Brown University Alpert Medical School | Rhode Island Hospital
Department of Plastic and Reconstructive Surgery
EDUCATIONAL
MISSION
PROGRAM DESIGN
UNIQUE ASPECTS
DIDACTICS
The Integrated Plastic Surgery program at Brown University/Rhode Island Hosital is committed to providing a comprehensive foundation for its graduating residents in both aesthetic and reconstructive scenarios. Success is defined as the production of capable, independent practitioners who will actively contribute to the field. The clinical half is bolstered by an increasingly high and broad surgical volume, while its academic counterpart continues to grow with frequent contribution to scholarly journals and participation in regional and national conferences. Additionally, numerous faculty are active participants in multiple academic societies, including the Plastic Surgery Research Council.
In line with this philosophy, interns are identified as plastic surgery residents from their first steps into the hospital. Protected time is given while off-service in order for residents to participate in a variety of weekly academic conferences and visiting professorships. The program stresses the continuity of these six years of training, as the constant communication and interaction among plastic surgery residents is critical to developing a sense of identity and the unique clinical acumen required of the plastic surgeon.
Highlights of our clinical program include
• 18 months of General Surgery experience distributed among PGY1-3 years. Rotations are carefully selected to optimize the development of clinical skills and judgment necessary for the safe and effective practice of plastic surgery.
• Our program draws on all the resources of a major academic medical center to provide off-service rotations in select surgical subspecialties. These complementary experiences highlight the inherently interdisciplinary nature of plastic surgery.
• Residents PGY 3-6 follow a rotating apprenticeship model, with operating room and clinic responsibilities dependent on the particular attending with whom they are training. Attending assignments are 3-months in duration.
PGY-1
The surgical oncology intern manages pre- and post-operative patients with breast, soft tissue, and hepatopancreaticobiliary neoplasms. There is significant operative exposure to these complex resections during the rotation.
The vascular intern develops skills in work-up and management of peripheral vascular disease, as well as complex wound management. Teaching conferences emphasize vascular anatomy and perioperative management of patients with significant cardiac and respiratory co-morbidities. The service is also home to Rhode Island’s renal and pancreatic transplant program.
The busy ACS service provides broad exposure to the diversity of clinical problems in general surgery. Strong support from mid-level practitioners on the service means interns are frequently sent to the operating room. They also get their first experience in the triage, work-up, and management of acute general surgical problems seeing consults at Rhode Island Hospital.
The trauma intern manages multisystem trauma and burn patients on the floor and is involved in primary resuscitation in all level A and B trauma activations. The trauma intern is routinely assigned to primary and secondary burn reconstruction operations.
The TICU intern manages critically ill trauma patients in the 11-bed Trauma ICU. The fundamentals of managing shock and respiratory failure are emphasized on daily teaching rounds. Residents gain experience in central and arterial line placement, endotracheal intubation, percutaneous tracheostomy, and bronchoscopy.
One of the most heavily operative rotations for interns, Pediatric Surgery provides the opportunity to learn the surgical management of ill children. Further, Hasbro Children’s Hospital, a Pediatric Level 1 Trauma Center, relies on the Pediatric Surgery team to lead the work-up and management of pediatric trauma. Interns see all surgical consults in the Hasbro Emergency Department and participate in daily teaching rounds on the floors, PICU, and NICU.
The surgical service at the VA provides a high volume of general, vascular, and thoracic surgery, as well as experience in head and neck surgery. The busy clinics allow residents to enjoy continuity with their patients. The minor procedure room is the ideal learning environment for interns to master fundamental surgical technique.
The Anesthesia rotation involves residents in perioperative patient management, especially as it relates to cardiovascular, respiratory, and metabolic changes that accompany surgery. Mastery of common procedures including endotracheal intubation, as well as arterial and central line placement, is emphasized.
With two PGY1 residents covering the various General Surgery services overnight, the Night float rotation, for many interns, forms the foundation for independent patient management. With a total of nine general surgery residents and one attending surgeon in-house overnight, the rotation provides an optimal balance of autonomy and oversight.
With a busy elective and emergency general surgery service, interns at The Miriam Hospital gain significant exposure to the full breadth of general surgery, seeing consults in the Emergency Department. As one of the most heavily operative rotation for interns, dedicated time in the OR for interns is a highlight of this rotation.
Interns have the opportunity to spend time with Oral Maxillofacial Surgery. Steve Brown, DMD works closely with our department performing orthognathic surgeries and complex mandible reconstruction.
Surgical Oncology
Vascular/Transplant
Acute Care Surgery (ACS)
Trauma
Trauma Intensive Care Unit (TICU)
Pediatric Surgery
VA
Anesthesia
Nights
The Miriam Hospital
OMFS
PGY-2
PGY-2s return to the Trauma service as senior residents responsible for evaluation and initial management of all trauma patients at Rhode Island Hospital, one of the busiest trauma centers in the United States. There is a heavy volume of operative trauma, both blunt and penetrating. In managing these patients, plastic surgery residents gain experience in both common (chest tube and central line placement) and uncommon (ED thoracotomy) resuscitative procedures. They also serve as the senior resident for the Trauma service and the TICU overnight.
The PGY-2 spends time in the SICU to become comfortable managing shock (septic, cardiogenic, hemorrhagic), respiratory failure, and multisystem organ failure while mastering accompanying procedures including endotracheal intubation, central line placement, and invasive monitoring.
PGY-2s return to ACS as the General Surgery consult resident at Rhode Island Hospital. There is sufficient operating room experience between consults. They are responsible for overseeing the general surgery inpatient services overnight.
Serving as a senior resident for the General Surgery service, PGY-2s and 3s are also responsible for all Plastic Surgery inpatients. The rotation at The Miriam is the most heavily operative of the junior years, including cases in complex abdominal surgery as well as in general plastic and hand surgery.
Returning to the Vascular Surgery services as a PGY2, plastic surgery residents serve as the dedicated Transplant resident. They perform a large number of dialysis access procedures and are involved in renal and pancreatic transplants. They are also responsible for managing inpatient transplant patients, as well as attending multidisciplinary rounds and clinic.
The PGY-2 Dermatology rotation includes significant time in Mohs, the interdisciplinary melanoma clinic, general dermatology clinic, and the dermatopathology lab.
The PGY-2 Ophthalmology rotation provides the opportunity to improve the ocular exam, especially as it relates to trauma or complications of periorbital surgery. Accordingly, time is spent in the operating room with Oculoplastic Surgery as well as in the Emergency Department and inpatient floors seeing consults with the Ophthalmology residents.
Trauma
Surgical Intensive Care Unit (SICU)
Acute Care Surgery (ACS)
Miriam General/Plastic Surgery
Vascular Surgery
Dermatology
Ophthalmology
PGY-3
Serving as a senior resident for the General Surgery service, PGY-2s and 3s are also responsible for all Plastic Surgery inpatients. The rotation at The Miriam is the most heavily operative of the junior years, including cases in complex abdominal surgery as well as in general plastic and hand surgery.
While on the busy orthopedic trauma service, PGY3s learn the surgical management of complex long bone fractures, both in the Emergency Department and in the OR. Transitioning to the orthopedic hand service, he/she gains experience in the clinic and operating room with a high volume of elective hand, elbow, and shoulder procedures.
The PGY3 ENT rotation involves participation in the operating room for the full breadth of adult and pediatric head and neck surgery. The clinic experience affords sufficient exposure to nasopharyngoscopy and other minor procedures. Consults provide complementary experience for management of facial trauma, complex airway management, and head and neck infections.
The Neurosurgery rotation provides PGY3s sufficient experience in neurological intensive care, as well as operative experience in intracranial and spine surgery, especially as they relate to the craniofacial and reconstructive operations undertaken by our department.
Residents on the Blue Team are primarily dedicated to craniofacial/pediatric plastic surgery, facial aesthetic and oculoplastic surgery, as well as oral and maxillofacial surgery. They staff surgeries and clinics with Drs. Albert Woo, Patrick Sullivan, Karl Breuing, Lee Edstrom, Jeffrey Hofmann, and Steven Brown.
Residents on the Green Team spend most of their time on surgery of the hand, upper extremity, and peripheral nerve. They staff clinics with Drs. Scott Schmidt, Jin Bo Tang, Reena Bhatt, and Jack Bevivino. The PGY-4 or 5 on the Green Team is the dedicated VA resident, and is responsible for clinics and cases at the VA.
Residents on the Red Team cover a broad range of reconstructive and aesthetic surgery, including reconstruction of the head & neck, breast, abdomen, trunk, and lower extremity. They utilize the diverse expertise of the Red Team attendings and employ the full breadth of reconstructive options, including free tissue transfer. They follow their patients in the clinics of Drs. Paul Liu, Richard Zienowicz, Rachel Sullivan, and Daniel Kwan.
PGY3s get an unique opportunity to perform lasers and injectables with dermatologists in the community. This allows residents to experience a different viewpoint for performing these procedures.
Miriam General/Plastic Surgery
Orthopedic Surgery
Otolaryngology (ENT)
Neurosurgery
Plastics Blue Team
Plastics Green Team
Plastics Red Team
Derm Lasers/Injectables
PGY-4, 5, 6
Residents on the Blue Team are primarily dedicated to craniofacial/pediatric plastic surgery, facial aesthetic and oculoplastic surgery, as well as oral and maxillofacial surgery. They staff surgeries and clinics with Drs. Albert Woo, Patrick Sullivan, Karl Breuing, Lee Edstrom, Jeffrey Hofmann, and Steven Brown.
Residents on the Green Team spend most of their time on surgery of the hand, upper extremity, and peripheral nerve. They staff clinics with Drs. Scott Schmidt, Jin Bo Tang, Reena Bhatt, and Jack Bevivino. The PGY-4 or 5 on the Green Team is the dedicated VA resident, and is responsible for clinics and cases at the VA.
Residents on the Red Team cover a broad range of reconstructive and aesthetic surgery, including reconstruction of the head & neck, breast, abdomen, trunk, and lower extremity. They utilize the diverse expertise of the Red Team attendings and employ the full breadth of reconstructive options, including free tissue transfer. They follow their patients in the clinics of Drs. Paul Liu, Richard Zienowicz, Rachel Sullivan, and Daniel Kwan.
One month of each year PGY4-6 is spent on away rotations to complement their experience in Rhode Island. These rotations are organized with the assistance of department personnel and may include a variety of domestic or international experiences, including mission trips like Operation Smile. Recent graduates have used this time to train at the following institutions:
o Chang Gung Memorial Hospital (Taipei, Taiwan)
o MD Anderson Cancer Center (Houston, Texas)
o Memorial Sloan Kettering Cancer Center (New York, New York)
o The Buncke Clinic (San Francisco, California)
o The Hospital for Sick Children (Toronto, Canada)
o Massachusetts General Hospital (Boston, Massachusetts)
o Asan Medical Center (Seoul, South Korea)
o Seoul National University Hospital (Seoul, South Korea)
o Hospital de la Santa Creu i Sant Pau (Barcelona, Spain)
Plastics Blue Team
Plastics Green Team
Plastics Red Team
Away Elective
One month of each year PGY4-6 is spent on away rotations to complement their experience in Rhode Island. These rotations are organized with the assistance of department personnel and may include a variety of domestic or international experiences, including mission trips like Operation Smile. Recent graduates have used this time to train at the following institutions:
o Chang Gung Memorial Hospital (Taipei, Taiwan)
o MD Anderson Cancer Center (Houston, Texas)
o Memorial Sloan Kettering Cancer Center (New York, New York)
o The Buncke Clinic (San Francisco, California)
o The Hospital for Sick Children (Toronto, Canada)
o Massachusetts General Hospital (Boston, Massachusetts)
o Asan Medical Center (Seoul, South Korea)
o Seoul National University Hospital (Seoul, South Korea)
o Hospital de la Santa Creu i Sant Pau (Barcelona, Spain)
A comprehensive didactic/conference schedule complements clinical experiences
Mondays: weekend review, where consults from the weekend are reviewed with attendings and discussed regarding evaluation and operative planning
Tuesdays: Combined Orthopedic-Plastic Surgery Hand Conference attended by plastic surgery staff as well as orthopedic staff including Dr. Edward Akelman (former president of ASSH)
Wednesdays: Grand Rounds and Plastic Surgery Education Network (PSEN) review
Monthly: Trauma-Plastic Surgery Combined Burn Conference, ENT-Plastic Surgery Combined Craniofacial Trauma Conference
Quarterly: Journal Club
Annually: The Versaci and Sexton Lectureships. Recent speakers include Dr. Andrew Lee (Johns Hopkins) and Dr. Julian Pribaz (Brigham and Women’s Hospital)
*Brown University Alpert Medical School Division of Plastic and Reconstructive Surgery