Richard J. Warren

Competency-based medical education for plastic surgery: where do we begin?

Background: North American surgical education is beginning to shift toward competency-based medical education, in which trainees complete their training only when competence has been demonstrated through objective milestones. Pressure is mounting to embrace competency-based medical education because of the perception that it provides more transparent standards and increased public accountability. In response to calls for reform from leading bodies in medical education, competency-based medical education is rapidly becoming the standard in training of physicians. Methods: The authors summarize the rationale behind the recent shift toward competency-based medical education and creation of the milestones framework. With respect to procedural skills, initial efforts will require the field of plastic surgery to overcome three challenges: identifying competencies (principles and procedures), modeling teaching strategies, and developing assessment tools. The authors provide proposals for how these challenges may be addressed and the educational rationale behind each proposal. Results: A framework for identification of competencies and a stepwise approach toward creation of a principles oriented competency-based medical education curriculum for plastic surgery are presented. An assessment matrix designed to sample resident exposure to core principles and key procedures is proposed, along with suggestions for generating validity evidence for assessment tools. Conclusions: The ideal curriculum should provide exposure to core principles of plastic surgery while demonstrating competence through performance of index procedures that are most likely to benefit graduating residents when entering independent practice and span all domains of plastic surgery. The authors advocate that exploring the role and potential benefits of competency-based medical education in plastic surgery residency training is timely.

Cosmetic surgery training in Canadian plastic surgery residencies: are we training competent surgeons?

BACKGROUNDnWith the demand for cosmetic surgery continuing to rise, it is necessary to reevaluate the current state of cosmetic surgery training during plastic surgery residency. An evaluation of cosmetic surgery training in US plastic surgery residency programs in 2006 identified several areas for improvement, resulting in changes to both the duration and content of training.nnnOBJECTIVESnThe authors assess the current state of cosmetic surgery training in Canadian plastic surgery residency programs.nnnMETHODSnA paper survey of all graduating Canadian plastic surgery residents eligible to complete the 2009 Royal College of Physicians and Surgeons of Canada fellowship examinations was performed (N = 29). The survey was conducted primarily at the Canadian Plastic Surgery Review Course in February 2009, with surveys collected from absent residents by e-mail within 1 month after the course. The survey covered 2 broad areas: (1) specifics regarding resident cosmetic surgery training and (2) confidence and satisfaction associated with this experience.nnnRESULTSnOf the 29 residents surveyed, 28 responded (96%). The majority of Canadian plastic surgery residency programs (75%) have a designated cosmetic surgery rotation, but 90% of respondents felt it has become increasingly difficult to gain exposure to cosmetic procedures as most are performed at private surgery centers. Elective rotations at cosmetic surgery practices and resident cosmetic clinics were considered the most beneficial for cosmetic surgery education. Residents considered cosmetic surgery procedures of the face (such as rhinoplasty and facelift) more challenging, but they had more confidence with breast and body contouring procedures.nnnCONCLUSIONSnCanadian plastic surgery residency programs need to ensure that residents continue to receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure our specialtys continued leadership in this evolving and highly competitive field. A multidimensional approach utilizing a variety of readily available resources will ensure that the current and future cosmetic surgery educational needs of Canadian plastic surgery residents are met.

Ordered distribution of α-putrescinylthymine in the DNA of bacteriophage φW-14

In the DNA of bacteriophage ϕW-14, half the thymine is replaced by a α-putrescinylthymine (putThy). Analysis of monopyrimidine tracts shows that putThy and thymine are distributed nonrandomly in φW-14 DNA: The sequence purine-putThy-purine occurs more than twice as frequently as the sequence purine-thymine-purine, which means that the post-replicative modification of φW-14 DNA is sequence-specific.

The Modified Lateral Brow Lift

In the aging face, the lateral third of the brow ages first and ages most. Aesthetically, eyebrow shape is more significant than height and eyebrow shape is highly dependent on the level of the lateral brow complex. Surgical attempts to elevate the brow complex are usually successful medially, but often fail laterally. The modified lateral brow lift is a hybrid technique, incorporating features of an endoscopic brow lift (small hidden incisions, deep tissue fixation) and features of an open coronal brow lift (full thickness scalp excision). Sensory innervation of the scalp is preserved and secure fixation of the elevated lateral brow is achieved. Side effects and complications are minimal.

The table tilt: Preventing traction on the brachial plexus during facelift surgery

Rhytidectomy remains a popular cosmetic surgical procedure, with recognized risks and complications.1 Surgeons who regularly perform facelifts continually seek out methods to improve their outcomes, which includes minimizing complications. We recently noticed a troublesome sequela not previously described: patients’ complaining of …

Apparent variability in expression of the Bla+ phenotype of plasmid RP1 inPseudomonas acidovorans (RP1) strains

Expression of the Bla+ phenotype of the incompatibility group P-1 plasmid RP1 appears to be a variable phenomenon inPseudomonas acidovorans strains, although all plasmid-bearing strains examined synthesize the RP1-encoded TEM 2 β-lactamase. There is also evidence suggesting that plasmid-encoded alterations to the outer membrane could be affecting the degree of resistance observed to β-lactam drugs in at least some strains.