Northwestern University Feinberg School of Medicine

Department of Surgery

Plastic Surgery Residency Structure

2017-2018 Rotation Schedule

Structure of the Program

Northwestern Plastic Surgery Residency is a fully accredited 7-year integrated program (6 clinical, 1 research). The program has been in existence since 1970 and graduates 2 residents per year. 

Chief: Dr. Gregory A Dumanian

Program Director: Dr. Jason Ko

Assistant Program Directors: Dr. Mohammed Alghoul, Dr. Marco Ellis, Dr. Noopur Gangopadhyay

The program is structured to get residents into the OR and assign patient care responsibilities on Day 1 of the PGY-1 year. As residents gain experience progressing through the years, they are given more responsibility and independence as appropriate. The rotation structure is designed by the residents, Dr. Ko and Dr. Dumanian - we all work closely to ensure that every rotation is the best possible educational experience, with changes made on a yearly basis based on resident feedback.

Junior residents (PGY1-3) spend time rotating through other services to obtain a breadth of knowledge regarding surgical care at a very busy tertiary care institution. Familiarity with the referring services' procedures, protocols, and staff is invaluable in the senior years as we work together to provide reconstructive care. 

Overview by Year

PGY-1 NMH Plastic Surgery

As an intern, we spend two months on the downtown NMH plastic surgery service.  These two months are a combination of operative experience and caring for our inpatients.  Generally, the intern works on an every other day schedule, alternating every other day between being “in” the operating room versus “out” covering the floor and consults.  Due to the busy nature of our downtown service, the intern often is needed to help cover OR cases even on their “out” days.  Types of cases covered by the intern include a variety of breast reconstructive cases, breast reductions, abdominal wall reconstruction, local flaps for Mohs and skin cancer reconstruction, skin grafts and pressure sore reconstruction, among others.  Consults include facial trauma, frequent intra-operative consults for assistance with closure and flap coverage, open abdomens in the ICU needing closure, wounds for patients on the floor and trauma/orthopedic/surgical oncology/vascular consults for unique flap coverage.  The intern also works closely with our wonderful PAs to run the service.

PGY-2 NMH Plastic Surgery

As a PGY-2, we spend one month on the downtown NMH plastic surgery service.  This is a time to start honing in on surgical skills.  Much of this month is focused on breast reconstruction cases, along with increasing independence in all the variety of cases performed as an intern. 

PGY-3 NMH/VA Plastic Surgery

During the PGY3 year, the resident spends a total of 6 months at both the downtown NMH service and the Jesse Brown VA Medical Center (JBVAMC) - with Tuesday and Friday spent at the JBVAMC, and Monday, Wednesday and Thursday spent at NMH.

JBVAMC: The JBVAMC rotation serves as an introduction to graduated autonomy where the resident functions as the Administrative Chief of service. The resident runs Tuesday clinics where they will primarily evaluate patients and formulate their treatment plan prior to staffing cases with the attending. This process fosters critical thinking and requires great initiative on part of the resident to continually read and expand their knowledge base. Fridays are spent in the OR with both Dr. Dumanian and Dr. Ko. The resident is also responsible for the scheduling of surgical cases and contacting manufacturer representatives for any necessary implant and prosthetic materials. Common cases at the VA include: hand trauma and arthritis, skin cancer reconstruction, abdominal wall reconstruction, and breast reduction.  Furthermore, the PGY3 resident usually preforms 1-2 free flaps while at the VA.

NMH: As the midlevel resident on service, the PGY3 resident spends Monday and Thursday in the OR, and Wednesdays are spent in clinic with Dr. Dumanian.  The strengths of the NMH rotation are the high case volume, case diversity, and lack of fellows were the PGY3 residents functions as the primary assistant in most cases. The PGY3 resident is also expected to primarily evaluate consults and formulate a preliminary plan prior to discussing and staffing of the consult with the PGY5, PGY7, and attending. At NMH the residents are exposed to a wide gamut of cases including but not limited to: autologous and prosthetic breast reconstruction, abdominal wall reconstruction, orthoplastic lower extremity reconstruction, facial reconstruction after excision of skin cancer or other H&N malignancy, and cosmetic surgery. It is not uncommon for 2-3 free flaps to be occurring simultaneously. In these scenarios, the PGY3 is called upon for microsurgical case coverage. By the conclusion of the 6-month NMH rotation, the PGY3 will preform between 2-5 free flap reconstructions as the primary assistant where they perform the microvascular anastomosis.

Research year (PGY 4)

The residency supports a fully-funded, required research year as part of our commitment to academics. Opportunities within the Division include the Laboratory for Wound Healing & Regenerative Surgery, Laboratory for Craniofacial Biology, and Section for Plastic Surgery Outcomes Research. Other resources include laboratories at the Rehabilitation Institute of Chicago (RIC), Simpson Querry Institute for BioNanotechnology, and global health programs through Operation Smile in Mumbai.

The research year has been an academically productive time for the residents, with most presenting at multiple national meetings and a multide of publications arising from the work done during that year. This is also the only year that the residents are able to obtain moonlighting priviliges. Many residents also participate in related and extracurricular projects, including clinical research, travelling mini-fellowships and mission trips, or teaching in the surgical curriculum or the Medical School Anatomy curriculum.

PGY-5/6 NMH Plastic Surgery

In many ways the NMH service as a PGY5 is a coming of age that enables you to integrate all of the technical skills and knowledge you’ve gained in the first three clinical years and begin the transition from performing as a resident to performing as a surgeon.   Having freshly completed the research year in PGY4, you are hungry to get back in the operating room and the NMH service satisfies that desire abundantly. 

In terms of case mix, the PGY5 is expected to meet the demands of operative autonomy and judgment for increasingly complex cases that span the gamut of a general reconstructive plastic surgery service at a major Level 1 center.  These include complex abdominal wall reconstruction, lower extremity reconstruction with both pedicled (e.g. reverse sural, soleus, gastroc) and free flaps, adult craniofacial reconstruction (e.g. cranioplasty, free flap coverage of scalp wounds) and breast surgery of all varieties (breast reduction; breast reconstruction with TE, latissimus flaps, DIEP, secondary procedures; augmentation/mammoplasy), post-oncologic reconstruction across the body, and a steady flow of intra-operative consultations for coverage from the other busy surgical services at NMH (e.g. groin coverage of bypass grafts, coverage of spinal hardware, APR defects, etc.).  The NMH service has a high volume of reconstructive microsurgery, and approximately 30-40% of the free flaps are done by the PGY5 and attending, with the remainder done by the service chief (PGY7) and attending.  In addition, the NMH service offers the PGY5 an experience in body cosmetic surgery (abdominoplasty, thigh plasty, liposuction) and occasional facial cosmetic surgery cases. 

Equally as important as the unparalleled operative experience, the PGY5 rotation at NMH demands that you take the next step in terms of leadership and patient management.  A prior resident has used the analogy of the PGY5 being “chief of staff” to the PGY7, who acts as “president” overseeing the service.  All consults seen by the junior residents and PAs are filtered through the PGY5, providing the opportunity to think critically and make important patient care decisions on a daily basis.  The PGY5 similarly takes primary responsibility for patient decision making for the inpatient plastic surgery service. 

The PGY5 NMH service months are the most demanding of the year, but this makes possible the growth that each resident achieves through his or her experience.

PGY-7 NMH Plastic Surgery

The NMH service is a high volume, diverse service with majority reconstructive cases along with cosmetic cases and inpatient consults. By revisiting this rotation over several years throughout the program, the core adult faculty are able to provide pointed feedback and a higher degree of graded responsibility.  By chief year, we aim for independence and confidence in the operating room from secondary breast procedures to free flaps. On service, the chiefs are ultimately responsible for overseeing the team of PAs and residents, confirming daily plans made by the PGY 5/6s, and education.  

Overview by Site

TMR

NMH - Northwestern Memorial Hospital

The flagship site of the program, it is also by far the busiest and most diverse experience, involving the residents in all types of aesthetic and reconstructive procedures practiced today. NMH is a busy academic center and an award-winning hospital, recently ranked 13th in the nation and 1st in Chicago and Illinois (see here). By revisiting this rotation over several years throughout the program, the core adult faculty (8 full-time faculty) are able to provide pointed feedback and a higher degree of graded responsibility.

Case mix includes the entire spectrum of complex abdominal wall, lower extremity, adult craniofacial, oncologic, pressure ulcer, and Mohs reconstruction, as well as breast surgery of all varieties (breast reduction; implant-based breast reconstruction, latissimus flaps, DIEP, secondary procedures; augmentation, mastopexy) and a steady flow of operative consultations from the other busy surgical services at NMH.  The aesthetic experience at NMH is composed of all aesthetic cases done in the ORs at NMH and the numerous in-office procedures, as well as the Chief Cosmetic Clinic Cases. Multiple free flaps are performed per week and residents have consistently done free flaps before the end of the PGY3 year. The residents on the NMH service gain operative skill and independence at a rapid pace due to the high operative volume, and the graduating chiefs easily exceed all the ACGME requirements by a large margin.

The plastic surgery service at NMH is composed of 2 PGY1s, a PGY3, and 2 to 3 senior residents (PGY4 and above) at all times, and runs smoothly thanks to the incredible help of 3 of the best PA's around.

Aesthetic

The chief aesthetic rotation is our opportunity to dedicate time to the evaluation and conduct of aesthetic surgery, with an emphasis on facial aesthetic surgery.  We will spend 3 out of 5 days with Dr. Thomas Mustoe, former chief of the division, in his private practice.  The remainder of the week will be spent rotating with other core faculty.  In addition, the chiefs run a resident cosmetic clinic one afternoon per week throughout the year.

Shriner’s Pediatric Plastic Surgery

Shriner’s is a unique rotation that is commonly thought of as one of the favorite rotations of our residency program.  Shriner’s Hospital for Children is located in the Oak Park suburb of Chicago and sees patients who travel here from all over the United States to receive specialized care in pediatric plastic surgery.  This particular Shriner’s hospital focuses on three areas: plastic surgery, orthopedic surgery and neurosurgery.  Unlike many other Shriner’s hospitals that focus on pediatric burn care, the cases here are focused on pediatric craniofacial.  Residents operate four days a week with one day of cleft clinic per week.  Cases here generally include anywhere from one to three LeFort Is and BSSOs per week, cleft lip and palate repairs, cleft rhinoplasty revisions, facial reanimation, free fibula flaps and other reconstructions for hemifacial microsomia and complex facial cleft repairs. This rotation is now staffed by a junior and a senior resident. 

Lurie_Service

Lurie Children’s Plastic Surgery

Ann and Robert H. Lurie Children’s Hospital of Chicago was completed in 2012 and is located on the downtown campus adjacent to Northwestern Memorial Hospital and Prentice Women’s Hospital. It is a tertiary care center that gives wide exposure to pediatric plastic surgery, including cleft lip and palate, craniosynostosis, orthognathic, distraction osteogenesis, facial reanimation, vascular anomalies, and the full-­‐breadth of pediatric hand and plastic surgery. Multidisciplinary clinics coordinate care for cleft, craniofacial and vascular lesion patients. Our three core plastic surgery faculty are craniofacial and/or microsurgery trained. Several community plastic surgeons operate at Lurie as well, broadening our exposure. Three-month rotations are spent at Lurie Children’s Hospital in the second, fifth, and sixth years. Dr. Gangopadhyay is the Clerkship Director for the Pediatric Plastic Surgery rotation at Lurie Children's.

Hand

The hand rotation spans 3 months of both 5th year and 6th year.  This time is spent with the surgeons of Northwestern’s Chicago Center for Surgery of the Hand, a group of seven fellowship-trained hand surgeons (2 plastic surgeons and 5 orthopedic).  The experience spans the breadth of hand and upper extremity surgery, including elective hand surgery, bony and soft tissue trauma, and complex reconstructive microsurgery and brachial plexus surgery.  Plastic surgery residents are the most senior level resident on the service and split call with several orthopedic surgery residents.  Educational conferences (in addition to standard plastic surgery curriculum) during this time include weekly indications conference and hand educational conference.  A typical week is approximately 1.5 days in clinic and 3.5 days in the operating room, at both an outpatient surgical center and at Northwestern’s main campus.

UC Burn

The residents spend 1 month as part of the team at the excellent Burn Unit at the University of Chicago during the PGY-2 year. This experience allows the residents to experience the full scope of pediatric and adult burn care, from evaluation to surgical care to postoperative and secondary management. 

SIU Hand Trauma

NMH is a busy Level I trauma center, but the hand trauma experience is supplemented with a 1 month rotation at Southern Illinois University at the end of the PGY3 year to expose the residents to a higher volume of traumatic hand injuries under the guidance of Dr. Neumeister and his excellent faculty. 

Call

NMH and Lurie cross-­‐cover home call runs from 6pm to 6am Monday through Friday. The week is generally organized as follows: Monday Lurie PGY5/6, Tuesday NMH PGY 5/6, Wednesday NMH PGY3, Thursday off service PGY3, Friday off service PGY2; the NMH PGY5/6 or chief takes back-­‐up call. Weekends are covered separately by NMH and Lurie services. NMH face call is shared with ENT and OMFS. Lurie hand call is shared with orthopedics. NMH hand call is a separate pool made up of the plastics hand resident and orthopedics residents.