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Customizing Residencies Based on Competency

For decades, integrated plastic surgery residencies across the country have operated in much the same way: at least six years of training after medical school centered on gaining the diverse set of skills necessary in this field. To progress through the residency program, trainees need to meet a variety of clinical and surgical milestones set by the Accreditation Council for Graduate Medical Education (ACGME). The program follows a set curriculum for every resident, regardless of the pace of their progression—as long as they meet these milestones, assessed every six months, they progress to the next stage.

But as useful as this training model has been, it doesn’t take into account individual differences in skills and learning, explains Scott Lifchez, program director of the Johns Hopkins/University of Maryland Plastic Surgery Residency.

“The current system allows trainees to pass using a minimum standard,” he says, “but it doesn’t allow people who are ahead of the curve to excel.”

To better address this void, Johns Hopkins has joined together with three other academic medical institutions—Baylor Scott & White (Texas A&M), the University of Michigan and the University of Pittsburgh—to form the Consortium for Competency-Based Plastic Surgery Training. This group’s aim, Lifchez says, is to promote a new residency model in which trainees are assessed frequently and promoted based on their attained skills, rather than the time they’ve spent in training.        

In the new model, Lifchez explains, residents who demonstrate competency in any areas early will move through their training sooner, with each curriculum customized to each resident.

With advances, a resident might be able to finish training up to a year faster, he adds.

“Pending ACGME approval in early 2018, this new model may apply to resident training as early as the next academic year,” Lifchez says.

Learning Through Apprenticeship

In may 2017, johns hopkins medicine launched a partnership with WellSpan Health, a health system that serves patients in central and southern Pennsylvania. As a result, residents training at Johns Hopkins’ Department of Plastic and Reconstructive Surgery are now able to train under the mentorship of Hooman Soltanian, a newly recruited department faculty member based at WellSpan York Hospital. Dr. Soltanian, a renowned microvascular surgeon, had been the interim chair of plastic surgery at Case Western. This training model allows for one resident to learn under one experienced attending—an apprenticeship style that’s currently not available elsewhere in the residency. “This complements other ways of learning plastic surgery by our residents,” Scott Lifchez says.

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