Models of Training

Plastic Surgery Training Models: Based Upon the ACGME Program Requirements for Graduate Medical Education in Plastic Surgery⁵

The Accreditation Council of Graduate Medical Education (ACGME), an independent, non-governmental accreditation body for graduate medical education, recognizes two training models: independent and integrated. Both the integrated and the independent models require a minimum of six years of clinical surgical education in which a minimum of three years are concentrated in plastic surgery education.

The primary difference between the integrated and the independent models is where the prerequisite training takes place. In the independent model, residents complete the  prerequisite training outside of the plastic surgery residency process in a surgical program accreddited by the Accreditation Council of Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPSC), or the American Dental Association (see below). In the integrated model, residents complete core surgical training and the plastic surgery-specific training under the authority and the direction of the plastic surgery program director.

Independent model

In the independent model of training, the residents complete the prerequisite training outside of the plastic surgery residency process followed by three years of concentrated plastic surgery training, with no less than 12 months of senior/chief responsibility in plastic surgery after successful completion of one of the following prerequisite curricula:

• Complete an ACGME-accredited residency in general surgery, including vascular surgery, neurological surgery, orthopedic surgery, otolaryngology, thoracic or urology;
• Satisfactory completion of a residency program in Oral and Maxillofacial surgery approved by the ADA is an alternate pathway for prerequisite training prior to a plastic surgery residency. This pathway is available only to those individuals holding a D.M.D./M.D. or D.D.S./M.D. degree. Training must also include a minimum of 24 months of progressive responsibility on surgical rotations under the direction of the general surgery program director after receipt of the M.D. degree. Rotations in general surgery during medical school, prior to the M.D. degree, will not be considered as fulfilling any part of the 24-month minimum requirement. 

Integrated model

In the integrated model, residents complete six years of ACGME-accredited plastic surgery training following receipt of an M.D. or D.O. degree from an institution accredited by the Liaison Committee on Medical Education or the American Osteopathic Association.

• The integrated curriculum must contain six years of clinical surgical training under the authority and direction of the plastic surgery program director.
• Of these, 36 months must be concentrated plastic surgery training with no less than 12 months of senior/chief responsibility on the clinical service of plastic surgery. Residents must complete the last 36 months of their education in the same plastic surgery program.
• The curriculum includes the basic experience in clinical general surgery. Additional clinical experiences appropriate to the training of a plastic surgeon should be provided in alimentary tract surgery, abdominal surgery, breast surgery, emergency medicine, pediatric surgery, surgical critical care, surgical oncology, transplant, trauma management and vascular surgery. 

References

1. The American Board of Plastic Surgery, Ind., Booklet of Information, July1, 2011 - June 30, 2012.
2. The American Medical Association, Policy Compendium, 1999, p. 673.
3. American Board of Medical Specialities; "What Board Certification Means." Accessed December 2010.
4. The American Board of Plastic Surgery, Inc., 2011 Certification in the Subspecialty of Surgery Of The Hand (SOTH).  Accessed January 2011.
5. ACGME Program Requirements for Graduate Medical Education in Plastic Surgery, Effective July 1, 2009.