The Resident Experience
This page is intended to answer some of your questions about our day-to-day schedule, our monthly rotation schedule, and our overall procedural experience.
The Integrated Program in Plastic Surgery at the Medical College of Wisconsin
The integrated model has been in place at the Medical College of Wisconsin since 1996. MCW is one of 45 fully accredited integrated Plastic Surgery training programs in the country. This accreditation means that it has received approval from the Residency Review Committee in Plastic Surgery and is different from other training programs that may call themselves "combined." In the Integrated Program, there is a true coordination and planning to provide directed general surgery training in addition to other surgical disciplines not normally involved in general surgery training. During your PGI and PGII years Sixty-five percent of the rotations are concurrent with general surgery residents at their respective levels, but there are also some rotations that are outside of the typical general surgery rotation, including one month of Moh's surgery, one month of orthopaedic surgery, one month of ENT, one month of oral surgery and six months of plastic surgery. During the first two years of their training as integrated residents, residents receive instruction and educational experience in burn management, cardiothoracic surgery, general surgery, pediatric surgery and trauma management. Each of these rotations has specific educational objectives and an assigned mentor to aid in attaining these objectives.
After successful completion of two years of directed general surgery training in the Integrated Program, the residents complete their Plastic Surgery training at the Medical College of Wisconsin over the next 48 months. After successful completion of six years in Plastic Surgery, the integrated resident will be considered board eligible. Opportunities for an additional year at MCW include 1) Fellowship in Hand and Microsurgery and 2) Fellowship in Craniofacial Surgery.
Resident Work Hours and Call
Although duty hours may vary from rotation-to-rotation, residents and staff work together through teaching and personal supervision between 70 and 75 hours per week. Sr. Residents have cosmetic clinic on Thursday and Friday afternoons. Typical operating room days include preoperative rounds beginning at 7 a.m. and a full day in the operating room from 8 a.m. - 4 p.m. Depending on the rotation, the resident may be on call as frequently as 1 of 3 nights or as infrequently as 1 of 5 nights. All call is taken from home, but there is a room available for the resident to stay overnight in each institution if necessary.
The residents are provided with a broad spectrum of plastic surgery by rotating to one of 3 hospitals – Froedtert Hospital (which functions as the "university hospital), Children's Hospital of Wisconsin (the only such hospital in the state), and the Clement A. Zablocki Veterans Administration Hospital (one of 3 in the state). Virtually all specific clinical areas of required experience are satisfied at Froedtert Hospital except those directly involving children, which, by agreement of the 2 institutions, are performed at Children's Hospital. The Veteran's Hospital provides experience related to cancer reconstruction, management of pressure sores and other chronic wounds, assorted cases of hand and facial trauma, and an occasional cosmetic case. While at the VA Hospital, the residents assume all pre and postoperative management of the patients. While at Froedtert Hospital, they are actively involved with all trauma and emergency admissions preoperatively as well as intra-operatively and postoperatively. In elective surgeries the residents' responsibility is primarily intraoperative and postoperative. In an attempt to address the preoperative input of elective cases, we have instituted a one-month elective for the residents that they may take with the staff physician of choice. In this elective, they are with him in his clinic for pre and postoperative evaluations, as well as to work in the operating room. This arrangement has been a positive experience in the view of the residents.
Residents are provided with graduated and progressive patient management responsibilities by full-time observation and involvement of the faculty during the first 6-8 weeks of a 3-month rotation and then as the resident's skills increase, more responsibility for patient management is given to the resident. It has been our experience that in the integrated program, this graduated and progressive management has been a slower process because of the 2 years of general surgery training that those trainees are receiving. The outpatient facilities used for resident experience are the same as those of the faculty. There is a small operatory in our main office. Residents can schedule small cases themselves in the plastic surgery operatory, or with supervision, operate on the patients they acquire through the residents' cosmetic clinic. This is viewed as an important training experience for the residents since they are required to assume responsibility for preoperative evaluation on the informed consent and intraoperative and postoperative care. Surgery is performed in both the outpatient and the inpatient setting. Most of this type of surgery is cosmetic in nature (breast, rhinoplasty, facelift, blepharoplasty, and liposuction). Again, the residents are supervised by the faculty in almost all cases and all preoperative cosmetic cases are screened and personally interviewed by the faculty staffing them. At the present time, the only means by which outpatient assignments provide residents with experience in patient follow-up is by word of mouth of the faculty member directly involved or the nurse working with him, and during the one-month rotation with the specific faculty member of their choice.