treatment options for a whistle notch deformity3. Describe malocclusion and maxillomandibular relations commonly associated withunilateral cleft lip and palate4. Discuss the management of velopharyngeal incompetenceFacial Skeletal AugmentationPGY-3-51. Discuss the indications and contraindications for the use of the following facialimplants: bone graft, hydroxyapatite bone substitutes, polyethylene, titanium2. Harvest an iliac crest bone graft3. Harvest a split skull bone graft40

COMMUNICATORPGY-3-51. Obtains and synthesizes a relevant history from patients and family2. Writes a preliminary report on operations on chart3. Writes clear progress notes, clinic notes and discharge summaries is able toinform patients and families about their condition at an appropriate andunderstandable level4. Dictates concise and clear description of operations5. Writes clear and consultation notes and discharge summaries and clinic notes6. Prepares and presents rounds in an organized manner7. Participates actively in scheduled rounds8. Able to explain surgical interventions, options and expected morbidity andprognosis to patients and familiesCOLLABORATORPGY-3-51. Works with ward, clinic and operating room nurses to manage patientsappropriately2. Identifies social, rehabilitative, dietetic concerns with patients and consults hand3. Therapists and appropriate allied health professionals4. Consults and works with medical specialists appropriatelyMANAGERPGY-3-51. Appropriate to level of training understand the importance of and mechanisms ofsafely utilize resources in a cost effective manner to benefit all patients2. Utilizes information technology to optimize learning3. Becomes practical and logical in the approach to clinical problem solving4. Recommends practices to effectively utilize resources including tithe undertakingof standard of care procedures5. Assists in organizing surgical care of the emergency inpatient craniofacial patientsHEALTH CARE ADVOCATEPGY-3-51. Become familiar with the important determinants of health affecting plasticsurgery patients such as smoking, obesity and other lifestyle and preventativemeasures2. Understands the data supporting prevention of primary and secondary illness andmorbidity in plastic surgery patients3. Understands the triage system of the surgical waitlist, it’s rationale, how patientsare upgraded4. Understands the value of outcomes research for surgical procedures5. Treats the individual as a whole person acknowledging, cultural, social,economic, family and personal influences on their psychosocial make-up and on41

their health and illness6. Assesses all patients for risk factors for a variety of plastic surgical conditions andadvises appropriate interventions7. Utilizes preventative measures correctly8. Participates in research and assists in disseminating resulting informationSCHOLARPGY-3-51. Contributes knowledge learned to service rounds2. Understands principles and practice of basic and applied research including thescientific method, design and conduct of clinical trials and critical appraisal ofliterature and the use of statistics3. Reads around clinical cases4. Prepares and presents scheduled rounds5. Participates actively in scheduled morbidity and mortality and Quality Assuranceconferences6. Actively participates in journal club7. Prepares and present clinical research papers at peer reviewed meetings/publishesin medical literature8. Participates effectively in teaching fellow professionals including juniorHouse staffPROFESSIONALPGY-3-51. Delivers care with integrity honesty and compassion2. Understands the professional, legal and ethical codes to which physicians arebound3. Exhibits appropriate personal and inter-personal professional behaviors4. At all times functions professionally5. Is sensitive to and responds appropriately to different patients of different socialstatus, ethnic groups, age and gender6. Exhibits appropriate professional behaviors for physician health and sustainablepractice42

Rotation Educational ObjectivesFoothills Medical CentreFacial Aesthetic SurgeryBrow LiftPGY-3-51. Discuss normal brow position and morphology2. Describe techniques of brow liftRhinoplastyPGY-3 and 41. Describe the assessment of a patient with a nasal deformity2. List the complications of rhinoplasty6. Discuss techniques of nasal osteotomy7. Describe the use of spreader grafts8. Discuss techniques of altering nasal tip projectionPGY-51. Perform a septoplasty2. Expose the nose through an external rhinoplasty approach3. Harvest cartilage graft from the septum and the conchaBlepharoplastyPGY-3 and 41. Describe the assessment of a patient with blepharochalasia2. Describe complications of lower lid blepharoplastyPGY-51. Describe an upper eyelid blepharoplasty2. Describe a lower eyelid blepharoplastyFat InjectionPGY-3 and 41. Describe principles of techniquePGY-51. Perform fat autograft harvest2. Perform a fat autograft injectionRhytidectomyPGY-3-51. Mark incisions for a rhytidectomy2. Discuss complications3. Describe a submental lipectomy and plication43

COMMUNICATORPGY-3-51. Obtains and synthesizes a relevant history from patients and family2. Writes a preliminary report on operations on chart3. Writes clear progress notes, clinic notes and discharge summaries is able toinform patients and families about their condition at an appropriate andunderstandable level4. Dictates concise and clear description of operations5. Writes clear and consultation notes and discharge summaries and clinic notes6. Prepares and presents rounds in an organized manner7. Participates actively in scheduled rounds8. Able to explain surgical interventions, options and expected morbidity andprognosis to patients and familiesCOLLABORATOR1. Works with ward, clinic and operating room nurses to manage patientsappropriately2. Identifies social, rehabilitative, dietetic concerns with patients and consultshand3. Therapists and appropriate allied health professionals4. Consults and works with medical specialists appropriatelyMANAGERPGY-3 and 41. Appropriate to level of training understand the importance of and mechanismsof safely utilize resources in a cost effective manner to benefit all patients2. Utilizes information technology to optimize learning3. Becomes practical and logical in the approach to clinical problem solvingPGY-51. Recommends practices to effectively utilize resources including titheundertaking of standard of care procedures44

HEALTH CARE ADVOCATEPGY-3 and 41. Become familiar with the important determinants of health affecting plasticsurgery patients such as smoking, obesity and other lifestyle and preventativemeasures2. Understands the data supporting prevention of primary and secondary illnessand morbidity in plastic surgery patients3. Understands the value of outcomes research for surgical procedures4. Treats the individual as a whole person acknowledging, cultural, social,economic, family and personal influences on their psychosocial make-up and ontheir health and illness5. Assesses all patients for risk factors for a variety of plastic surgical conditionsand advises appropriate interventions6. Utilizes preventative measures correctly7. Recognize and appropriately manages body dysmorphic disorderPGY-51. Understands the triage system of the surgical waitlist, it’s rationale, howpatients are upgraded2. Participates in research and assists in disseminating resulting informationSCHOLARRecognizes gaps in knowledge and develops strategies to correct this by self directedreading and consulting with other professionalsPGY-3-51. Contributes knowledge learned to service rounds2. Understands principles and practice of basic and applied research including thescientific method, design and conduct of clinical trials and critical appraisal ofliterature and the use of statistics3. Reads around clinical cases4. Prepares and presents scheduled rounds5. Participates actively in scheduled morbidity and mortality and Quality Assuranceconferences6. Actively participates in journal club7. Prepares and present clinical research papers at peer reviewed meetings/publishesin medical literature8. Participates effectively in teaching fellow professionals including juniorHouse staffPROFESSIONALPGY-3-51. Delivers care with integrity honesty and compassion2. Understands the professional, legal and ethical codes to which physicians arebound45

3. Exhibits appropriate personal and inter-personal professional behaviors4. At all times functions professionally5. Is sensitive to and responds appropriately to different patients of different socialstatus, ethnic groups, age and gender6. Exhibits appropriate professional behaviors for physician health and sustainablepractice46