Plastic Residency Training Manual

University of Louisville
Plastic Surgery Residency
Training Manual

Educational Programs, Policies, and Guidelines
for Progression and Graduation

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PREFACE – THE OATH OF HIPPOCRATES
Table of Contents
1. INTRODUCTION AND ACADEMIC MISSION OF THE PROGRAM .................................................................................. ‐ 5 ‐
2. EDUCATIONAL PROGRAM: THE TEACHING PHILOSOPHY, ACGME CORE COMPETENCIES, AND SPECIALTY GOALS ...... ‐ 6 ‐
3. GENERAL OBJECTIVES AND RESIDENT EVALUATION PARAMETERS (COMMON TO ALL CLINICAL SERVICES) .............. ‐ 12 ‐
4. CLINICAL COMPONENTS OF THE FIELD OF PLASTIC SURGERY .................................................................................. ‐ 15 ‐
5. THE CLINICAL SERVICES: THE EDUCATIONAL GOALS AND EVALUATION PARAMETERS FOR EACH ROTATION ........... ‐ 16 ‐
6. EDUCATIONAL CONFERENCES AND ROUNDS .......................................................................................................... ‐ 30 ‐
7. ETHICS CURRICULUM ............................................................................................................................................. ‐ 36 ‐
8. MEDICAL‐LEGAL CURRICULUM ............................................................................................................................... ‐ 37 ‐
9. SOCIOECONOMICS & PRACTICE MANAGEMENT EDUCATION .................................................................................. ‐ 38 ‐
10. ANNUAL SYMPOSIA AND VISITING PROFESSORS .................................................................................................. ‐ 40 ‐
11. KEEPING THE PLASTIC SURGERY OPERATIVE LOG (PSOL) ....................................................................................... ‐ 43 ‐
12. BASIC SCIENCE EDUCATION AND RESEARCH EXPERIENCE ...................................................................................... ‐ 44 ‐
13. ETHICS, HONESTY AND CONDUCT ......................................................................................................................... ‐ 45 ‐
14. TEACHING RESPONSIBILITIES ................................................................................................................................ ‐ 46 ‐
15. SERVICE ROTATION SCHEDULE ............................................................................................................................. ‐ 46 ‐
16. DUTY HOURS LIMITATIONS .................................................................................................................................. ‐ 48 ‐
17. CALL RESPONSIBILITY ........................................................................................................................................... ‐ 50 ‐
18. FACULTY SUPERVISION AND RESIDENT OPERATING ROOM STAFFING ................................................................... ‐ 54 ‐
19. THE MEDICAL RECORD ......................................................................................................................................... ‐ 60 ‐
20. MEDICAL RECORD DOCUMENTATION FOR MEDICARE COMPLIANCE ..................................................................... ‐ 61 ‐
21. ACCURATE BILLING PROTOCOL ............................................................................................................................. ‐ 62 ‐
22. TRANSITION OF CARE ........................................................................................................................................... ‐ 63 ‐
23. HIPAA COMPLIANCE ............................................................................................................................................. ‐ 66 ‐
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24. TIME OFF POLICY .................................................................................................................................................. ‐ 70 ‐
25. OVERSEAS HUMANITARIAN MISSIONS ................................................................................................................. ‐ 73 ‐
26. OUTSIDE EMPLOYMENT ....................................................................................................................................... ‐ 73 ‐
27. ROLE OF THE PLASTIC SURGERY RESIDENT IN THE EDUCATION OF THE UNDERGRADUATE MEDICAL STUDENT ...... ‐ 75 ‐
28. ONGOING COMMITTEES ....................................................................................................................................... ‐ 76 ‐
29. ONGOING EVALUATIONS...................................................................................................................................... ‐ 78 ‐
30. RESIDENT PERFORMANCE EVALUATION ............................................................................................................... ‐ 79 ‐
31. GUIDELINES FOR ADVANCEMENT AND PROGRAM COMPLETION .......................................................................... ‐ 80 ‐
32. IN‐SERVICE EXAMINATION ................................................................................................................................... ‐ 81 ‐
33. RESIDENT GRIEVANCES ........................................................................................................................................ ‐ 82 ‐
34. DISCIPLINARY ACTIONS AND GROUNDS FOR DISMISSAL ....................................................................................... ‐ 83 ‐
35. POLICY ON RESIDENT RECUITMENT ...................................................................................................................... ‐ 84 ‐
36. APPLICATION FOR EXAMINATION BY THE AMERICAN BOARD OF PLASTIC SURGERY ............................................. ‐ 87 ‐
37. STRESS AND FATIGUE IN THE WORKPLACE ........................................................................................................... ‐ 87 ‐
38. PERSONAL AND UPFRONT .................................................................................................................................... ‐ 89 ‐
39. GUIDE TO THE APPENDICES .................................................................................................................................. ‐ 90 ‐
40. CONFIRMATION OF UNDERSTANDING .................................................................................................................. ‐ 92 ‐
ATTACHMENT 1: BLOCK ROTATION AND DESCRIPTION OF SERVICES .......................................................................... ‐ 93 ‐
ATTACHMENT 2: PRINCIPLES OF MEDICAL ETHICS ...................................................................................................... ‐ 94 ‐
*Manual originally prepared by Gordon Tobin, M.D. Updated by Bradon Wilhelmi, M.D. and Larry Florman, M.D. in 2017.
Formatting converted by Andrea Sinclair in 2018.
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PREFACE
Oath of Hippocrates
From HIPPOCRATIC WRITINGS, translated by J. Chadwick and W. N. Mann, Penguin Books, 1950.
I swear by Apollo the healer, by Aesculapius, by Hygeia (health) and all the powers of healing, and call to witness
all the gods and goddesses that I may keep this Oath, and promise to the best of my ability and judgment:
I will pay the same respect to my master in the science (arts) as I do to my parents, and share my life with him
and pay all my debts to him. I will regard his sons as my brothers and teach them the science, if they desire to
learn it, without fee or contract. I will hand on precepts, lectures, and all other learning to my sons, to those of
my master, and to those pupils duly apprenticed and sworn, and to none other.
I will use my power to help the sick to the best of my ability and judgment; I will abstain from harming or
wrongdoing any man by it.
I will not give a fatal draught (drugs) to anyone if I am asked, nor will I suggest any such thing. Neither will I give
a woman means to procure an abortion.
I will be chaste and religious in my life and in my practice.
I will not cut, even for the stone, but I will leave such procedures to the practitioners of that craft.
Whenever I go into a house, I will go to help the sick, and never with the intention of doing harm or injury. I will
not abuse my position to indulge in sexual contacts with the bodies of women or of men, whether they be
freemen or slaves.
Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no
one.
If, therefore, I observe this Oath and do not violate it, may I prosper both in my life and in my profession,
earning good repute among all men for all time. If I transgress and forswear this Oath, may my lot be otherwise.

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1. INTRODUCTION AND ACADEMIC MISSION OF THE PROGRAM
A. Welcome
On behalf of the full‐time academic faculty and the community volunteer faculty, we welcome you to
the University of Louisville Plastic Surgery Residency Training Program. This is an independent model three‐year
program. As such, it follows prior graduate surgical training that has taught you the fundamental ACGME core
competencies and basic surgical skills. Therefore, our program is designed to build upon and further enhance
these core competencies and surgical skills, and to teach the art, principles and skills specific to Plastic and
Reconstructive Surgery. The operative and clinical experience available to you in this program is renowned for
being exceptionally diverse and challenging. We approach this experience systematically, with analytic logic and
evidence‐based medical principles, in order to give you the finest set of general competencies and surgical skills
for independent practice in Plastic Surgery throughout your career. If diligently pursued and fully utilized, this
experience will prepare you well for a rewarding lifetime career of excellent patient care. It will also prepare you
well for certification by the American Board of Plastic Surgery, which is an essential credential of your career,
and which should be achieved at the earliest possible time.
B. Academic Mission
The mission of the University of Louisville Plastic Surgery Residency Program is to train surgeons who are
compassionate and skillful in patient care; who use scholarly principles to maintain and apply mastery of the
knowledge of their discipline; who use good science and analytical logic in effective surgical problem solving and
outcome review; who are careful and safe in their application of judgment and technique; who continuously
improve their communications, care and care delivery systems; who stand out as impeccable examples of ethical
and professional conduct, and who become Board certified and leaders in their profession and communities.
C. Guidelines
In order to maximize your experience in this program and to facilitate smooth day‐to‐day operational
procedures, guidelines are clearly outlined for you in the following pages. These guidelines are intended to instill
a program of intellectual challenge and active learning and to provide you with an unambiguous understanding
of your obligations, responsibilities, and educational opportunities during your training period.
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D. Manuals
This manual is a supplement to the Department of Surgery House Staff Manual and The University of
Louisville Resident Policies and Procedures Manual. You are provided these documents along with this manual
and must also review them to fully understand your responsibilities.
E. Attestation
If any element of this document for Plastic Surgery Residents, the Surgery Department Manual or the
University Manual is unclear, contact the Program Director for clarification of policy. When you are finished
reading this document you will be required to sign the attestation form at the end.
2. EDUCATIONAL PROGRAM: THE TEACHING PHILOSOPHY, ACGME
CORE COMPETENCIES, AND SPECIALTY GOALS
A. Teaching Philosophy of this Program
For each of you, this is a second residency. Therefore, we expect progression beyond the basic
competencies and skills that you have learned to date to substantially more advanced levels, analogous to
progression from undergraduate to graduate school. As such, our educational philosophy emphasizes rapid
acquisition of advanced learning methods, development of keen cognitive and analytic skills, refinement of
surgical techniques (e.g. microsurgery, gentle handling of tissues, meticulous attention to detail), and advanced
applications of ACGME Core Competencies. The key elements and goals of our educational philosophy are listed
below, and presented thereafter in greater detail. These key elements are:
Goal 1: Progression in the ACGME Core Competencies and their applications to the specialty of Plastic
Surgery.
Goal 2: Insistence on active learning (in contrast to passive) and engagement in a variety of learning
experiences and settings. Interactive conferences and the Socratic Method are used extensively.

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Goal 3: Use of analytic logic, the scientific method and evidence‐based medicine in patient
problem analysis and solution design.
Goal 4: Rapid progression to independent judgment and practice by insisting that the resident always
be challenged and always first take the lead in problem analysis, literature use, solution design,
judgment and technical execution, with faculty critique at the conclusion.
Goal 5: Encouraging a diversity of technical and cognitive experience by teaching encounters with a
broad array of full‐time and volunteer faculty, and asking residents to critically analyze and rationally
select among differences in approaches and techniques.
B. Explanation of the Goals
Goal 1: Progression in the ACGME Core Competencies.
A primary obligation that you accept in becoming a physician and surgeon is to master the general
competencies of medical practice and the specific skills of your discipline, and to maintain that mastery
throughout a lifetime of patient care. To this end, the University of Louisville Plastic Surgery Residency Program
incorporates and emphasizes the six ACGME core competencies in our training, our evaluation process and our
goals for the outcome of your experience here. We expect you to come with basic competencies and to further
refine them here. These six competencies are as follows:
1. Patient Care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health.
2. Medical Knowledge about established and evolving biomedical, clinical and cognate sciences
(e.g. epidemiological and social‐behavioral) and the application of this knowledge to patient
care.
3. Practice‐Based Learning and Improvement that involves investigation and evaluation of their
own patient care, appraisal, and assimilation of scientific evidence, and improvements in patient
care.
4. Interpersonal and Communication Skills that result in effective information exchange and
teaming with patients, their families, and other health professionals.
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5. Professionalism, as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
6. Systems‐Based Practice, as manifested by actions that demonstrate an awareness of a
responsiveness to the larger context and system of health care and the ability to effectively call
on system resources to provide care that is of optimal value.

We pursue these six ACGME competencies diligently through all components of our educational
program and patient encounters. The ACGME core competencies are emphasized in the UofL House Staff
Orientation, and then built upon in our Plastic Surgery Resident Orientation. These core competencies are then
re‐enforced through our weekly ACGME Core Competency Conference (Plastic Surgery Grand Rounds
Conferences) and interaction with faculty in surgical care plan formulations for each individual patient.
Goal 2: Engagement and Active Learning.
This program focuses on active (versus passive) learning and continuously challenges the intellectual
skills of the resident. Thus, residents are given the encouragement and skills to constantly question and verify
the validity and scientific accuracy of the information they are given in lectures, conferences and literature. Each
judgment, diagnosis, and selection of technique or design is expected to be logically justified. Participation
rather than observation is required. The purpose is to develop a more analytic process that upgrades the quality
of medical knowledge and ultimately the quality of medical care that results. A welcome side effect is an
enhanced acquisition and retention of information for Board and other examination processes.
Goal 3: Use of Analytic logic, the scientific method and evidence‐based medicine.
Our philosophy emphasizes the analysis of practice principles and treatment of individual patient
problems using logical processes, such as deductive reasoning, inductive reasoning, the scientific method and
evidence‐based medicine. For example, the scientific method would translate into terms of clinical medicine as
follows: observation=disease or deformity; hypothesis=differential diagnosis or suspected condition cause;
hypothesis testing=problem analysis, medical workup and data analysis; conclusion=diagnosis and the treatment
or reconstructive procedure derived logically from the conclusion.
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A classic method used in Plastic Surgery for logical design of reconstructive procedures is to formally
analyze the missing elements of a defect needing reconstruction, and to surgically restore or replace “like with
like or with the most similar”. Furthermore, we expect the resident to generate a hierarchy of approaches and
solutions and the rank order to be defended by logic and evidence based citations (e.g., the “reconstructive
ladder”). Our approach requires that the resident be the first to go through this process, with critique by faculty
to follow, rather than the reverse order. This causes judgment and analytic skills to grow most rapidly, and thus
best prepare residents to smoothly make the transition into independent practice. The ability to access the
scientific literature of our discipline, and to analyze it critically for acceptance or rejection, is essential to the
best quality patient care and to lifelong learning. We emphasize literature use and analysis and evidence‐based
medicine/evidence‐based practice (EBM/EBP) in each clinical challenge. EBM/EBP principles are learned early in
our ACGME Core Competency Conference and practiced in each patient care plan formulation and each
literature analyses session of Journal Club and conference presentations.
Goal 4: Accelerated Progression to Independent Practice.
Our educational program is specifically designed to accelerate progression to independence in judgment
and practice. We foster this by challenging the resident to be the first to evaluate the patient, analyze the
problem, derive the diagnoses, make the judgments and design the solution. Only then is the faculty critique
and input given ‐ rather than in the reverse order as done in many programs. In addition, we strive to provide
graduated responsibility based on progressive acquisition of knowledge, progressively increasing judgment
challenges and progressive refinement of technical skills.
Requiring residents to take the intellectual lead in problem analysis and solution design and presenting
increasing challenging judgment decisions with expectations of increasingly skilled performance requires a great
degree of interaction between the attending faculty and the resident. The faculty must constantly encourage
and require resident analytic thinking in surgical problem‐solving, resident application of the scientific method
of data analysis, and resident use of a sound physiologic and evidential basis for surgical practice, all in keeping
with the values incorporated in the core competencies.
Optimal growth of technical skills in rapid fashion is also achieved by an analogous process by
encouraging the resident to take the lead as a supervised primary surgeon, rather than an observer. The
resident is given progressive technical responsibility under faculty supervision or rapidly as performance allows.
The senior residents are expected to have progressed further than the junior residents, but all are encouraged
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to progress as rapidly and fully as their capabilities permit. Our Microsurgery Laboratory and Fresh Tissue
Dissection and Practice Laboratory substantially serve the growth of advanced technical skills.
By the final semester of the senior year, if not sooner, each resident is expected to have matured
sufficiently in judgment, knowledge and technical skill so as to be ready for independent practice and for the
Board certification examinations.
Goal 5: Optimal Use of Our Diversity of Experience.
This program has been blessed with a rich amount of clinical material that spans the entire spectrum of
the field and gives in‐depth challenges of great complexity. We also have an exceptionally large number of
complex cases that require interaction with other specialties which provides valuable experience in
interdisciplinary case management. Our full‐time faculty is supplemented by a large, active volunteer
community faculty who welcome resident teaching and who participate actively. This provides a diversity of
technical and cognitive approaches to problem solving and technical execution. We use this diversity by insisting
that the residents critically analyze the alternative approaches they encounter in order to logically choose the
best and most appropriate cognitive approaches and technical procedures for each patient. The residents are
continually challenged to logically justify these choices and defend them with basic anatomic and physiologic
rationale and evidence‐based practice.
C. The UofL ACGME Core Competency Orientation
The UofL Graduate Medical Education Office holds a full day of orientation in the ACGME Core
Competencies during the house staff orientation process that is mandatory for all incoming house staff. Then,
our Plastic Surgery Residency Orientation emphasizes the ACGME Competencies and their application to our
specialty. This orientation is mandatory for all residents and staff each year.
D. ACGME Core Competency Conference
In order to enhance ACGME competencies in our curriculum and to adapt them most accurately to
plastic surgery, an ACGME Core Competency conference is held each week (Wednesday). During each session, a
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Plastic Surgery topic representing an important aspect of every competency is presented and discussed in
rotation. This conference schedule is posted in the Division offices.
E. ACGME Core Competencies in Each Patient Encounter
This program requires that each new patient or new problem in an established patient be first analyzed
by the resident in perspective of the relevant ACGME competencies, and a solution outlined that is also in
perspective of the ACGME competencies and evidence‐based practice. This analysis and proposed solution is
then presented to the attending (or the Patient Care Plan Conference) and discussed with the same orientation
to ACGME competencies and evidence‐based practice principles.
F. ACGME Core Competencies in the Clinical Rotations
We have adopted the goals of the curriculum outlined by the American Council of Academic Plastic
Surgeons (ACAPS), and administered by the Accreditation Council for Graduate Medical Education (ACGME). This
Milestone Project identifies the knowledge and skill sets to be acquired during each clinical rotation. These are
to be reviewed by each resident at the time of each rotation change and midway through each rotation. The
ACAPS has organized these Milestones along lines of the ACGME Core Competencies (Section 5: The Clinical
Services).
G. ACGME Core Competencies in the Evaluation Process
Evaluation of resident performance and progress is done in perspective of the ACGME core
competencies. Beginning July 2017, this will be performed with a standardized process uniform to all University
of Louisville Residency programs called MedHub. This computer‐driven system will be explained to you in great
detail.
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3. GENERAL OBJECTIVES AND RESIDENT EVALUATION PARAMETERS
(COMMON TO ALL CLINICAL SERVICES)

Fundamental skills that are essential objectives common to all clinical rotations also become major
components of the resident performance evaluation process. These skills and evaluation parameters are as
follows:
A. Patient Care
1. Residents must show proficiency in obtaining, documenting, and communicating an accurate
medical history.
2. Residents must show proficiency in performing, documenting and communicating an accurate
physical examination.
3. Residents must show proficiency in judicious selection of laboratory and imaging studies that
are most relevant and specific to the diagnostic workup process.
4. Residents must show proficiency in integration and analysis of the history, physical findings,
laboratory, and imaging data in producing an accurate diagnosis and patient problem list.
5. Residents must document a comprehensive care plan, including progress monitoring and
follow‐up.
6. Residents must respond to the psycho‐social aspect of the illness or injury, including
disfigurement and functional limitations.
7. Residents must promote health education for prevention of disease and injury.
8. Residents must demonstrate commitment to their role as patient advocate, growing into their
role as activists for health equity.
B. Medical Knowledge and Application to Patient Care
1. Residents must develop a comprehensive and scientifically accurate medical knowledge base
through advanced literature searches and analysis, plus other scientific inquiry methods.
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2. Residents must develop skill in selection and use of evidence‐based medicine from texts and
journal articles selected by effective library and internet search techniques.
3. Residents must supply knowledge of scientific study design and appropriate statistical methods
to the appraisal of medical studies and other information relevant to the diagnostic and
therapeutic needs of the patient.
4. Residents must use Information Technology to manage and organize information, to enhance
their education.
5. Residents must appropriately select the medical knowledge set relevant to the patient’s
condition and problems.
6. Residents must develop skill in integrating medical knowledge with clinical data and diagnostic
procedures to refine the diagnosis, and problem list and management plan.
7. Residents must develop skills in application of medical knowledge to managing complex
problems, such as multiple injuries and co‐morbid conditions, with logical prioritization of
therapeutic goals and interventions.
C. Practice‐Based Learning and Improvement
1. Residents must develop habits of continually analyzing practice experience and converting this
to improvements in care.
2. Residents must develop an openness and eagerness to seek and accept feedback from faculty,
peers, and patients.
3. Residents must prepare a portfolio developed around cases presented in the weekly Indication
and Care Plan Conferences that provide evidence of learning and shows the processes used.
This will include PowerPoint summaries of presentations, journal articles, or internet searches
demonstrating additional information sources and readings and any correspondence from
faculty, staff, or patients.
D. Interpersonal and Communication Skills
1. Residents must communicate clearly and accurately to patients and their families, and confirm
understanding of key concepts.
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2. Residents must communicate clearly and effective with other health professionals.
3. Residents’ medical records must be completed, timely and legibly.
4. Residents must work effectively in team settings.
5. Residents must develop refined listening skills.
6. Residents must facilitate education of students, staff, therapists, patients and their families.
E. Professionalism
1. Residents must develop professional attitudes showing:
a. reliability and punctuality;
b. ethics and integrity;
c. initiative and leadership.
2. Resident must show cooperative attitudes that promote teamwork and mutual respect;
3. Residents must accept responsibility for their actions and their consequences.
4. Residents must develop humanistic qualities that include:
a. establishment of ethically sound patient relationships;
b. demonstrations of compassion, sensitivity, and respect for the dignity of patients and their
families;
c. and sensitivity and respect to age, culture, disabilities, ethnicity, gender and sexual
orientation.
5. Residents must respect patient confidentiality in all settings and meticulously conform to
HIPAA guidelines.
F. System‐Based Practice
1. Residents must demonstrate a thorough understanding of the systems influencing the delivery
of care to their patients, and integrate their practice appropriately within the larger care
systems.
2. Residents must fully evaluate the risks/benefits, limitations, and cost of available resources used
in their practices.
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3. Residents should improve the system of care by thoughtful analysis and advocacy for both
incremental and innovative improvement in care provision.
4. CLINICAL COMPONENTS OF THE FIELD OF PLASTIC SURGERY
We cover the broad field of plastic surgery in a balanced, comprehensive fashion. The 12 components of
the Plastic Surgery field, as designated by the Plastic Surgery Residency Review Committee (RRC), are each
addressed in our designated reading program, in the topic rotation of our conference schedule (Appendix 7, 8),
in our clinical rotations (Attachment 2 of this Manual), and in the description of clinical rotations that follows
(Section 5). Within each of the 12 components of the Plastic Surgery field, specific knowledge and skill goals
have been outlined by the American Council of Academic Plastic Surgery, and published as the Plastic Surgery
Curriculum (PSC) (Appendix 1). You are advised to review these PSC components and skill goals at the beginning
and mid‐point of each clinical rotation.
These 12 areas comprise the basic clinical arenas of the specialty, and the designated goals within each
arena must be mastered over the length of the program. Your experience must be reflected in your Plastic
Surgery Operative Log (PSOL) with depth and balance in all areas. These 12 areas are as follows:
1. Congenital defects of the head and neck, including clefts of the lip and palate, and craniofacial surgery.
2. Neoplasms of the head and neck, including the oropharynx, and training in appropriate endoscopy.
3. Craniomaxillofacial trauma, including fractures.
4. Aesthetic (cosmetic) surgery of the head and neck, trunk, and extremities.
5. Plastic surgery of the breast.
6. Surgery of the hand/upper extremities.
7. Plastic surgery of the lower extremities.
8. Plastic surgery of congenital and acquired defects of the trunk and genitalia.
9. Burn management, acute and reconstructive.
10. Microsurgical techniques applicable to plastic surgery.
11. Reconstruction by tissue transfer, including flaps and grafts.
12. Surgery of benign and malignant lesions of the skin and soft tissues.

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5. THE CLINICAL SERVICES: THE EDUCATIONAL GOALS AND
EVALUATION PARAMETERS FOR EACH ROTATION

The 12 areas of plastic surgery are covered by the service rotations of our hospitals. There are specific
educational goals for each rotation of the residency. These include the general goals stated above as well as
more specific goals of acquiring the knowledge and skills of the clinical focus of each rotation. Each hospital in
our program makes a unique and substantial contribution to these goals. Each major rotation is described
below, along with the relevant milestones and evaluation parameters from the Plastic Surgery Curriculum (PSC)
of the American Council of Academic Plastic Surgeons and background readings. The PSC outline of milestones
(Appendix 1) is distributed along with the Plastic Surgery Residency Training Manual annually. It is also
accessible on‐line. You must review the goals listed below and the related sections of the PSC at the beginning of
the program, and again at the midpoint of each rotation. The background readings should be completed by the
beginning of each rotation in the first year. They are selected from the current textbook, Grabb and Smith Plastic
Surgery. By the second year of the plastic surgery residency, residents are expected to have progressed from
textbooks to peer‐reviewed journal and review articles.
Additionally, the ACGME has designed a Milestone Project to provide a framework for assessment of the
development of the resident in key dimensions of the elements of physician competency. The Milestones are
designed to use in semi‐annual review of resident performance and reporting to the ACGME. Milestones are
knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a
developmental framework from less to more advanced. They are descriptors and targets for resident
performance as a resident moves from entry into residency through graduation. The Review Committee will
examine milestone performance data for each resident to determine whether they are progressing overall.
The Milestone levels are designed to best describe a resident’s current performance and attributes.
Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from
novice to expert. These levels do not correspond with post‐graduate year of education. Selection of a level
implies that the resident substantially demonstrates the milestones in that level, as well as those in lower levels.
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Level 1: The resident demonstrates milestones expected of an incoming resident.
Level 2: The resident is advancing and demonstrates additional milestones, but is not yet performing at
a mid‐residency level.
Level 3: The resident continues to advance and demonstrate additional milestones, consistently
including the majority of milestones targeted for residency.
Level 4: The resident has advanced so that he or she now substantially demonstrates the milestones
targeted for residency. This level is designed as the graduation target.
Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating
“aspirational” goals which might describe the performance of someone who has been in practice for
several years. It is expected that only a few exceptional residents will reach this level.
THE UNIVERSITY OF LOUISVILLE HOSPITAL ROTATION
The UofL Hospital rotation has a broad clinical base with a concentration of trauma, burn, and critical
care experience. The Hospital is designated as a Level I Trauma Center, and it houses our adult burn unit. Thus,
the clinical goals of this rotation are to become skilled in the following principles and techniques:
 critical care;
 trauma and burn resuscitation;
 maxillofacial trauma, extremity trauma, and general trauma surgery;
 burn care, grafting, and reconstruction;
 major flap and microvascular reconstructions.
These clinical goals are supported by several weekly bedside teaching rounds. These include Plastic Surgery
Service rounds, with the University attending, interdisciplinary Burn Service rounds, and multidisciplinary
trauma rounds, involving all services participating in trauma care. The multi‐disciplinary structure of this service
also serves the goal of developing skills in effective interdisciplinary relationships for care of critically ill patients,
which is present to a degree found in few other programs.
In addition, the University of Louisville Hospital rotation serves the goal of enhancing progress toward
independent judgment and responsibility, as it is a resident‐run service, with the faculty serving in supervisory
roles as attending consultants and teaching first assistants. The University clinics serve the goal of developing
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skills in pre‐ and post‐operative care and in non‐operative management of appropriate conditions. The
Outpatient Clinic provides progressive responsibilities and continuity for Plastic Surgery residents. This clinic
gives our residents the experience and responsibility for being the primary plastic surgeon for the patient in the
context of appropriately supervised care. Increased responsibility and autonomy are encouraged in progressing
PGY‐levels. Safe opportunities for independent activity are provided. Supervision by attending surgeons is
always present at the clinics. Dr. Joshua H. Choo will provide overall supervision at the University Hospital. He is
complemented by all faculty when the needs arise.
University Hospital Level 1 (PGY‐6) Goals
The fundamental ability to diagnose patients’ medical conditions and initiate a treatment plan will be
achieved at this level. The resident will be responsible for Patient Care with the University Ward Service patients
and operations specifically for patients that will be following up at the ACB. The resident’s primary
responsibilities will be to University patients admitted through ER as traumas or that have been preoperatively
seen through the ACB. The resident is expected to evaluate and treat patients with the supervision of the faculty
for their level of training using their appropriate level of Medical Knowledge. The resident is expected to
demonstrate Practice‐Based Learning and Improvement for their level of training and experience as deemed
appropriate by the attending supervising. The resident is expected to utilize effective Interpersonal and
Communications Skills in working with patients, families and other health professionals. Professionalism should
be adhered to in performing duties ethically and sensitively with this diverse patient population. Residents
should apply System‐Based Practice principles in caring for these patients through effectively using system
resources in providing optimal care.
The main objective for residents to develop on this rotation will be to demonstrate the ability to devise
an appropriate treatment plan. The resident will be responsible for providing Patient Care to ACB initiated or
University Plastic Surgery trauma patients. The resident is expected to evaluate and treat patients with the
supervision of the faculty for their level of training using their appropriate level of Medical Knowledge. The
resident is expected to demonstrate Practice‐Based Learning and Improvement for their level of training and
experience as deemed appropriate by the attending supervising. The resident is expected to utilize effective
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Interpersonal and Communications Skills in working with patients, families and other health professionals
appropriate for their level. Professionalism should be adhered to in performing duties ethically and sensitively
with this diverse patient population. The resident should apply System‐Based Practice principles in caring for
these patients through effectively using system resources in providing optimal care for their level of experience.
In the last year, the resident is expected to demonstrate superior operative skills to at the level to safely
teach other residents through complex cases. The resident will also be expected to provide Patient Care for all
ACB initiated and University Trauma initiated patients that are admitted to the hospital. The resident is expected
to evaluate and treat patients with the supervision of the faculty for their level of training using their
appropriate level of Medical Knowledge. The resident is expected to demonstrate Practice‐Based Learning and
Improvement for their level of training and experience as deemed appropriate by the attending supervising. The
resident is expected to utilize effective Interpersonal and Communications Skills in working with patients,
families and other health professionals. Professionalism should be adhered to in performing duties ethically and
sensitively with this diverse patient population. The resident should apply System‐Based Practice principles in
caring for these patients through effectively using system resources in providing optimal care by striving to
practice cost‐effective measures.
Background Reading: Negligan/Mathes’ Plastic Surgery; Selected Readings In Plastic Surgery
HAND AND UPPER EXTREMITY ROTATION
This rotation is done with U of L Hand Surgery at Jewish, University and Children’s Hospitals. The primary
goal that this rotation serves is mastering the principles of management, surgery and therapy of hand and upper
extremity disorders in adults and children. It also provides a strong digit and extremity replantation experience
and reinforces the goals of strengthening microsurgical experience. This rotation is supplemented by weekly
conferences that covers all areas of hand surgery and by several annual symposia in anatomy, internal fixation
and other relevant topics. Dr. Bradon Wilhelmi is charged with the Hand Service.
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Hand Level 1 (PGY‐6) Goals
The focus of this rotation is to demonstrate the ability to recognize and manage post‐operative
problems. The resident will take hand call weekly and see all hand patients admitted to Plastic Surgery with
hand conditions. With regard to Patient Care, the resident is expected to develop and execute a proper patient
care plan. In demonstrating Medical Knowledge the resident is expected to prepare and have knowledge of
operative procedures appropriate for treated patients. The resident will demonstrate Practice‐Based Learning
through participation in the education of patients, family and junior learners. Interpersonal and Communication
Skills will be developed and demonstrated by counseling and educating these patients and their families in an
understandable and respectful manner. Professionalism should be exhibited by consistently demonstrating
ethical behavior and recognizing ethical issues in these patients. System‐Based Learning will be achieved
through recognizing basic elements needed to establish a practice (staffing, insurance, and accreditation).
The emphasis of this rotation will be on how to manage multiple patients and surgical consultations.
Patient Care will be assessed by your demonstration of appropriate manual dexterity for training level. This will
be taught and stressed during the rotation. Medical Knowledge will be developed by use of collateral reading in
preparing for cases. Practice‐Based Learning will be determined by observing and developing the resident’s
ability to critique personal practice outcomes. Interpersonal and Communication Skills refined and evaluated
through the residents communication with members of the health care team skills. Professionalism will be
taught to extend the residents patient management skills to demonstrate compassion and sensitivity towards
others. System‐Based Practice will be taught to the resident at this level through developing the use of tools
(checklists, briefings) to prevent adverse events.
The overall objective of this will be to help the resident independently perform routine procedures in
the care of the hand surgical patient. Patient Care will be assessed by the residents’ ability to demonstrate a
superior manual dexterity and appropriate economy of motion in the operating theatre. Medical Knowledge will
be assessed through one’s ability to demonstrate knowledge base in the clinical setting and operating room for
their level. Practice‐Based Learning will be assessed by the resident’s ability to discuss on‐going research in the
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field of hand surgery. Interpersonal and Communication Skills will be developed through managing transitions of
care and optimizing communications across systems. Professionalism will be emphasized through striving to
maintain one’s personal health and wellness. System‐Based Practice is addressed through discussion of cost‐
effectiveness in patient care in the hand surgery field (managing length of stay, operative efficiency, etc.).
Background Reading: Green’s Operative Hand Surgery; Neligan/Mathes’ Plastic Surgery.
THE ADULT RECONSTRUCTIVE ROTATION
The adult reconstructive service at Jewish and Norton Hospitals provides a rich and diverse exposure to
all areas of adult plastic surgery, and serves goals of developing general reconstructive judgment and skills. The
thoracic and cardiovascular service at Jewish Hospital provides challenging thoracic reconstructions and
provides the goals of developing both reconstructive skills and critical care management. This rotation also
includes a large transplant service and serves the goals of developing skills and knowledge in difficult wound
problems as well as basic transplantation biology. The adult oncologic service at the Norton Hospital Cancer
Center and the Brown Cancer Center serves the goal of enhancing judgment and experience in breast
reconstruction, head and neck oncologic reconstruction, gynecologic oncologic reconstruction, and orthopedic
oncologic reconstruction. Dr. Terry McCurry and Dr. Gordon Tobin mentor and direct this service.

Reconstruction Level 1 (PGY‐6) Goals
The overall focus of this rotation will be to develop the ability to recognize and manage post‐operative
problems. In this rotation, the resident will work under the direction of Dr. Tobin and Dr. McCurry. Patient Care
will be stressed to have the ability to develop and execute patient care plan. Medical Knowledge will be
developed through the resident’s ability to prepare and knowledge of operative procedures for reconstructive
patients. Practice‐Based Learning will be emphasized by having the resident participate in the education of
patients, families and junior learners. Interpersonal and Communications Skills will be enhanced through
observation of counseling and educating patients and their families in an understandable and respectful
manner. Professionalism will be developed by the resident who will be expected to consistently demonstrate
ethical behavior and recognize ethical issues in reconstructive patients. System‐Based Practice will be enhanced
through teaching basic elements needed to establish a practice (staffing, insurance and accreditation).

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Reconstruction Level 2 (PGY‐7) Goals
The emphasis of this rotation will be on developing the ability to manage multiple patients and surgical
consultations. In this rotation the resident will work under the direction of Dr. Tobin and Dr. McCurry. Patient
Care will be developed by teaching the resident to have appropriate manual dexterity and technical efficiency.
Medical Knowledge will be stressed through providing resources for collateral reading to prepare for
reconstructive cases. Practice‐Based Learning goals will help the resident to develop a better ability to critique
personal practice outcomes in the outpatient setting. Interpersonal and Communication Skills will be refined
through communicating with the members of the health care team effectively. Professionalism requirements
will stress performing clinical and administrative responsibilities in a timely manner. System‐Based Practice will
be demonstrated by observing the residents ability to consistently utilize tools to prevent adverse events such as
checklists, briefings, smart phone.
Reconstructive Level 3 (PGY‐8) Goals
The thrust of this rotation is for the resident to demonstrate the ability to independently perform
routine procedures in the care of the surgical patient. In this rotation, the resident will work under the direction
of Dr. Tobin and Dr. McCurry. Patient Care will be demonstrated by the residents’ ability to independently
manage multiple patients and surgical consultations. Medical Knowledge will be assessed as demonstrated in
practice in the clinical setting. Practice‐Based Learning will be reinforced through attention to demonstration
and commitment to life‐long learning and self‐improvement. Interpersonal and Communication Skills will be
enhanced through the ability to manage transitions of care and optimizing communication across systems.
Professionalism will be developed through demonstration of consistent commitment to continuity of patient
care. System‐Based Practice will be encouraged through discussions on cost effectiveness (Managing length of
stay, operative efficiency) in the reconstructive patient.
Background Reading: Neligan/Mathes’ Plastic Surgery; Selected Readings in Plastic Surgery.
THE VETERANS AFFAIRS MEDICAL CENTER ROTATION
This resident‐run rotation is based in a large Veterans Affairs Medical Center Hospital ten minutes from
the main campus. Its primarily mission serves the goals of acquiring experience in head and neck oncology and
reconstruction, cutaneous malignancy oncology and reconstruction, and management of neurological injury
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complications, such as decubitus ulcers. In addition, this rotation serves the important goal of developing
independent judgment and responsibility; both the service and its clinics are resident‐run with a full‐time plastic
surgeon attending serving in a supervisory role. Dr. Morton Kasdan is charged with all plastic surgery services at
the VAMC through 12/2018.
VAMC Level 1 (PGY‐6) Goals
On this rotation, the main goal will be to learn how to develop the ability to diagnose conditions and
execute patient care plan. The VAMC Plastic Surgery rotation is under the direction of Dr. Kasdan. Patient Care
will develop the ability to recognize and manage post‐operative problems. Medical Knowledge will be achieved
through the preparation for operative procedures. Practice‐Based Learning is attained though the participation
in the education of patients, families and junior learners. Interpersonal and Communication Skills will be
encouraged by having residents counsel and educate patients and their families in an understandable and
respectful manner. Professionalism is consistently encouraged allowing the resident to demonstrate ethical
behavior and recognize ethical issues in practice. System‐Based Practice is optimized though learning how to
recognize basic elements (staffing, insurance, accreditation) needed to establish a practice from Dr. Kasdan
extensive clinical experience.
This rotation will emphasize development of manual dexterity for training level. The VAMC Plastic
Surgery rotation is under the direction of Dr. Kasdan. Patient Care will involve independent management of
multiple patients and surgical consultations. Medical Knowledge will be honed in preparation and knowledge of
operative procedures. Practice‐Based Learning is developed through participation in the education of patients,
families and junior learners. Interpersonal and Communication Skills are refined through counselling and
educating patients and their families in an understandable and respectful manner. Professionalism is developed
through consistent mentoring under Dr. Kasdan demonstrating ethical behavior and reinforcing ethical issues in
practice. System‐Based Practice will be outlined consistently using tools to prevent adverse events.

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The thrust of this rotation will be developing independence to perform procedures in the care of the
plastic surgical patient. The VAMC Plastic Surgery rotation is under the direction of Dr. Kasdan. Patient care will
involve demonstrating the ability to improve operative skills through economy of technique. Medical Knowledge
will be attained through application of knowledge base in the clinical setting with Dr. Kasdan. Practice‐Based
Learning is obtained through commitment to life‐long learning and self‐improvement under Dr. Kasdan’s
mentorship. Interpersonal and Communication Skills are refined by using ability to manage transition of care and
optimizing communication across systems and in sign outs. Professionalism is advanced through demonstration
of consistent commitment to continuity of patient care. System‐Based Practice will be addressed through
consistently practicing cost effective care as taught by Dr. Kasdan.
Background Reading: Neligan/Mathes’ Plastic Surgery.
HEAD AND NECK ROTATION
An in‐depth head and neck experience is available. This is a rotation at the University Hospital, Norton
Hospital and Kosair Children’s Hospital under the mentorship and direction of Dr. Jarrod Little. The primary goal
of this rotation is to learn the principals of head and neck anatomy, oncology, trauma and reconstruction. This
rotation provides a very diverse exposure to head and neck plastic surgery and other plastic surgery. The goal of
learning, evaluation and pre‐ and post‐operative care of the head and neck patient is served by the experience
of taking care of these specialized patients at a variety of hospitals to intensively teach these specialized skills.
Residents will learn a multidisciplinary approach to the management of these complex patients from the
perspective of an otolaryngology trained plastic surgeon.
Head and Neck Level 1 (PGY‐6) Goals
The emphasis of this rotation will be on ability to recognize and manage post‐operative problems. The
Head and Neck rotation will be primarily at Norton Hospital under the direction of Dr. Little. Patient Care will be
developed through the ability to execute a patient care plan. Medical Knowledge will be achieved preparation
and development of operative plan and procedures. Practice‐Based Learning will be learned through
participation in the education of patients and their families. Interpersonal and Communication Skills will be
obtained through counseling patients and their families in an understandable and respectful manner.
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Professionalism will be expected and taught consistently expecting proper ethical behavior and recognition of
ethical issues in practice. System‐Based Practice will be reviewed to emphasize the basic elements needed to
establish a practice.
The thrust of this rotation will be to learn how to independently manage multiple patients and surgical
consultations. The Head and Neck rotation will be primarily at Norton Hospital under the direction of Dr. Little.
The resident will be expected to develop the appropriate manual dexterity for level. Medical Knowledge will be
facilitating to providing collateral reading for head and neck patients and operations. Practice‐Based Learning
will be developed by teaching the resident the ability to critique personal practice outcomes. Interpersonal and
Communication Skills will stress effective communication with members on the health care team.
Professionalism will be refined by demonstration of compassion and sensitivity towards the head and neck
patients. System‐Based Practice will be established through consistent use of tools (checklists, briefings) to
prevent adverse events.
The overall objective of this rotation will be to have the resident be able to independently perform
routine procedure in the care of the surgical patient. The Head and Neck rotation will be primarily at Norton
Hospital under the direction of Dr. Little. Patient Care will emphasize management of multiple patients and
surgical consultations. Medical Knowledge allow for demonstration of knowledge base in the clinical setting.
Practice‐Based Learning will be developed through teaching commitment to life‐long learning and self‐
commitment. Interpersonal and Communication Skills will be enhanced through management of transition of
care and optimizing communication across systems. Professionalism will be taught and obtained through
monitoring own personal health and wellness. System‐Based Practice will be attended by striving to achieve and
teach cost‐effective care.
Background Reading: Grabb and Smith’s Plastic Surgery; Neligan/Mathes’ Plastic Surgery
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INTERDISCIPLINARY SUBSPECIALTY TRAINING OPPORTUNITIES
The major rotations listed above provide the major clinical experiences for our program and serves the
goals of developing the specialty knowledge and skills associated with the specific patient populations and
educational experiences of each hospital. In addition, within these major rotations certain multidisciplinary
subspecialty goals and in‐depth experiences are incorporated. The Division of Plastic and Reconstructive Surgery
supports this interdisciplinary approach to shared educational programs in order to fulfill the goals of providing
experiences that utilize specialized skills held or shared by other disciplines.
Short Elective Rotations Level 3 (PGY‐8) Goals
Residents will have an opportunity to select electives as suggested by the RRC in the above areas. During
these third level rotations the residents will be able to further refine their knowledge base and skills in their
selected rotation. The resident is expected to continue to advance their Patient Care skills and operative
technique when appropriate. They will have an opportunity to further their Medical Knowledge on that specific
elective through collateral reading and preparation for cases. Practice‐Based Learning will be addressed varying
on rotation and specialty. Interpersonal and Communication Skills will have an opportunity to flourish in working
within a new team and system. The resident will still be expected to demonstrate appropriate Professionalism as
a representative of the University of Louisville Plastic Surgery program. These super specialty electives will
provide the resident with a multitude of practice models to help develop practice management strategies with
staffing, insurance, and accreditation.

Oculoplastic Surgery
An in‐depth Oculoplastic experience is available. This is provided primarily by Dr. Douglas Gossman, a
skilled oculoplastic surgeon and Plastic Surgery volunteer faculty member. His background is in the discipline of
ophthalmology, with previous training in neurosurgery. He works closely with the University full‐time and
volunteer plastic surgery faculty in major reconstructions of orbital trauma, cranial base oncologic resections,
and craniofacial operations, as well as providing experience in congenital ptosis and other orbital
reconstructions, not common to most plastic surgery programs.
Background Reading: Grabb and Smith’s Plastic Surgery

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Aesthetic Rotation
The primary goals of this rotation are to acquire the principles and techniques of aesthetic surgery and
skills in management of the aesthetic patient. Jewish Hospital and the Norton Medical Pavilion house aesthetic
units where many plastic surgeons in this community perform aesthetic procedures. This provides a very
concentrated aesthetic clinical exposure for the rotating resident. The goal of learning, evaluation, and pre‐ and
post‐operative care of the aesthetic patient is served by experience in the office practice of selected aesthetic
surgeons, both voluntary faculty and full time faculty who are willing to intensively teach these skills. During this
rotation residents are initiated to their own “private practice” in aesthetic surgery by using the office facilities of
the full time faculty, to consult with aesthetic patients that they have procured. This is done under the
supervision of the full time faculty. This rotation is supplemented by an aesthetic conference that covers all
major areas of aesthetic surgery in sequence over a 2‐year period. Dr. Jerry O’Daniel has responsibility for this
rotation.
Background Reading: Negligan/Mathes’ Plastic Surgery; Nahai’s The Art of Aesthetic Surgery
Burn Surgery
An in‐depth experience in burn care and reconstruction is available. Adult burns are treated by Plastic
Surgery and General Surgery burn teams based at the University of Louisville Hospital under the supervision of
the Plastic and General Surgery faculties. Children’s burns are similarly co‐managed with the Pediatric Surgery
Service at Kosair Children’s Hospital Pediatric Burn Unit.
The Craniofacial Rotation
This rotation is centered on the Pediatric Plastic Surgery Service of Kosair Children’s Hospital, and the
primary goals of this rotation are to learn the principles and techniques of cleft lip and palate, craniofacial, and
pediatric plastic surgery, including pediatric burns. The related goals of out‐patient pre‐ and post‐operative
evaluation and management of these pediatric subspecialties are gained by attendance at outpatient facilities of
The Cleft and Craniofacial Clinics of the Commission for Children with Special Healthcare Needs, The University of
Louisville Child Evaluation Center Clinic, and patient encounters in the office of pediatric plastic surgeons. Dr.
Mark Chariker coordinates the activities of this rotation. Special note must be made concerning the experience
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in cleft lip and palate surgery. These cases are not numerous in the Commonwealth of Kentucky. They must be
considered a precious quantity, and all must be attended by at least one resident.
Background Reading: Grabb and Smith’s Plastic Surgery; Neligan/Mathes’ Plastic Surgery; Millard’s Cleft Craft;
Selected Readings In Plastic Surgery
Orthopaedic / Hand Surgery
This rotation is at the Norton Hospital under the direction of Dr. Amit Gupta, an orthopedic surgeon. He
has a team of orthopaedic surgeons that the plastic surgery residents rotate with to learn the principles of
orthopedic surgery, bone anatomy and physiology and internal fixation.
Background Reading: Campbell’s Orthopaedic Surgery, Green’s Operative Hand Surgery
Outpatient Anesthesia
This rotation is at an outpatient surgery center called the CaloSpa. During this rotation the residents
learn the principals of outpatient anesthesia in an ambulatory setting under the direction of Dr. Calobrace and
his anesthesia team. This is a unique and treasured opportunity for the residents to learn how to preoperatively
assess and provide patients for safe anesthesia for outpatient procedures.
Background Reading: Neligan/Mathes’ Plastic Surgery; Nahai’s The Art of Aesthetic Surgery
Cosmetic Dermatology
This rotation is performed under the mentorship and direction of Dr. Marc Salzman and the Jewish East
Outpatient Facility. Through this rotation the residents learn about skin care and skin care products. They also
have an opportunity to diagnose and manage unique skin conditions. Ultimately, the residents obtain
experience with chemical peels, dermabrasion and laser in the management of facial burns, depigmentation and
facial rhytids.
Background Reading: Neligan/Mathes’ Plastic Surgery; Nahai’s The Art of Aesthetic Surgery

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SPECIAL FACILITIES
The opportunities for residents to expand and achieve their educational goals are enhanced by several
specialized facilities developed within the University and Teaching hospitals of our program. They include the
following:

The Microsurgery Training Laboratory
This facility for basic and advance training in microsurgery was developed by the late Dr. Robert Acland
and is located in the Price Institute of Surgical Research, in the Medical Dental Research Building. It has trained
more micro‐surgeons than any other facility in the world. Each of our residents receives formal training course in
microsurgery on matriculation, and can return as needed for additional practice.
Background Reading: Acland’s Microsurgical Practice Manual; Grabb and Smith’s Plastic Surgery
The Fresh Tissue Dissection & Surgical Practice Laboratory
This facility was created by Dr Robert Acland and is devoted to anatomic dissection of fresh cadavers for
both training and research purposes and has become a model for fresh tissue laboratories both nationally and
internationally. Our residents have material available for dissection virtually constantly. This is used for our
formal dissection courses, such as the Fresh Tissue Dissection Conference and The Focus on Anatomy Course, as
well as informal group’s individual dissections to learn anatomic detail or practice surgical procedures.
Additionally, residents are encouraged to undertake anatomic research projects.
Background Reading: Dr. Tobin’s monograph, Myocutaneous Muscle Flaps in Grabb and Smith’s Plastic Surgery
The Aesthetic Centers
One of the strengths of our aesthetic rotation is that the overwhelming majority of aesthetic surgery in
the community is done in the units specialized for aesthetic surgery in our teaching hospitals. This places the
residents in immediate proximity to virtually all practitioners and exposes them to the full spectrum of technical
and conceptual approaches and to the most advanced techniques.
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6. EDUCATIONAL CONFERENCES AND ROUNDS
The Program goals and ACGME competency of medical knowledge are supported by a comprehensive
educational program of conferences, rounds, courses, and tests of progress in medical knowledge. Although
extensive, these group activities are not intended to be a substitute for a disciplined, regular individual reading
program. Rather, they are intended to guide and supplement such a program. All residents must attend these
conferences, unless specifically designated as limited to residents on a specific rotation, and these become
options to residents not currently on that rotation.
The University campus, our teaching hospitals, and the Medical Society Buildings are clustered in a four‐
block area (except the VAMC, which is five minutes away), and all conference sites are within these teaching
facilities. Attendance of all residents is mandatory at all the above listed conferences, rounds, courses, symposia,
Journal Clubs, Visiting Professor lectures, and research seminars except conferences specific to individual
rotations, for which mandatory attendance applies only to the resident on that rotation.
The full time faculty always attends the plastic surgery conferences when in town. Quite often, members
of the volunteer faculty also attend. The educational input from experienced faculty is vital to the success of the
education program. Faculty and resident attendance will be monitored by the Program Director.
GENERAL CONFERENCES – ALL RESIDENTS TO ATTEND
Reconstructive Conference (Grand Rounds)
Wednesdays, 7:00 a.m., Jewish Hospital Rudd Heart & Lung Building, 15th floor conference room
This weekly conference progresses through the core curriculum of reconstructive surgery over the year’s
schedule. These lectures are given by faculty, visiting professors, and residents, who present topics in their area
of interest and expertise. A high degree of interactivity by the residents is expected. Reconstructive Grand
Rounds cover the 11 clinical areas of Reconstructive Plastic Surgery, as defined by the RRC (aesthetic topics are
covered on alternate weeks). Additionally relevant ACGME core competencies, medical‐legal, ethics, practice
management, and basic science topics are covered when relevant. The Conference schedule is Appendix 7.
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ACGME Core Competencies Conference
Wednesday, 8:00 a.m., Jewish Hospital Rudd Heart & Lung Building
This weekly conference is focused on enhancing the ACGME Core Competencies and applying them to
Plastic Surgery. The first half hour is devoted to a discussion of topics from the 6 ACGME Core Competencies in
rotating sequence. The second half hour is devoted to the Indications and Care Plan Conference twice monthly,
alternatively with faculty meeting and Quality Improvement Conference.
Indications and Care Plan Conference
Mondays, 1:30 pm, ACB
This weekly conference focuses on management plans for upcoming challenging cases and indications
for surgery. The patients are presented to the faculty and resident group by the resident responsible for care of
the patient. Relevant ACGME core competencies in the plan are cited and emphasized. As with all patient
presentations, the resident must generate and describe a complete management plan prior to faculty input. This
plan will then be analyzed and refined by the faculty and other residents in a Socratic format.
Quality Improvement and Morbidity Analysis Conference
8:00 a.m., one Wednesday each month, Jewish Hospital Rudd Heart & Lung Building
This monthly conference analytically reviews quality improvement and patient safety issues, including
the morbidity and mortality experience of the service. Cases are presented and analyzed first by the resident
involved in the patient’s clinical care and then discussed by the other residents and faculty. The format of the
review is to use analytic logic and the scientific method to identify the cause and then the prevention or
correction of the complication. A systems approach to patient safety is incorporated and balanced with
individual responsibility as appropriate. The ACGME Competency of Practice‐Based Learning is directly served by
this conference. Each resident is expected to present all cases of complications, mortality or “near miss” events
from the preceding month. The classical patient presentation format will be used and all relevant data (including
autopsy results for mortalities) will be made available. The discussion will always include the following
components:
 The complication will be clearly stated.
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 The case will be presented in classical format.
 A hypotheses of cause based on all available data will be given.
 An analysis of the hypothesis will follow.
 A conclusion and recommendation for future avoidance of such events based on the analysis will be made.
 When relevant, pertinent references regarding the complication should be distributed.
Basic Science, Research and Evidence‐Based Medicine Conference
First Mondays 1:00 pm, ACB
This conference covers basic science topics relevant to plastic surgery (e.g. wound healing). It also
reviews progress of ongoing research projects in our Plastic Surgery Research Laboratory or in clinical studies
and it allows residents and faculty to prepare and present scientific papers for upcoming regional and national
meetings, such as the annual KSPS presentation each September. It is used to teach the principles of evidence‐
based medicine and demonstrate application to clinical decision making. This conference has been incorporated
into our Reconstructive Conference and ACGME Core Competency schedule and is held at least quarterly.
Hand Conference
Every other Monday, 3:00 p.m., Hagan Library (alternates with Cosmetic Conference).
These conferences are given by the faculty, the residents, or the visiting professors to the program. The
schedule includes 25 plastic surgery specific hand topics as chosen by the Program Director and the residents.
Fresh Tissue Dissection and Surgical Practice Lab Sessions
Every other Monday, 4:00 pm, MDR Building
This exercise is a dissection of clinically relevant anatomy done on a fresh cadaver in our Fresh Tissue
Dissection and Surgical Practice Laboratory. Anatomy relevant to clinical practice, such as flap design frequently
used on a challenging upcoming case is dissected and discussed. The discussion is led by a designated faculty
member or expert, with residents doing the technical dissection to enhance their skills. Handouts and graphic
supplements are frequently used.
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Surgery Grand Rounds
Fridays, 7:00 a.m., ACB Auditorium
This weekly conference is presented by faculty or a visiting expert. Plastic Surgery residents will be
notified when the subject is of relevance to our specialty. In such an instance, conference attendance will be
required.
Surgery Department Resident Grand Rounds and Teaching Conferences
Fridays, 8:15 a.m., ACB Auditorium
This weekly conference is scheduled for resident education by the Surgery Department for all surgical
services. Plastic Surgery residents are required to attend those which ACGME core competency cover basic
science, medico‐legal, ethics, and practice management issues that are relevant to Plastic Surgery. The
conference is given by academicians or clinicians from the University faculty or by outside experts in specific
topics.
Journal Club Meetings
Quarterly, on the 3rd Monday, 6:30 p.m.
This quarterly conference uses both classic, current, and journal papers from Plastic and Reconstructive
Surgery, and other relevant journals. The articles are briefly summarized, critically analyzed and related to
clinical practice by the presenting residents, followed by an organized general discussion by other residents and
faculty. The articles are chosen by the educational chief resident with faculty guidance. The location is usually at
a restaurant conference room or the home of a Division member. It will be the responsibility of the faculty
discussant and Education Chief Resident to select the articles. The articles chosen will then be assigned by the
Education Chief Resident to each of the other residents for review, presentation and critical analysis, at the
conference.
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Board Preparation Quiz Sessions
Every Monday, 2:30 p.m., Hagan Library
A 30‐minute session with pre‐assigned reading and multiple choice questions conceived by a faculty
member. This will be followed by an in‐depth discussion of the subject. Mock‐oral exams will be given simulating
examinations given by the American Board of Plastic Surgery.
Plastic Surgery Research Conference
Every Monday, 1:00 p.m., Hagan Library
Discussion of ongoing research efforts as well as the prospects for future research projects.
Facial Trauma Conference
Third Wednesday of every month, 7:00 a.m., Ambulatory Care Building Auditorium
This is a combined conference with Plastic Surgery, Otolaryngology, Oral/Maxillofacial Surgery, and
Oculoplastic Surgery.
Cosmetic Surgery Clinic
Every other Monday (alternates with Hand Conference & Fresh Tissue Dissection Lab)
This clinic is held at the private office and is attended by one or more of the full‐time faculty.
Workshops
As needed
Discussion on particular topics with hands‐on participation in management of specific challenging plastic
surgery areas or defects. In these workshops, residents will learn algorithms and approaches to specific defects.
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Hand Case Presentations
Every Monday, Hagan Library
The resident on the Hand Rotation presents the interesting cases from the prior week of hand call and
hand rotation.
Craniofacial Case Presentations
Every Monday, Hagan Library
The resident on the Head & Neck Rotation presents one of the 50 assigned craniofacial syndromes in
PowerPoint form, including photos and genetic risk factors.
CONFERENCES SPECIFIC TO INDIVIDUAL ROTATIONS:
The following conferences are organized for residents on specific services. Most of these conferences
are multidisciplinary and provide excellent opportunities for interdisciplinary interaction, information exchange
and development of professional communication skills. The resident assigned to the specific rotation identified
must attend, and others may attend optionally.
Burn Rounds
Monday, 8:00 a.m., UofL Hospital, 8th Floor Burn Unit
These multidisciplinary weekly bedside teaching rounds in the University Hospital Burn Unit refine burn
care teaching and management judgment for cases in the burn unit. These rounds are held in conjunction with
the General Surgery Trauma Service. The patients are presented to the faculty and resident groups by the
resident responsible for the patient, and discussion is led by the Plastic and Trauma Surgery Faculty. The Plastic
Surgery resident rotating at University Hospital is to attend.
Multidisciplinary Breast Oncology Conference
Thursday, 8:00 a.m., Brown Cancer Center
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A multidisciplinary team approach to breast cancer is presented and includes representatives from
diagnostic radiology, surgical oncology, medical oncology, radiation oncology, plastic surgery, pathology, social
services, tumor registry and tumor genetics. This weekly conference is attended by the reconstructive service
resident at Norton and Jewish Hospitals.
James Graham Brown Cancer Center Oncology Conference
Friday, noon, James Graham Brown Cancer Center, 2nd Floor Conference Room
A formal presentation on topics relating to cancer care is presented. When relevant topics are
presented, this weekly conference is to be attended by the plastic surgery resident rotating on the University
Hospital service. On rare occasions, the plastic surgery resident is requested to present a case on topic.
Melanoma Conference
Monthly, Wednesday, 7:00 a.m., ACB Auditorium
A multidisciplinary team approach to melanoma is presented and includes representatives from
diagnostic radiology, surgical oncology, medical oncology, radiation oncology, plastic surgery, pathology, social
services, tumor registry and tumor genetics.
7. ETHICS CURRICULUM
Basic knowledge of medical ethics principles and practices is included in our educational curriculum, by
case example upon occurrence, by presentations, in the General Competencies Conference, by other
conferences and special seminars and printed matter for self‐study. These avenues for the ethics curriculum are
described below.
A. ACGME Core Competencies Conference: An ethics topic is presented at least each semester.
B. Plastic Surgery Ethics Round‐Table Discussion: An ethics dilemma will be discussed in round‐
table fashion at least quarterly.
C. Reconstructive and Aesthetic Conference: Ethics discussions are integrated into the topic
presented whenever relevant.
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D. Surgery Department Resident Teaching Conference: Ethics, medical‐legal, practice
management and basic science topics are regularly scheduled in this weekly conference held every
Friday at 8:15 A.M. You will be informed when any of these topics are scheduled. Attendance is
mandatory for these topics.
E. Special seminars in medical ethics are regularly held by the UofL, our Teaching Hospitals and the
Medical Society. You will be notified of these seminars when they occur.
F. Each resident will receive a copy of The Principles of Medical Ethics and The Fundamental
Elements of the Patient ‐ Physician Relationships from the Code of Medical Ethics of the AMA. They are
Attachment 2 of this manual.
G. The current edition of the Code of Medical Ethics of the AMA is available to all residents in the
Division office for reference and self‐study, and is provided to all residents joining the Greater Louisville
Medical Society, and Kentucky Medical Association ($40.00 for the entire residency). It is Supplemental
Reference Manual #1. Basic knowledge of medical‐legal principles and current legal issues are included
in our educational curriculum by case example upon occurrence, by presentations in the General
Competencies Conference, by special seminars and by self‐study courses described below.
8. MEDICAL‐LEGAL CURRICULUM
A. ACGME Competencies Conference: A medical‐legal topic is given at least each semester. Dr. Morton
Kasdan has given particularly valuable presentations on medical‐legal topics and is our faculty expert on the
subject.
B. Reconstructive and Aesthetic Conference: Medical‐legal discussions are integrated into the topics
C. CD‐ROM Course: Dr. Gordon Tobin has arranged for each resident to receive a CD‐Rom on Basic
Medical‐Legal principles and risk management by joining the Greater Louisville Medical Society and Kentucky
Medical Association.
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D. Special seminars in medical‐legal issues are held by the UofL, our teaching hospitals, our Medical
Society, and our medical liability carrier. Your attendance is mandatory at all of these. You will be informed
when these seminars are scheduled.
E. Residents will receive a summary of basic medical‐legal principles and periodic updates. This summary is
reprinted from the Law and Medicine series published in the Journal of the American Medical Association.
F. The current edition of the Legal Handbook for Kentucky Physicians (KMA) is available to all residents in
the Division Reference Library and is provided to all residents joining the Greater Louisville Medical Society and
Kentucky Medical Association.
G. The ASPS manual, Patient Consultation Resource Book, is available to all residents in the Division
Reference Library. The informed consent templates it contains may be used to improve your patient informed
consent or council you to design your individual informed consent forms.
9. SOCIOECONOMICS & PRACTICE MANAGEMENT EDUCATION
Basic knowledge of socioeconomics and practice management principles are included in our educational
curriculum by case example upon occurrence, by presentations in the General Competencies Conference, by
other Conferences and by special seminars and self‐study courses described below.
A. ACGME Core Competencies Conference: A practice management, topic is given at least once each
semester.
B. Reconstructive and Aesthetic Conference: Socioeconomic discussions are integrated into the topics
C. Surgery Department Resident Teaching Conference: Practice management, topics are regularly
scheduled in this weekly conference. You will be informed when any of these topics are scheduled. Attendance
is mandatory for these topics.
D. Special seminars in practice management are held by the UofL Compliance office, our teaching hospitals
and the Greater Louisville Medical Society (GLMS). You will be notified of these seminars when they occur. The
GLMS provides a comprehensive on‐line course for entering practice that includes contract negotiations with
employing groups, contract negotiations with insurers, personnel and office management. This is available to
resident members ($40 for the entire residency).
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E. The UofL Compliance Office holds an annual seminar in Medicare compliance regulations and
documentation at the beginning of each academic year. Attendance is mandatory.
F. The Department of Surgery holds an annual seminar in CPT coding early in each academic year.
Attendance is mandatory.
G. A summary of Medicare Compliance Regulations is available through the University of Louisville

Compliance Office.
H. A set of manuals on basic practice management principles are available to all residents for a self‐study
course. These are most useful during the senior year, or whenever practice arrangements are being made.
I. The manual from the AMA course, Establishing Yourself in Medical Practice is available. Sections include:
personnel, facilities, patient flow, patient records, financial, practice setting and legal.
J. The Resource Book for Plastic Surgery Residents (ASPS) is available to all residents. The section “How to
Select a Practice” is most useful for that purpose. It is Appendix 5 and Supplemental Reference Manual #9.
K. The AMA Handbook, Marketing Strategies for Private Practice is available. It contains excellent
instructions on good communications to patients and referring physicians. Skill, compassion, good care and good
communications are all the marketing you will ever need. It is Supplemental Reference Manual #5.
L. The Greater Louisville Medical Society Department of Practice Services provides an excellent
introduction to managed care issues, and managed care contracts. This information is available by joining the
Medical Society. It is Supplemental Reference Manual #6.
M. The ASPS/PSEF Catalogue is an excellent source of practice management information. It is Supplemental
Reference Manual #10.
N. The Annually updated and issued CPT manual (AMA) contains and defines all the CPT codes, modifiers,
and detailed instructions for their use. It is Supplemental Reference Manual #7.
O. The Medicare Billing and Documentation Guidelines (UofL Compliance Office) describes the Medicare
Compliance regulations. It is Supplemental Reference Manual #8.
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10. ANNUAL SYMPOSIA AND VISITING PROFESSORS

A. Annual Symposia
The Division sponsors or co‐sponsors a number of annual courses or symposia. All residents must
attend. These courses include the following:
1. Microsurgery Course: At the beginning of the residency, each resident spends time in the
Microsurgery Training Course that is offered by our Microsurgery Laboratory (Section 5:8).
Additional practice time can be arranged individually thereafter. The course is taught by Dr. Bradon
Wilhelmi. A widely acclaimed videotape teaching series is used, which was produced by former
faculty member Robert Acland, M.D.
2. Surgical Anatomy Course: Each year the Divisions of Plastic Surgery and Hand Surgery co‐sponsor a
surgical anatomy course or flap dissection. The topics covered alternate between flap and upper
extremity anatomy. The course uses fresh cadaver dissections done in our Fresh Tissue Dissection
and Surgical Practice Laboratory. Simultaneously, lectures on the dissection topic are given by the
faculty of the Divisions of Plastic and Hand Surgery, or by visiting professors and a useful course
syllabus of anatomic diagrams and relevant journal reprints are distributed.
3. Maxillofacial Fixation Course: Each year a hands‐on course in maxillofacial plating and internal
fixation is sponsored by the Division and supported by plate manufacturing companies.
Demonstrations are given by the faculty, with residents performing the technical exercises at
individual practice stations.
4. Hand Internal Fixation Course: Each year a hands‐on weekend course in upper extremity plating
and internal fixation is sponsored by the Division of Hand Surgery and AO/Synthes for the Hand
Fellows and Plastic Surgery Residents. Demonstrations are given by the faculty, with residents
repeating the technical exercises at individual stations.
5. Research Symposium: “Research!Louisville,” is a weeklong research symposium that contains
courses, a keynote speaker and research presentations, and is sponsored by the University of
Louisville and our teaching Hospitals. The keynote speaker has often been Nobel Prize recipients or
scientists of international distinction.
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6. Other Courses/Symposium: At least yearly, other conferences or symposia of value to plastic
surgeons are sponsored by the Division, the University, our teaching hospitals or the Medical
Society. Recent examples are: the Tri State Craniofacial Symposium (Annual), Grant Writing,
(November 2004), Craniofacial/Maxillofacial Techniques 2003, Biomedical Ethics (2000). The ABA
Regional Burn Symposium (2002) Burn Care, (Oct. 1999), Research Design, (Aug. 1999), Maxillofacial
Distraction, (May 1999), Vascular Lesion/ Hair Removal/Tattoo Removal Lasers, (1998). Skin
Resurfacing Lasers (1998) Composite Allograft Symposium (1997), ASPS CPT Coding (1997). These
courses and conferences are given by experts in the respective topics.
7. Visiting Professors: The Division of Plastic Surgery, The Kentucky Society of Plastic Surgery, and The
Louisville Surgical Society, closely related units such as Hand Surgery, sponsor several visiting
professors and invited lecturers each year. Current and recent examples include the following:
Randolph Sherman, M.D. (2017) Robert J. Allen, M.D. (2017) Joseph P. Hunstad, M.D. (2017)
Steven C. Haase, M.D. (2016) James R. Payne, M.D. (2016) Stephen B. Baker, M.D. (2016)
Maurice Nahabedian, M.D. (2016) Michael R. Zenn, M.D. (2016) Louis L. Strock, M.D. (2016)
Norman M. Cole, M.D. (2015) Dennis Hammond, M.D. (2015) David Netscher, M.D. (2014)
Robert M. Kellman, M.D. (2014) W. P. Andrew Lee, M.D. (2014) M. Nahabedian, M.D. (2014)
Albert Losken, M.D. (2014) C. Scott Hultman, M.D. (2014) Geoffrey Gurtner, M.D. (2013)
Neil F. Jones (2013) Navin K. Singh, M.D. (2013) William H. Bowers, M.D. (2012)
Dean S. Louis, M.D. (2012) Jeffrey Janis, M.D. (2012) V. Leroy Young, M.D. (2012)
Peter C. Amadio, M.D. (2012) Richard A. Mladick, M.D. (2012) M. Yaremchuk, M.D. (2012)
Charles J. Eaton, M.D. (2012) Scott L. Spear, M.D. (2011) Peter C. Amadio, M.D. (2011)
Paul S. Cederna, M.D. (2011) Richard A. Mladick, M.D. (2011) J. Peter Rubin, M.D. (2010)
Diego Ribuffo, M.D. (2010) Maurice Nahabedian, M.D. (2010) David P. Green, M.D. (2010)
Charles N. Verheyden, M.D. (2010) Maurice Nahabedian, M.D. (2009) Charles Butler, M.D. (2009)
Paul N. Manson, M.D. (2009) Joachim Prein, M.D., D.M.D. (2009) Randal Rudderman, M.D. (2009)
Warren Schubert, M.D. (2009) Lt. Col. Robert Hale, D.D.S. (2008) Ian T. Jackson, M.D. (2008)
‐ 41 ‐

Eduardo Rodriguez, M.D., D.D.S. (2008) Dean Louis, M.D. (2008) Gregory Ruff, M.D. (2008)
Ron Silverman, M.D. (2008) Gregory Evans, M.D. (2007) David Elliot, M.D. (2005)
G Patrick Maxwell, M.D. (2005) Fu‐Chen Wei, M.D. (2004) Wayne Morrison, M.D. (2003)
Frank D. Burke MB, MS, FRCS (2003) Julio Taleisnik, M.D. (2002) Martin Robson, M.D. (2002)
David Evans, MB, BS, FRCS (2001) James May, M.D. (2001) Thomas J. Krizek, M.D. (2001)
Raphael Acosta (2001) Viktor E. Meyer, MD (2000)
Richard Wassermann, M.D. (2000) Harry Buncke, M.D. (1999) Richard Roberts, Ph.D. (1999)
Hyrar Shahianian, M.D. (1999) Alan Dimick, M.D. (1999) C. Lin Puckett, M.D. (1999)
Helmuth Goepfert, M.D. (1999) H. Bruce Williams, M.D. (1999) Christopher Colton, M.D. (1999)
Henry Steve Byrd, M.D. (1998) Maurice Jurkiewicz, M.D. (1998) Suzanne Ildstad, M.D. (1998)
Milomir Ninkovic, M.D. (1998) Michael Chancellor, M.D. (1998) Arnuf Stenzel, M.D. (1998)
Steve Aryian, M.D. (1997) Goran Lunborg, M.D. (1998) Dennis Lynch, M.D. (1997)
Eduardo Zancolli, M.D. (1996) James Strickland, M.D. (1997) James May, M.D. (1996)
Susumi Tamai, M.D. (1996) Jim Urbaniak, M.D. (1997) Jesse Jupiter, M.D. (1997)
In addition, the Department of Surgery and Louisville Surgical Society maintain active Visiting Professor
Programs, including the annual Yandell lectureship. Many of these lectures are relevant to plastic surgery and
the residents will be invited.
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11. KEEPING THE PLASTIC SURGERY OPERATIVE LOG (PSOL)
In order for the Division Director to certify program completion and allow you to sit for your Board
examinations, you must have gained sufficient clinical experience during your training. The current standard is to
have performed enough procedures to be well above the minimum standards defined by the Residency Review
Committee in all 12 PSOL categories (Section 4). PSOL documentation of cases performed is by current
procedural terminology (CPT) coded and logged by each resident at least weekly, on both a personal record and
on the ACGME website (www.acgme.org) designed for this purpose. You will be given a user I.D. and password
to access your log. You are expected to have at least one quality procedure experience each weekday (M‐F). A
weekly confirmation that your PSOL is up‐to‐date with experience recorded each day must be confirmed with
the Division’s Program Coordinator, and the quality of experience should be reviewed with the faculty member
designated as the service supervisor on your rotation. Vacation approval, elective experience, and operative
privileges may not be granted if the case logs are not up to date with daily entries. You are required to be up‐to‐
date on operative logs prior to being allowed to participate in weekly clinical activities on Monday mornings or
you will be subject to being placed on probation. Disciplinary actions may be invoked as described in Section 34.
You cannot graduate from this training program unless your PSOL logs are completed and reflect an adequate
volume and balance of operative experience in every category.
The PSOL documentation of your experience in residency has become of prime importance in confirming
service to the University and its hospitals in maintaining resident salary lines, and in obtaining your hospital
operative privileges after graduation, although these were not the original intent of the PSOL. Be sure that each
and every one of your procedures are recorded. If procedures involving new technology (e.g., new lasers, new
endoscope, etc.) are not on the document, record them under “other” and record the exact device (e.g., type of
laser). Keep a copy of your PSOL for the purpose of credentialing after graduation, with a spare copy in a safe
place. The ACGME will keep copies of your operative logs for a short time, but not permanently. The Division will
not keep copies beyond your graduation. It is in your best interest for you to keep these records securely and
permanently, as all hospital and other credentialing agency requests will be referred to you.
Instructions for the ACGME Resident Data Collection System are online at www.acgme.org.
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12. BASIC SCIENCE EDUCATION AND RESEARCH EXPERIENCE
The University of Louisville Division of Plastic Surgery has a strong academic commitment to basic
and clinical research. We maintain active basic science and clinical research programs that provides
important experience to all residents. Both residents who are pursuing an academic career and those who
plan a community practice need to understand the principles of scientific analysis and investigation in
order to analyze literature and practice evidence‐based medicine necessary for optimal patient care.
A. Participation in and reporting of original research is an important facet of this program,
and we expect all residents to develop skills in experimental design, data analysis and
scientific writing. The standard of care that you practice will be determined to a significant
degree by published data and papers. It is essential to be able to critically evaluate
scientific papers, to recognize quality versus junk or weak science, and to recognize
therapies that are evidence‐based. Whether or not your future career plans involve an
academic position, this is an essential skill and a requirement for completing this residency.

B. Grand Rounds Reconstructive and General Competencies Conferences: Presentations of
research topics at least once each semester are included in these conferences.

C. An annual Basic Science Symposium, “Research!Louisville” is held each fall. This includes
basic science courses, a nationally renowned keynote speaker, grant writing and project
design seminars, and presentations of University of Louisville research projects.
D. It is required that each graduating senior will have published or have prepared for
submission to a peer reviewed journal at least one article from work largely or completely
done during the plastic surgery residency here and co‐authored with a full‐time clinical
faculty member. Such publications can include a clinical series, chart review, or basic
research from involvement with one of the many basic science studies underway in our
laboratory at the Price Institute of Surgical Research, and the subject must be approved by
the Program Director and the faculty. Make an appointment with a faculty member early in
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your program to begin this project. It cannot be realistically accomplished in less than one
year. The graduating resident does not necessarily need to be the first author on the
publication, but he/she needs to perform a sufficient amount of the work and writing to
allow authorship and he/she must write a draft of the manuscript. Failure to satisfy this
requirement voids the senior resident the opportunity to attend a national meeting
(Section 26) and the opportunity for an elective at the end of the senior year rotation.
Failure to do this also may become grounds for not signing your residency completion
certificate (Section 31) and subsequent ineligibility to sit for the American Board of Plastic
Surgery certification examination. Being the primary author of a book, or a book chapter
will satisfy the research requirement.

E. It is required that each resident present a paper, each year, at the annual meeting of the
Kentucky Society of Plastic Surgery held each September. This may be the paper described
in Section D, or another appropriate clinical or experimental report. Presenting a paper at
this conference, and preparing it (or another paper) for submission to a peer‐reviewed
journal is one element of the prerequisites for the senior elective (Section 16) and the
senior opportunity to attend a national meeting (Section 25) or the Program Director may
not certify the resident to sit for the American Board of Plastic Surgery Examination.
13. ETHICS, HONESTY AND CONDUCT
A. Absolute honesty, integrity and professional conduct must be maintained in all
professional situations and the highest standards of personal and professional ethics
always upheld. Physicians are among the most trusted and respected of all members in our
society, and this trust must be earned and maintained by each of us on an ongoing basis.

B. Courtesy, respect and professional conduct is expected in all interactions at all times. This
standard must be maintained irrespective of the behavior of other parties. Aggravating
behaviors is part of human nature and is occasionally encountered from patients or other
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professionals. You must discipline yourself to not be drawn into lessening your standards,
irrespective of the level of aggravation.
C. Dress at work must be neat, professional and traditional at all times. White laboratory
coats, with business shirts, ties and slacks (or equivalent dress for women) are acceptable
substitutes for suits or conservative business jackets and slacks. For military residents,
uniforms may be worn in appropriate settings, and the uniform protocols of your service
apply. We do not observe “casual Fridays” or other breaches of professional dress or
demeanor.
14. TEACHING RESPONSIBILITIES
This is a teaching service at all times. Residents are expected to teach medical students and
rotating residents from other services in all activities whenever they are present. Involve them in all
aspects of our educational program. Offer them technical opportunities, such as monitored suturing and
wound care when appropriate, and offer them opportunities to develop analytical reasoning skills in
patient care in the same manner used by the faculty in your education.
15. SERVICE ROTATION SCHEDULE
The service rotations are designed to provide the plastic surgery resident with a rich,
comprehensive and balanced exposure to all areas of plastic and reconstructive surgery. The primary
rotations outlined in the Block Diagram of service rotations (Attachment 1) take place at the following
institutions:
1. University of Louisville Hospital
2. Veterans Affairs Medical Center
3. Kosair Children’s Hospital
4. Norton Hospital
5. Jewish Hospital
6. Jewish Hospital East
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7. Frazier Rehabilitation Center
8. Plastic and Aesthetic Center of Jewish Hospital
9. Plastic and Aesthetic Center of the Alliant Medical Pavilion
10. Outpatient Operating Suite of University Surgical Associates
11. Operating Suite at the Brown Cancer Center
These each offer a unique and valuable educational experience to the resident, and these facilities
are considered to be the core facilities of the University of Louisville Plastic Surgery Resident Training
Program. Most are in immediate proximity to the conference sites, libraries and educational services of the
program.
The resident assigned to the service encompassing each of these sites must first cover the cases of
his/her assigned service. To spend any time away from these hospitals, specific permission must be given
by either the Program Director or the full‐time academic faculty who have cases on that service that day.
However, we strongly encourage requesting this permission for cases of strong educational value or critical
PSOL need, wherever they might occur.
The service rotation schedule is designated to cluster the educational experience provided by our
core facilities into blocks of a meaningful level of concentration for a meaningful length of time. The service
rotation schedule (Attachment 1), and the educational goals of each rotation are described in Section 5.
The first obligation of the plastic surgery residents is to significant cases of full‐time academic faculty
members of the Division, for assisting in surgical cases and supervised patient care. If a conflict occurs
between educationally valuable cases of full‐time academic faculty members or community faculty
members, the conflict must be discussed at least 24‐hours in advance in order to allow sufficient time for
resolution or arranging alternative assistance if needed. This pertains to all situations including vacation
time, any leave of absence, or if the resident wishes to perform a case with other divisions or with a
member of the volunteer faculty. When there are conflicts in staffing cases, it is the responsibility of the
chief administrative resident to resolve the issue. It is the administrative chief resident’s right to assign
another resident to the full‐time academic faculty case, if this is discussed with the full‐time academic
faculty member at least 24‐hours ahead of time. If these policies are violated, the offending resident will be
disciplined, including loss of permission to participate in cases of the volunteer faculty for the remaining
duration of the rotation. Unexcused absence from cases of the academic full‐time faculty, without approval
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for good educational reason, warrants disciplinary action and possible training termination as detailed in
Section 34.
Each hospital has an assigned faculty supervisor, who is also responsible for the service rotation
most closely associated with that hospital. These supervisors report to the Program Director. They are as
follows:

1. University of Louisville Hospital and Clinics Service: Dr. Joshua Choo
2. Adult Reconstruction: Drs. Terry McCurry and Gordon Tobin
3. Veterans Affairs Medical Center Hospital and Clinics/Adult Oncology: Dr. Morton Kasdan
4. Head and Neck Aesthetic and Reconstruction: Dr. Jarrod Little
5. Hand Service: Dr. Bradon Wilhelmi
6. Kosair Children’s Hospital/Pediatrics Plastic Surgery Service: Dr. Mark Chariker
Note: All cleft lip and palate cases must be attended by at least one resident. These operations are always
performed at Kosair Children’s Hospital. It is the responsibility of the rotating resident to always check the
schedule for these cases. If a senior resident is not up to date on the required number of these cases, then
these cases will take priority over any other cases being performed in the program. Attendance at cleft
cases takes priority over attending requirements or needs.
Plastic surgery service rotation continues until June 30 in the year of your graduation.
16. DUTY HOURS LIMITATIONS
The 80‐hour work hour limits call structure and conditions recommended by the ACGME Plastic
Surgery RRC Program Requirements and the University are observed.
A. Resident duty hours must not exceed 80 hours per week when averaged over 4 weeks, which is
inclusive of all in‐house call activities and moonlighting. “Duty hours” are defined as:
a. Patient care (both inpatient and outpatient).
b. Administrative duties related to patient care (i.e., dictation).
c. In‐house call activities.
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d. Academic activities (conferences).

B. “Work site” is defined as University Hospital, Jewish Hospital, Norton Hospital, VAMC, Jewish
Hospital East, Frazier Rehabilitation Hospital, Norton Children’s Hospital, University of Louisville
Clinics, all private offices.

C. Residents will be given 10 hours off for rest and personal activities between duty periods.
D. In‐house call is not a requirement of the Plastic Surgery Residency Program with the exception of
the Hand Service Rotation, and that will be no more frequent than every third night, averaged over
a four‐week period.

E. Continuous on‐site duty, including in‐house call, must not exceed 24 consecutive hours.
F. Residents may remain on duty for up to 4 additional hours to participate in didactic activities,
transfer care of patients, conduct outpatient clinics and maintain continuity of medical and surgical
care. Residents will be released from duties by 1:00 pm the next day following in‐house call. No
new patients may be accepted by the resident after 24 hours on call.

G. Resident time spent in the hospital when on second call, reserved call or University call will be
counted towards the 80 hours.

H. Residents will be given 1 day off out of 7 free of all educational, clinical and administrative
activities, averaged over a four‐week period, inclusive of call. One day is defined as one continuous
24‐hour period free from all clinical, educational, and administrative activities. At‐home call cannot
be assigned on these days.
Residents will be verbally questioned in regards to their mental alertness whenever necessary.
Residents will have access to on‐call rooms during the day for resting as necessary especially during
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post‐call periods. Any resident needing back‐up support with post‐call patient care responsibilities
must contact the Program Director immediately.

I. Residents and faculty will be constantly on guard for signs of stress and fatigue and take
appropriate action whenever needed.

J. The University of Louisville School of Medicine has instituted a “Cab Voucher System”, which is
available to residents and on‐call medical students, 24 hours a day. For details, go to:
http://louisville.edu/medschool/gme/hsc_files/cabprogram.htm.
K. Monitoring: Random monitoring by the Program Director and Full Time Faculty will be performed.
Residents are required to complete the work duty log every week in MedHub. This will be checked
weekly for completeness, timeliness and compliance.

L. All violations of the Duty Hour Policy must be immediately reported to the Program Director
regardless of time or date.

M. A thorough explanation of these rules is available in the University of Louisville School of Medicine
Resident Policies and Procedures Manual, Section VII.A, Pages 10‐11.
17. CALL RESPONSIBILITY
A. During weekdays, from 06:00 to 16:00, the resident on each service will be responsible only for
that service and its emergency room consults, intraoperative consults, floor calls and consults, and
calls from resident or faculty patients of only that service, that are directed to the resident. The
only exceptions to the day call responsibilities described in Section 15, above, are when covering
for another resident and true emergencies requiring response from the most readily available
resident, irrespective of rotation assignment. Each resident in the Division of Plastic Surgery is
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required to take night and weekend call based upon the monthly resident call schedule that is
posted prior to the first day of each month.

B. Night and weekend call and work hours follow Department of Surgery Standards, as outlined in
the current House Staff Manual.

C. The overall attending and resident call schedule is made monthly by the Program Director. The
administrative chief resident assists by assigning first call, second call and chief resident on call, for
each day (see below). Modifications to this call schedule may be made after the schedule is posted,
if deemed necessary by the Program Director. Weekend call changes at 06:00 the morning of the
call day and lasts for 24 hours. Weekday night call is from 16:00 to 06:00 the next morning. On
night and weekend call, the first call resident will cover all teaching services, all consults to them
and emergency rooms, all telephone calls. The second‐call resident and chief resident on‐call will
be responsible and available for backing up the first‐call resident with either physical and/or
intellectual support. The second‐call resident and chief resident on call will be available by pager
and telephone contact at all times to provide this back‐up support. Both resident and faculty
monthly call schedules are published each month on‐line and posted in the Division office.

D. Be reminded that all residents are acting under the auspices of the University of Louisville and
University Surgical Associates. P.S.C., and the Plastic Surgery attending on call in particular. All
night and weekend cases that the first‐call resident sees in consultation in the Hospitals or
Emergency Rooms, Operating Rooms or Wards, will be presented initially to the senior‐call
resident. It is then the responsibility of either the first‐call or the senior‐call resident to present
each case and all pertinent data pertaining to that case to the attending of record. This may be
modified based upon the attending’s preference, which should be clearly determined at the
beginning of each call period. (For example, some attendings will wish to be called by the first‐call
resident, while others may agree to let the senior‐call resident make clinical decisions up to a pre‐
determined level.) Similarly, any patient phone calls that are not straight‐forward and require
more complex decision making, or that could significantly impact upon a patient’s care should be
presented to the senior‐call resident. The need to contact the attending in this situation will be
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determined by the senior‐call resident, acting on attending guidelines. Outpatient cases at Kosair
Children’s Hospital (KCH) Emergency Room will be discussed directly with the KCH medical staff
member on‐call that month who has been assigned responsibility for the patient by the KCH call
schedule rotation. Admissions by the University faculty to KCH (from ER or direct) and inpatient
consults are to be discussed with the faculty attending on call. Similarly, other affiliated hospitals,
University faculty cases and referrals will be discussed directly with the responsible attending.
Failure to meet call responsibilities may result in disciplinary actions or dismissal, as described in
Section 34.

E. First call may be taken from home, if responses are prompt and conscientious. An in‐house call
room is available if convenient for the resident on any specific night. All prior consults and
obligations must be met promptly, thoroughly, and courteously, both during work hours and while
on night call.

F. All admissions to the plastic surgery service must be approved by the attending plastic surgeon, as
residents do not have independent admitting privileges. Failure to obtain attending approval of an
admission, transfer or a treatment plan will leave the resident legally liable for any complications,
mismanagement, or malpractice action that ensues. This will also constitute grounds for
disciplinary action or dismissal, as described in Section 34.

G. The first‐call resident’s primary responsibility is to see the Emergency Department consultations,
ward consultations and patient care calls of the University Plastic Surgery Services at the University
of Louisville Hospital, Veterans Affairs Medical Center (VAMC), Norton HealthCare Hospitals
(Norton, Kosair Children’s, Alliant Medical Pavilion and the Norton HealthCare affiliates), Jewish
Hospital and Frazier Rehabilitation Center. However, based upon the request of the full‐time
faculty, the first‐call resident may be asked to see patients at other emergency departments or
hospitals with which the University of Louisville Plastic Surgery full‐time faculty are affiliated.
Currently, we take no ER calls at hospitals other than those listed above, but we do receive
occasional consultation requests.
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H. Calls originating from any of the aforementioned emergency departments or hospitals for consults
directed toward volunteer faculty or community surgeons on an affiliated medical staff will be
handled as follows:
a. Based upon the learning value and complexity of the case the resident may assist in the
case as an agent under the supervision of the community surgeon responsible for the
patient’s care. The primary responsibility for care of these patients cannot be transferred
from the responsible community surgeon to the resident under any circumstances,
although the resident may perform minor outpatient procedures (e.g., lacerations,
abrasions, minor burn care, etc.) for the community surgeon under his/her supervision and
responsibility and send the patient for follow‐up to the community surgeon’s office or
admit the patient to the community surgeon’s service.
b. If a volunteer faculty member who is an active teacher in the program specifically requests
the on‐call resident’s assistance with a case, and the on‐call resident is not engaged in
another case, every effort should be made to accommodate that request. The on‐call
resident should not, however, be excessively burdened with time‐consuming cases of
marginal or no educational value. If the resident feels that he/she is being taken advantage
of in this process, the Program Director and the full‐time faculty should be informed, he
will instruct the responsible volunteer faculty member in proper protocol.

I. Consults originating from the affiliated emergency departments (such as Kosair Children’s) when a
community volunteer faculty member or is on call will be covered by the on‐call resident only for
actively teaching volunteer faculty and only on days (currently every third) when the University of
Louisville Hospital Plastic Surgery team is on maxillofacial trauma call. During months when the
Plastic Surgery full‐time attendings are on call at any of the UofL affiliated hospitals, the on‐call
resident will cover consults and admissions to the full‐time faculty members at all times,
irrespective of the UofL Hospital 3‐day rotation maxillofacial trauma call schedule.

J. Plastic surgery residents do not have independent practice or admitting privileges, therefore, they
are not allowed to admit, accept transfer from another institution, nor treat any patient at any
hospital without the expressed authorization of the attending or staff surgeon responsible for the
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patient. At UofL Hospital and VAMC, this is the full‐time faculty. At other affiliated hospitals, these
actions must be authorized by the fully licensed staff plastic surgeon that is responsible for the
specific case and recorded in the patient’s medical records. These actions or any other care can be
done only on behalf of the staff surgeon. Taking independent action to accept an admission, treat a
patient or see a consult without appropriate authorization by the staff surgeon exposes the
resident to liability and is forbidden. This constitutes grounds for disciplinary action and possible
dismissal, as described in Section 33.

K. In the event that you are asked to assume responsibility for a patient without prior staff
authorization and chart documentation, courteously refer the request to the appropriate surgeon
on call at that hospital, or to the service on call if a rotating schedule is in effect, but do not assume
independent responsibility or give any impression that you are permitted to do so.
18. FACULTY SUPERVISION AND RESIDENT OPERATING ROOM
STAFFING
The following resident supervision guidelines are designed to provide graded, surgical
responsibility with a maximum rate of conceptual, judgmental and technical growth while simultaneously
providing the highest quality of patient care, and compliance with supervision standards of our hospitals,
the University and all accrediting bodies. These supervisory responsibilities apply to all of our teaching
hospitals. The faculty is ultimately responsible for all patient care, and the residents provide care only
under faculty supervision. Residents are given progressive graded responsibility, but always with
accountability to the responsible faculty. As described in Sections 1, 2 and 3, however, the resident must
be fully intellectually accountable for a complete analysis and solution of the medical problem(s). This
includes:
a. an evaluation sequence leading to an accurate diagnosis or an accurate analysis of a
defect;
b. design of an appropriate solution (including non‐surgical treatment when indicated); and
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c. articulation of the hierarchy of options with a well‐supported rationale for their ranking.
This analysis should always be done first, and should always be presented to the faculty. The
attending should only then give the appropriate feedback and critique of the plan (including probing
questions) refinements, other options that merit consideration, references, approval and ultimately
supervised implementation. Further discussions should cover avoidance of complications and plans for
follow‐up. This interactive process is at the heart of our program to maximize conceptual and judgmental
growth. This step should be observed at all levels of resident experience, even very early in the program
when the resident has incomplete knowledge of many clinical conditions. Ultimately the faculty must be
available and present for at least the key portion of the procedure.
RESPONSIBILITIES OF THE RESIDENT
 It is the responsibility of the resident to communicate about every patient that they see in the course
of their duties with an attending physician. If the resident feels they do not have the appropriate level
of faculty supervision, they are to immediately contact the Program Director. If the Program Director is
not available then the resident can contact the next in line attending on call and back up call resident.
 It is the responsibility of the resident to communicate with the attending physician about both
inpatients and outpatients referred and/or seen by our service.
 It is the responsibility of the resident to discuss acceptance of new patients to the service with the
appropriate attending physician.
 It is the responsibility of the resident on‐call in the evenings, on weekends, and on holidays to notify
the attending physician of any new patients seen, and to communicate and/or round with the
attending physician(s) on call.
 It is the responsibility of the resident to notify the appropriate attending physician of any and all
patients going to the operating room.
 It is the responsibility of the resident to notify the attending physician of any changes in the patient’s
status.
 It is the responsibility of each resident to monitor their own Duty Hours thereby assuring the duty
hours limitations are not exceeded. When there is about to be a Duty Hour violation, the resident is to
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immediately request that another resident take his/her place. If this is not possible, then the Program
Director must be immediately contacted.
 We frequently have medical student rotating on our service. The plastic surgery residents are the
primary teachers of these medical students. It is the responsibility of the resident to proctor, and even
mentor, the students. The resident is also responsible for the behavior, professionalism, supervision,
and education of the medical students.
 The level of technical responsibility given to the resident will progress sequentially as determined by
the growth of technical skill:
 Residents will first learn the key elements of new procedures as an observing assistant.
 The key portions are then progressively turned over to the residents as their ability permits,
with supervision by the attending as a teaching first assistant.
 In selected procedures, practice in the fresh cadaver lab may be helpful.
 Next, the resident assumes the role of surgeon for the entire procedure, with the faculty
member observing or serving as a teaching first assistant only as required by the level of
complexity or by compliance regulations.
 As resident skill further improves, the resident care progresses to full independence in selected
teaching settings such as University Hospital, with the attending always readily available for
consultation or assistance.
 Surgery residents at the UofL Hospital and the Louisville VAMC (but not at other affiliated
hospitals) are allowed to perform certain cases in the operating room under attending
supervision and availability, but without the physical presence of an attending in the operating
room. However, a plastic surgery resident cannot take any patient to the operating room
without previously discussing the case and formulating an operative and management plan
with the attending of record and approved by him. No operation can be done without previous
consultation and notification of scheduling with the attending. The attending must be made
aware that an operation is to be scheduled and exactly when. Failure to do so will leave the
resident legally liable for any potential complications, mismanagement or malpractice that may
ensue from such treatment. This may also constitute grounds for disciplinary action and
possible dismissal from the University of Louisville Plastic Surgery Resident Training Program,
as described in Section 34.
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RESPONSIBILITIES OF THE FACULTY (ATTENDING PHYSICIANS)
 It is the responsibility of the attending faculty member of each clinic and service to communicate
with the resident staff regarding all inpatient and outpatient aspects of patient care.
 It is the responsibility of the attending faculty member assigned to rotations/clinics to be available
for discussion and examination of patients encountered by the resident staff.
 It is the responsibility of the attending faculty member to be available by phone or beeper during
the normal hours of operation. If a given attending will be unavailable to the residents for any
prescribed period of time (i.e. vacation), that attending must have signed out to another
responsible faculty member and notified the Program Director.
 It is the responsibility of the attending faculty member who is on‐call to discuss and see patients
with the resident staff during his/her call period. This means that the resident will have full access
to the on‐call faculty member by personal interaction, telephone, and beeper during the call
period.
 It is the responsibility of the attending faculty member to post an accurate call schedule such that
the resident staff and hospital partners are aware of who is the attending faculty on call at all
times.
 It is the responsibility of all faculty members to be aware of the signs and symptoms of stress and
fatigue among the residents, and to immediately notify the Program Director.
 When properly informed of scheduling, it will be the attending’s responsibility to be physically
present in the operating room at the key points of appropriate cases for both supervision and
education. The faculty members will also hand‐write a note in the chart or complete a UofL
attestation form. This type of presence and documentation is required by Medicare compliance,
hospital protocol or reimbursement criteria. The same presence and documentation applies for
procedures performed in the emergency room or hospital ward, and for consultations and history
and physicals (H&Ps) that require physical presence and documentation for compliance or
reimbursement. In the University Hospital operating room, the faculty attestation form fulfills the
requirement of a hand written note by faculty.
 All cases at University should be staffed by the Attending on call when the patient was admitted,
first seen, or consulted under.
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 All revision surgery for University patients should be staffed by the Attending that was initially
involved or performed the original surgery.

RESPONSIBILITIES OF THE PROGRAM DIRECTOR
 It is the responsibility Program Director to communicate to the residents at orientation and
reiterate throughout the academic year that they must discuss clinical care of all patients with the
attending staff.
 It is the responsibility of the Program Director to communicate with the faculty that it is the faculty
who is ultimately responsible for all clinical care.
 It is the responsibility of the Program Director to make certain that the faculty call schedule
provides an opportunity for 24 hour, seven days per week supervision of resident clinical activity.
 It is the responsibility of the Program Director to make certain sufficient faculty are available for
staffing purposes of all inpatient and outpatient clinical activities involving resident staff.
 It is the responsibility of the Program Director to be aware of all issues concerning resident stress
and fatigue, and to assure that the resident is directed for appropriate care of these issues.
CHIEF RESIDENT RESPONSIBILITIES
 At any given time, one of the two senior residents will serve as Administrative Chief Resident. The
senior resident, who is responsible for the UofL Hospital, either primarily or as the main back‐up
support to a junior for the quarter, will be designated as the Administrative Chief Resident or will
carry out the duties associated with this administrative position as follows:
o They will be responsible for making the monthly on‐call schedule and submitting it at least
ten (10) days prior to the start of the month to the residency coordinator for posting on
the website, or by transmittal via email.
o They will insure that cases are adequately covered and the educational opportunities best
used at the affiliated hospitals.
 The chief resident is not expected to review the operative schedule at every
hospital on a daily basis. However, if a conflict arises, the chief resident is
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responsible to correct the problem to the best of his/her ability. Consultation with
the designated attending supervisor of the hospital service is available, if needed.
o The resident designated as Chief at University of Louisville Hospital will be responsible for
the preparation and the presentation quality of all walk rounds. This includes making
certain that any relevant data needed, such as radiographs or prior records are available
near the bedside, and to insure that concise and polished formal presentation of the cases
are made in the traditional format and style.

 When not serving as Administrative Chief Resident, the other senior resident will serve as
Education Officer, whose duties are as follows:
o They will be responsible for organizing the Grand Rounds speaker schedule and for
organizing the format along the guidelines of the 12 RRC mandated topics.
 Each month will be assigned to one of the RRC mandated topics (unless a separate
conference is dedicated to that field). Also, medical legal, ethics, practice
management and basic science topics will be each included at least once each
semester as a Grand Rounds or General Competencies Conferences topic.
o They will be responsible for collecting attendance sign‐in sheets and distributing CME
evaluation forms at all conferences and rounds.
 This may be delegated to a designated junior resident, with faculty approval.
o They will be responsible for organizing bedside teaching rounds whenever scheduled, for
making certain that each of the other residents will also have cases to present at
Indications Conference and Core Plan, and that Quality Improvement and Morbidity
Analysis Conference presentations are organized and timely (Section 6).
o They will be responsible for assisting with the Journal Club, as detailed in Section 6.
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19. THE MEDICAL RECORD
A. Medical records must be kept accurate, current and neat. Written records and signatures must be
highly legible. If your signature is not clearly and easily readable to our nurses, you must print your
name beside it. Also, you must add your pager number to the chart of each patient under your
care, and to all admission and postoperative orders. All abbreviations must comply with those
approved by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the
participating hospitals.

B. The resident will perform the operative dictation at University Hospital and the VAMC. Some
attendings prefer to do the majority of their operative dictations at the Norton and Jewish
Hospitals, so clarify this individually. Who is to dictate the operative report and write orders should
be clearly decided immediately at or before the completion of the case. All dictations should be
done on the day of the procedure, and immediately after the case is completed.

C. The resident is responsible for dictating all H&Ps, consults, discharge summaries and operative
notes, unless otherwise instructed. The attending will write a consultation note and a brief
operative note in the chart unless otherwise arranged.

D. For uniformity, the Medicare (HCFA) format for encounters (H&Ps, consultations, and discharge
summaries) is used for all patients. This includes the exact elements of the subunits (e.g., chief
complaint, referring M.D., history of present illness, past medical and surgical history, review of
systems, family/social history the items to be documented on the sections of the physical exam,
lab diagnosis and recommended plan.

E. A preoperative note is to be written on all patients the night before surgery, after giving informed
consent. This should document the discussion of the condition, the treatment offered and
recommended, the risks of the offered treatment and alternative treatments (including no
treatment) the goals of each, limitations of each, and the patient’s decision to accept or reject the
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offered treatment. The patient’s status with respect to laboratory work, insulin use, anticoagulant
use, and NPO status should be reviewed.

F. All residents must complete medical records in a timely manner for the entire length of their
training or they may not be eligible to sit for American Board of Plastic Surgery Examination.
20. MEDICAL RECORD DOCUMENTATION FOR MEDICARE
COMPLIANCE
Specific documentation guidelines must be followed for the medical records of Medicare and
Medicaid patients (Supplemental Reference Manual, UofL Compliance Office Handbook). These guidelines
will likely apply to all other records soon enough. All history and physicals (for consults, admissions and
office visits) must include:
1. A Chief Complaint (one sentence describing the main reason for consultation, admission or
evaluation).
2. The service or referring physician and reason for the opinion requested must be stated.
3. Documentation must include a History of Present Illness (HPI), which should include all
features and associated events of the condition.
4. The Review of Systems must systematically cover the standard systems.
5. The Past Medical/Surgical History PM/SH) must include a surgical history, a medical
history, medication allergy section, and a medication listing.
6. A Family History and Social History (F/SH) should be included.
7. The physical examination should cover all systems, but focus in detail on the area
responsible for the consultation, and significant positive findings. The physical should also
include, and specifically list, a general status report, vital signs, a brief examination of the
head, eyes, ENT, neck, heart, chest, breasts, lungs, abdomen, each of four extremities and
pelvis/genitalia/ rectum (if these exams are appropriate).
The University of Louisville Compliance Office annually conducts compliance courses and
distributes a comprehensive compliance manual (Medicare Documentation and Billing Guidelines,
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Supplemental Reference, #8) and pocket reminder cards. Each resident must attend the compliance course
and maintain the manual and cards. If lost, replacements are available from the UofL Compliance office. It
is the responsibility of the resident to determine and inform the faculty member whether or not a patient
is a Medicare or Medicaid patient. This will allow both the resident and the faculty member to provide the
appropriate level of presence and written documentation required for compliance on the patient’s chart.
21. ACCURATE BILLING PROTOCOL
Billing for operative procedures, consultations, and admissions done at Norton, Jewish, and Kosair
Children’s Hospitals is the responsibility of the attending surgeons. At University Hospital, all operations,
new patient evaluations, H&Ps, consultations and ward, or ER procedures must be documented in the
medical record and reported by the plastic surgery resident using the current yellow card system. These
yellow cards must be submitted to the Division secretary on a daily basis each morning. The cards must be
filled out completely to allow our billing personnel to submit the appropriate charges in an efficient and
timely manner. Required data includes the attending of record, the patient’s name and hospital number,
and the procedure performed with appropriate CPT language or code and appropriate clinical detail to
allow for adequate coding and billing. For example, laceration repair should cite the number of centimeters
closed, locations of the laceration, and whether or not it was a simple, closed in one layer, intermediate
(multiple layers) or complex (with debridement and/or advancement repair). Skin flaps and skin grafts are
described in square centimeter of area. These billing protocols serve two main purposes: (1) to fully return
appropriate compensations for the services rendered; and (2) to familiarize residents with proper billing
procedures. In your future practices, each of you will be highly dependent upon complete knowledge of
the proper coding and billing process. Lack of knowledge, unintended errors, or inadequate documentation
of services rendered may subject you to severe penalties for fraud, irrespective of intent. It is in your best
interest to now learn how to do this accurately and with precise documentation.
Residents not yet thoroughly familiar with CPT coding should become so. This will be the language
of communication with third party payers for your practice lifetimes. Each resident must have access to a
current CPT manual and one will be made available to you (Supplemental Reference Manual, #7).
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22. TRANSITION OF CARE
DEFINITIONS
Transition of Care: Transition of care is defined as when a physician transfers the care of a patient to
another physician. This includes sign‐out as well as sign‐in. It also includes the transfer of a patient from
one level of care to another, e.g. transfer of a patient from the wards to the ICU or vice versa. By definition,
transition of care also occurs when a physician transfers the care of a patient at the end of a rotation and a
new physician assumes the care of the patients on that service.
Proper Hand‐Over of Patients: The proper hand‐over of patients should include at least the following. The
exiting physician must notify the attending and co‐resident(s) who will be responsible for patient care that
they will be leaving. The exiting physician must give a proper verbal checkout which includes the patient’s
active problems, advanced directives, diagnostic tests pending, current medications, and the diagnostic
and therapeutic plan. The exiting physician should also attempt to anticipate any events that may occur
with his or her patient in their absence and give the best course of action. The exiting physician should also
make aware any orders that have been or need to be placed. This should all be done face‐to‐face to ensure
accuracy and proper evaluation of the exiting physician’s checkout to ensure patient care and safety as
well as improving resident education.
RATIONALE
Effective communication is vital to safe and effective patient care. Many errors are related to
ineffective communication at the time of transition of care. In order to provide consistently excellent care,
it is vitally important that we communicate with one another consistently and effectively when the care of
a patient is handed off from one physician to another. This policy is meant to define the expected process
involved in transition of care, and applies to each of our teaching sites where we provide inpatient and
outpatient care. All residents and faculty members must demonstrate responsiveness to patient needs that
supersedes self‐interest. Physicians must recognize that under certain circumstances, the best interests of
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the patient may be served by transitioning that patient’s care to another qualified and rested provider. It is
also essential for residents and faculty members to do so by abiding by current duty hour policy.
SPECIFICATIONS
Service Schedules
A. It is the duty of the Plastic Surgery Chief Resident to determine the call schedule at least 1 month
prior to the start of the rotation and for this information to be updated at the University of
Louisville Hospital Switchboard. It will also be transmitted to each faculty member and resident via
email.
B. It is the duty of the Program Chairman to determine the call schedule for the faculty at least one
month in advance. This information will be updated monthly at the University of Louisville Hospital
Switchboard and posted on the Division’s bulletin board. It will also be transmitted to each faculty
member and resident via email.
C. All vacations and times away from duties will be reported to the Program Coordinator who will
inform the faculty and residents via email.
D. All residents take call from home. When called into the hospital, the 80‐hour Duty Policies will be
strictly adhered to.
E. With the exception of vacations and illness, all residents will be available for discussions of patients
with the on‐call resident.
On‐Call Principles
A. There are presently 6 residents at the PGY‐6, PGY‐7, or PGY‐8 level.
B. Each night the residents will sign out to the on call resident and transfer care of the patients to the
on call resident until 6:00 AM the next morning.
C. The hand‐off will occur either in person or by telephone. This should not be by text message or
email. A list of patients on all services must be transmitted by email or text message.
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D. Hand‐over information should include the following:
 Patient location (e.g. Bed # and Institution #).
 Active problems, including ongoing management plans.
 Tasks requiring completion or results/findings requiring follow‐up.
 “Watch out for…”
 Emphasis must be given to critically ill or unstable patients.
End of Rotation/Off Service
A. On completion of an inpatient rotation, the resident physician must communicate with the
resident physician that is coming on service to assume the care of his or her patients. This will
ensure that each patient on the service continues to receive continuous, high quality care without
interruption.
B. Communication must include an off‐service note written by the resident rotating off service. The
off‐service note must briefly summarize the patient’s course to date, and include any active
problems, advanced directives, diagnostic tests pending, current medications, and the diagnostic
and therapeutic plan.
C. Communication should also include a face‐to‐face hand off that provides an opportunity to discuss
each patient and allow questions and clarification of any issues. If for some compelling reason this
is not possible, then the residents should at least review the list of patients over the telephone and
a patient list must be left by the resident rotating off service for the incoming resident in a
prearranged location.
Resident Evaluation
A. Residents will be verbally evaluated via in person or by telephone on his or her transfer skills by the
attending(s) and/or the senior co‐residents weekly unless otherwise specified above.
B. A question will be added to the quarterly evaluations from attending and for peer evaluations to
comment about resident’s “transfer of care” performance.

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23. HIPAA Compliance
(Excerpted from “Portable Surgical Mentors,” Larry D. Florman, M.D., Springer‐Verlag, 2007)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was instituted in the
United States to ensure the protection of individuals’ health information while also allowing
communication between parties involved with patient care. It was not until 1999, however, when the U. S.
Department of Health and Human Services developed the Privacy Rule that made implementation of HIPAA
mandatory. Effective April 2003, organizations (i.e., “covered entities”) subject to HIPAA regulations were
required to comply with patient information protection policies. “Covered entities” refers to health plans,
healthcare providers, and health care clearinghouses.
Required disclosures of identifiable individual health information include a request by a patient for
his/her information or a request by the U.S. Department of Health and Human Services in special instances,
such as a review. The privacy rule outlines six permitted disclosures of individual health information,
including the following:
1. Per request of the patient.
2. For treatment, payment, and healthcare operations.
3. To individuals identified by the patient, who may be informed; in emergency situations, the
healthcare provider must use his/her professional judgment to determine the best interest of
the patient.
4. Incidental disclosure.
5. Limited data set with the removal of certain individual identifiers.
6. Public interest, which encompasses disclosures required by law; public health activities; abuse,
neglect, and domestic violence; health oversight activities; judicial and administrative
proceedings; law enforcement purposes; decedents; cadaver organ and tissue donation;
research with permission of governing body, such as Institutional Review Board; threat to
health or society; essential government functions; workers compensation.
State governments reserve the right to have supplemental policies to further increase patient
privacy protection. Check with your institution to determine additional policies and guidelines. In short,
treat identifiable health information as patient property. Be careful how, where, and to whom you discuss
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and distribute patient information. Protection of patient privacy rights is required by law.

SUGGESTIONS FOR HIPAA COMPLIANCE
 Be aware of your surroundings. Do not discuss patients in public places such as elevators, waiting
rooms, public hallways, and lobbies.
 Dispose of identifiable health information, such as patient lists, in the appropriate manner. Most
hospitals have labeled containers for material that is to be shredded.
 Do not publicly display patient information. This includes both in hospitals and outpatient clinics
(i.e., do not leave patients charts unattended).
 When discussing scenarios or presenting a case to individuals not directly involved in the care of a
patient, do not disclose identifiable patient information.
 Do not identify patients over the internet.
HIPAA AT A GLACE
What is HIPAA?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) governs the use and disclosure of
protected health information (PHI) that is created or received by a covered entity that relates to:
o The physical or mental health of an individual (living or deceased).
o The provision of health care.
o The payment for health care.
o Identifies the individual or reasonably may be used to identify the individual.
It gives individuals the right to:
o Request restrictions on use or disclosure of their personal health information.
o Access medical records (including research records).
o Amend medical records.
o An accounting of disclosure of their personal health information.
o Request alternate confidential communications.
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o Lodge complaint with covered entity and/or the Department for Health and Human
Services.

It creates administrative requirements. The covered entity must:
o Designate a privacy official.
o Develop policies and procedures that are HIPAA compliant.
o Provide privacy training to the workforce.
o Implement administrative, technical, and physical safeguards to protect the privacy of
personal health information.
o Develop sanctions for violations of the HIPAA Privacy Rule.
o Meet the documentation requirements.

It described individual penalties for noncompliance such as:
o Civil penalties of $100 for each violation, up to $25,000/person/year.
 Liability exists if a person knew, or reasonably should have known, of a violation
and did not try to rectify the situation.
o Criminal penalties
 Knowing: up to $50,000/year and/or imprisonment of up to 1 year.
 False pretenses: up to $100,000/year and/or imprisonment of up to 5 years.
 Intent to sell, transfer, or use for commercial advantage, personal gain or malicious
harm: up to $250,000/year and/or imprisonment of up to 10 years
It has had impact on how researchers recruit subjects:
o If a subject refuses to authorize the use and disclosure of public health information,
the individual cannot participate in the research study.
o Accounting for disclosures prior to research.
o Waiver of authorization processing.
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o Specific uses of decedent data
There are specific allowable uses and disclosures of PHI for research:
 Authorization from subject
 Waiver of authorization from IRB
 Use of de‐identified data
 Use of limited data set
 Preparatory to research
 Decedent data
It is obvious that HIPAA has necessitated a whole new nomenclature for physicians, all individuals
in the health care industry, and certainly for the patients who are protected by the law. Interestingly,
HIPAA is nothing new to physicians. In 400 B.C.E. Hippocrates, acclaimed as the father of medicine,
proclaimed in his oath that we should uphold the privacy of our patients.
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24. TIME OFF POLICY

BEREAVEMENT, MATERNITY LEAVE/ PATERNITY LEAVE, JOB/FELLOWSHIP INTERVIEWING, SCIENTIFIC MEETING, ETC.
Time off, in addition to regularly scheduled days off, and approved vacation time, may be granted at the
discretion of the Program Director or the Associate Program Director for a variety of reasons. These reasons
include bereavement, maternity leave/paternity leave, job/fellowship interviewing, attendance at a scientific
meeting, etc. In addition, there may be other extenuating reasons that a resident would request additional time
off during the course of their training. The Resident Time‐Off Request Form is mandatory to be filled out for this
time and leave to be approved. The form is available from the Plastic Surgery Resident Coordinator or on
MedHub. All important elements of this form must be completed in order for a time off request to be approved.
It is the resident’s responsibility to arrange coverage for their duties during their absences, as well as
notification of the attending physician responsible for the educational site at which they are rotating. Those
faculty include Drs. Wilhelmi and Choo (ULH), Dr. Kasdan (VAMC), Dr. Little (NH, NKC), and Drs. McCurry or Dr.
Tobin (JH). Depending on the timing, the service, and the resident’s specific duties, additional faculty may
require notification to ensure the smooth flow of patient care responsibilities. The Resident Time‐Off Request
Form must be signed by the Program Director and the Chief Residents before the time off request is approved
and valid. These forms will be maintained in the Residency Coordinator’s office and in the resident’s file as a
permanent record of time off during the residency training program.
As the rotations in the ancillary services (i.e. Anesthesiology, Oral‐maxillofacial Surgery, Dermatology,
etc) are relatively short, no time off for any reasons will be given. Vacation time is not to be taken during these
rotations.
Time off is readily granted when a resident is presenting a paper at a scientific meeting, but also needs
to be approved. Time off is typically granted for fellowship and job interviews, but this must be approved and
will be limited to 7‐10 working days during the course of the year.
Additional time off for interviewing may require the use of the resident’s allotted vacation time.
Extended periods of time off for medical leave and maternity/paternity leave may also be necessary and require
approval by the Program Director and subsequent notification of the University’s GME office depending on the
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length of time and nature of the request. Additional training time may be required by the American Board of
Plastic Surgery. Please refer to the Medical Leave and Maternity/Paternity Policy for additional details.
VACATION TIME
A. The residents in the University of Louisville Plastic Surgery Resident Training Program are entitled to 10
(ten) days of vacation annually. Prior approval for any vacation or leave must be requested by
submitting both the Resident Time‐Off Request Form and a verbal notification to the Division’s Program
Director at least six weeks prior to the beginning date of absence. The form must be signed first by the
covering resident, by the Chief Residents, and then by the Program Director. Unauthorized absences will
result in loss of subsequent vacation time and disciplinary measures, as described in Section 34.
B. An additional leave of 10 weekdays is available for residents who qualify for attendance at a national
meeting (Section 26), for interviews, and foreign volunteer surgical missions (Section 27). These 10 days
are at the discretion of the Division Director. Interviews must be verified in writing, to include who and
where the interview is with, and submitted six (6) weeks prior to date of absence to the Division
Program Director.
C. Vacations, leave, or interviews may not be taken during the months of June and July, as these are both
periods of resident transition and heavy clinical loads. Time off is also discouraged around UofL’s Winter
Break, and potential days off during this time will be arranged by the Program Director. Any urgent
matters requiring leave during this time require a letter of explanation to be countersigned by the
Program Director.
D. No more than one week of absence during the three‐year training period is allowed from the UofL
Hospital Chief rotation, and none between June 15, and September 15 due to trauma coverage
responsibilities.
F. Only one resident can be absent at any given time, be it for vacation, leave, microsurgery lab training, or
any other cause. Consult with each other well ahead of vacation plans to prevent overlap.

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NATIONAL MEETING ATTENDANCE
Junior and senior residents may travel to one (1) approved national ASPS, ASPS sponsored, AAAPS or
Senior Residence conference. Current UofL travel guidelines must be followed in order to receive
reimbursement (up to allotted maximum) from Division funds. Registration, airfare, hotel accommodations, and
meals up to the allowable per diem are included in this limitation. Resident surgeon fees from aesthetic patients
may, within certain limits, be used for these activities. However, $1000 is the absolute limit of these
contributions. All expenses in excess of $1000 must be borne by the resident.
The time for these conferences will not be counted against vacation, but it is limited to the length of the
conference plus one‐day travel time on each end and, must not exceed eight days total. The resident must notify
the Program Director and the faculty in time to submit early ASPS registration and receive the early ASPS
registration discount and obtain low airfares for the chosen meeting. For the ASPS, early registration usually
closes in late July. A preliminary draft of the paper described in Section 10 must be turned in to the Program
Director by senior residents. If the Senior Residents Conference is chosen, the registration date is in January. An
abstract for presentation at the meeting must be submitted and an advanced draft of the paper described in
Section 12 must be submitted to the Program Director.
Also, the resident must have fulfilled the following criteria:
 The resident must have demonstrated satisfactory clinical performance as determined by their
written evaluations.
 The resident must have exceeded the 30th percentile in all categories of the annual Plastic Surgery
In‐Service Training Examination.
 Senior residents must have exceeded the RRC minimal required experience in all categories on the
Plastic Surgery Operative Log (PSOL).
 The resident must have given, or be prepared to give, the KSPS presentation.
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25. OVERSEAS HUMANITARIAN MISSIONS
An extra week of leave will be provided to allow senior residents to participate in travel abroad for
approved humanitarian activities in the field of cleft lip and palate or craniofacial surgery. This trip will be at
your own expense or with travel covered by scholarships. In the past few years, this time has been used to travel
with operation HOPE to the Philippines with Dr. Rigor from the UofL Department of Anesthesiology. Permission
for this trip is dependent upon the satisfactory accumulation of PSOL cases as detailed in Section 5, upon
satisfactory overall performance, and the senior presentation at KSPS, with preparation of a paper for peer
reviewed journal submission. Contact the Program Director to obtain essential information needed for this
opportunity. A certain amount of funding may be available for this activity, keeping in mind that all expenses in
excess of $1000 must be paid by the resident.

26. OUTSIDE EMPLOYMENT
The Plastic Surgery Program follow the “Policy on Resident Moonlighting,” as established and revised by
the Graduate Medical Education Committee of the University of Louisville School of Medicine. Refer to this
policy for current institutional requirements around moonlighting.
The Plastic Surgery Program does not require residents to participate in outside employment activities
(moonlighting). A resident may engage in moonlighting to a limited extent in their junior or senior years. This
privilege may be withdrawn or denied at any time by the Department Chair, or the Program Director. The
Program Director is required to monitor and approve in writing all moonlighting hours and locations for
residents and maintain this information in the resident’s file.
Moonlighting must be done outside of the usual time where the resident would be expected to be
present in the hospital or clinic on a particular service. Chief Residents on the service must have signed out to an
equivalent level resident to cover during the moonlighting period. Moonlighting internally at University Hospital,
Norton Healthcare, Jewish Hospital, or the Veteran’s Affairs Medical Center is strictly prohibited. The time that
residents spend Moonlighting must be counted toward the 80‐hour Maximum Weekly Hour Limit. The time that
residents spend Moonlighting must also be logged into MedHub.
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Resident physicians who hold either a Regular or Residency Training (RT) license in the State of Kentucky
shall be free to use off‐duty hours in appropriate related activities, including engaging in outside employment
activities, so long as the resident obtains the prior approval of the Division Chief/Program Director for such
outside employment activities, and so long as such activities do not interfere with the resident’s obligations to
the University, impair the effectiveness of the educational program engaged in, or cause detriment to the
service and reputation of the hospital to which the resident is assigned. Institutional Practice (IP) and Fellowship
Training (FT) licenses are valid only for duties associated with the training program for which the license are
issued, and do not cover outside employment activities.
The Division, Department, and University do not provide professional liability insurance or any other
insurance coverage for resident off‐duty activities of employment, and assumes no liability or responsibility for
such activities or employment. Confirmation of professional liability insurance for resident off‐duty activities or
employment will be the responsibility of the moonlighting employer.
Resident physicians who hold J‐1 visas are not permitted to engage in activities or have additional
income other than what is listed on their forms DS2019. Federal regulations specifically prohibit outside or
additional income for individuals with J‐1 visas.
Resident’s must inform the Program Director in Plastic Surgery of their intent to moonlight, and must
sign our Moonlighting form. They must provide the location and frequency of moonlighting or any subsequent
additions, deletions, or changes in moonlighting activity prior to initiating such activity. This Moonlighting form
must be signed by both the Program Director and the resident, and will be kept in the resident’s file.
Residents who choose not to moonlight must sign our Moonlighting statement indicating they plan to
not moonlight. If they choose later to moonlight, this can be reconsidered at the discretion of the Program
Director. This Moonlighting form must be signed by both the Program Coordinator and the resident, and will be
kept in the resident’s file.
The Program Director will have authority to approve, disapprove, and enforce this policy. The Program
Director will monitor the impact the resident’s moonlighting activity to assure that the activity does not
contribute to excess fatigue or is detrimental to the resident’s educational performance. Such findings of excess
fatigue or adverse effect on educational performance are grounds for immediate disapproval and termination of
moonlighting privileges.
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Residents are not to represent themselves to moonlight employers as being fully trained in their
specialty. Further, residents who moonlight are not to present themselves as agents of the University of
Louisville during moonlighting activities. University lab coats, name badges, and identification cards are not to
be worn outside of the resident’s training program activities. It is the resident’s responsibility to assure the
billing procedures of the moonlighting employer are conducted in an ethical and legal manner.
Please refer to the written policies on this matter for both the Department of Surgery as well as the
School of Medicine (Appendix 3‐4). Residents who violate the policies will be subject to disciplinary action as
detailed in the University of Louisville, School of Medicine House Staff Agreement.
27. ROLE OF THE PLASTIC SURGERY RESIDENT IN THE EDUCATION OF
THE UNDERGRADUATE MEDICAL STUDENT

While much of any resident’s energy and effort is necessarily focused upon his or her own growth and
education, a piece of this growth is as a teacher and leader in the community. Residents are inevitably role
models for those around them, especially as examples of professionalism for all medical students with whom
they come in contact.
The relationship between students and house officers is, or should be, a uniquely close one; it provides
unparalleled opportunities for one‐on‐one teaching. An important part of the educational process is optimizing
personal communication skills with both students and patients, teaching them how best to communicate with
one another.
Practice‐based learning is one of the six critical components of contemporary graduate education, and it
needs to be exemplified in the undergraduate years. When a house officer demonstrates exactly how he does
something and why he does it, this often becomes a wonderful educational experience for any student and
epitomizes practice‐based learning. System‐based practice involves realization that the practice of medicine
occurs in a vastly complex social and medical system in the United States, which is a system not duplicated
around the world. Understanding the greater context in which patients develop illnesses and/or in which
patients seek corrective care or alleviation constitutes a very good example of system‐based practice. As an
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example, correcting a surgical abnormality only to return a patient to an unattainable or intolerable social
situation could present little help at all from this perspective. A piece of your development is in growing into
Students should be treated with respect and collegiality, and at the same time be closely observed and
not permitted to take on, nor given, responsibilities beyond their skills. Every effort should be made to permit
them a good experience during their rotation with us. The Program Director and the faculty expect that all of
our residents play vital and important roles in medical education, and your performance in that area contributes
significantly to our evaluation of your development.
28. ONGOING COMMITTEES
Residents are encouraged to understand ongoing program improvement processes, and participate where
appropriate.
PROGRAM EVALUATION COMMITTEE
The Program Director must appoint the members of the Program Evaluation Committee (PEC). The PEC
may be a small group of Associate Program Directors, but must be composed of at least two program faculty
members and should include at least one resident. The Program Director may be one of those two faculty
members. To ensure that everyone agrees on their roles, there must be a written description of the committee's
and its members' responsibilities.
The PEC should actively participate in:
o planning, developing, implementing, and evaluating educational activities of the program.
o reviewing and making recommendations for revision of competency‐based curriculum goals and
objectives.
o addressing areas of non‐compliance with ACGME standards.
o reviewing the program annually using evaluations of faculty, residents, and others.
The program, through the PEC, must document formal, systematic evaluation of the curriculum at least
annually, and is responsible for rendering the Annual Program Evaluation (APE). Through the APE the program
must monitor and track each of the following areas:
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o resident performance;
o faculty development;
o graduate performance, including performance of program graduates on the certification
examination;
o program quality;
o residents and faculty must have the opportunity to evaluate the program confidentially and in
writing at least annually;
o the program must use the results of residents’ and faculty members’ assessments of the program
together with other program evaluation results to improve the program;
o progress on the previous year’s action plan(s).
The PEC must prepare a written plan of action to document initiatives to improve performance in one or
more of the areas listed above, as well as delineate how they will be measured and monitored. The action plan
should be reviewed and approved by the teaching facility and documented in meeting minutes.
CLINICAL COMPETENCY COMMITTEE
The Clinical Competency Committee (CCC) for the Division of Plastic Surgery Program is comprised of the
Program Director as well as site directors from University of Louisville Hospital, Jewish Hospital, and Norton
Hospital. The Committee will meet semi‐annually in December and June to review and discuss summative
evaluation data points on each resident. Evaluation data includes In‐Service scores, operative case logs,
faculty/resident evaluation summaries, duty hour compliance, and other items as necessary. They can also
propose improvement strategies for individual residents who are not successfully meeting the six core
competencies.
The purpose of the Clinical Competency Committee (CCC):
o To review all Plastic Surgery Residents’ evaluation data semi‐annually
o To advise the Program Director regarding resident progress, including promotion, remediation and
dismissal
o To report Milestone Evaluations on each resident semi‐annually to the ACGME

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The Clinical Competency Committee (CCC) must:
o Review all Resident evaluation data semi‐annually
o Meet with the Clinical Competency Committee semi‐annually to discuss assigned residents
o Prepare a letter of summary for each resident’s file to include the committee’s recommendation
regarding resident progress, promotion, remediation and dismal
o Track Resident Progress on an ongoing basis
o Advise Program Director of resident progress
o Prepare detailed Milestone Evaluations semi‐annually to the AGCME
o The Clinical Competency Committee (CCC) will meet semi‐annually, or more frequently as needed.
29. ONGOING EVALUATIONS
In order to provide useful data for the educational mission and program improvements regular
evaluations are completed by both faculty and residents. Evaluations are completed as follows:
A. Faculty Review of the Program
The faculty will review the program goals and objectives at least once a year.
B. Resident Review of Program
Once a year, all residents will be given the opportunity to anonymously evaluate the overall
program. Strict measures are taken to insure anonymity, in an effort to gather frank and genuine
responses. Use this opportunity to strengthen our program and our comment on our educational
policies and efforts.
C. Faculty Evaluation of Resident Performance
At the end of each monthly rotation both full‐time and volunteer faculty are given the
opportunity to evaluate the resident’s performance during their rotation. This data is used in
performance evaluations as well as Clinical Competence Committee reviews. Faculty is encouraged to be
honest and constructive during these evaluations and faculty development activities focused on
evaluation skills are offered by the university.
D. Resident Evaluation of Faculty Performance
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At the end of each monthly rotation residents are given the opportunity to anonymously
evaluate the faculty’s performance during that rotation. In order to ensure anonymity this information is
aggregated and given to individual faculty members by the Program Director during the annual
evaluation of the full‐time faculty. An annual report is provided to volunteer faculty for their own
awareness and self‐development.
E. Implementation of Program Changes
Although review of the program and faculty official occurs at least once a year, improvement is
an ongoing process. To keep ourselves focused on continuous improvement all suggestions made by
faculty and residents are evaluated immediately and captured in the Meeting Minutes where the
suggestion was made. All implemented suggestions are also revisited in subsequent Faculty Meetings in
order to follow up on progress and data analysis.
F. Internal Review
In compliance with ACGME Institutional requirements, the University of Louisville requires an
internal review of each program and its educational program and policies between RRC evaluation visits.
Residents, without faculty presence, are interviewed in this process. You are excused from all clinical
duties and obligations for these interviews.
G. ACGME Evaluation
The Plastic Surgery RRC of the ACGME evaluates all programs every five years. Residents,
without faculty presence, are interviewed in this process. You are excused from all clinical duties and
obligations for these interviews.
30. RESIDENT PERFORMANCE EVALUATION
The performance of each resident will be reviewed and discussed by the faculty twice per year, as
described in detail under the “Clinical Competency Committee” section. Significant concerns will be documented
and communicated to the resident at their semi‐annual meeting with the Program Director. Any significant
concerns from these evaluations will be formally summarized in a letter of advancement or non‐advancement
and presented to the resident for his/her review and records. If individual circumstances require more frequent
formal reviews and closer monitoring, this will be arranged. The letters of advancement or non‐advancement
will remain a part of the permanent file of residency training for the individual.
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31. GUIDELINES FOR ADVANCEMENT AND PROGRAM COMPLETION
Advancement and program completion is by judgment of the Program Director with Faculty consensus.
The principal standards that must be met for progression include the following:
o Absolute honesty, integrity and highest ethical standards must be maintained in all
circumstances.
o Upon the admission of every patient, and prior to each and every significant operative
procedure, you must contact the responsible University faculty member to present your analysis
and your management plan for review, and to arrange scheduling.
o Completion of your Plastic Surgery Operative Log at levels exceeding the minimal standards in
all categories.
o Completion of all hospital charts, and full compliance with all required documentation in records
for billing and Medicare compliance is required.
o All Medicare patients must be identified to the responsible faculty member at each encounter
for proper documentation of Medicare compliance requirements.
o A research project must have been actively pursued with a good chance of ultimate completion
and publication.
o A paper must be completed and prepared for a Kentucky Society of Plastic Surgeons
presentation, by each resident, each year, in September.
o Attendance and participation in all conferences must be faithful.
o A strong performance on the in‐service examination is expected and you must maintain an
active and ongoing program of reading and study.
o Courtesy and respect in all interactions is expected. Responses to consultations and pages must
be prompt and courteous
o Your record must be free of sexual harassments, dependency or abuse of drugs or alcohol.
o A certain level of skill must have been gained in the actual performance of the surgical
operations that have been learned. These technical skills will be finely tuned during the entire
course of your career in plastic surgery.
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PROMOTION POLICY
Each resident will be evaluated and promoted on the basis of clinical judgment, knowledge, technical
skills, humanistic qualities, professional attitudes, behavior and overall ability to manage the care of a patient
within the 6 core competencies. Formal evaluations will occur at the end of each of the resident’s rotation as
described in the section on Evaluation above. These written evaluations will be discussed with the resident on a
semi‐annual basis and placed into the appropriate resident’s file in the Program Coordinator’s office. The
residents have ready access to their files and shall review them on a regular basis.
If at any time a resident’s performance is judged to be detrimental to the care of a patient(s), action will
be taken immediately to assure the safety of the patient(s). The Program Director will promptly provide written
notification to the affiliate program director or department/division chairperson of the resident’s unacceptable
performance or conduct. The faculty will recommend whether promotion will occur at the spring semi‐annual
resident evaluation meeting. The Program Director and Department Chair will make the final decision on
promotion based on the faculty recommendation. A score of less than 30th percentile on the In‐Service exam
may result in repetition of the present PG year and lack of promotion to the next PGY level.
All residents are required to write at least one manuscript. The form of such a project may be a review
article, clinical or experimental paper, case report, or book chapter. The manuscript must be considered suitable
for submission for publication by the Department Chair or Program Director before it is submitted to a journal 6
months before graduation. A copy of the submitted manuscript must also be given to the Department Chair,
Residency Coordinator, and Department Medical Editor.
32. IN‐SERVICE EXAMINATION
Annual evaluation of core curriculum knowledge in plastic surgery will be measured by the In‐Service
Examination. The In‐Service Examination is a standardized test administered every spring (usually early March)
and is offered by the Plastic Surgery Education Foundation (PSEF). The examination takes approximately 5 hours
and is given online in one location. The Division of Plastic Surgery will register you for this examination and will
also assume all fees involved. All residents must participate in this examination.
Most training programs in Plastic Surgery administer this examination. Your performance will be
compared to that of other plastic surgery residents overall and in your year of training. The results of your
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performance will become part of your permanent resident file and can be used as a deciding factor in
determining whether or not advancement to the senior year, as well as if graduation will occur. A score of less
than 30th percentile denotes a poor performance and will serve as evidence of failure to acquire sufficient
knowledge to pass the written part of the Plastic Surgery Board examination. Also, a score of less than 30th
percentile may result in placement of the resident on academic probation. Residents may not automatically be
signed to sit for the American Board of Plastic Surgery examination if on academic probation. In addition, the
exam scores may be distributed to the plastic surgery residents, full time academic faculty and volunteer faculty
to allow these individuals to assist in providing educational opportunities and counseling. The In‐Service Exam
scores may be included in any letter of recommendation/support for future employment, as well as toward
obtaining hospital‐operating privileges.
To assist in your study efforts, the Division of Plastic Surgery will provide you with Neligan/Mathes’
Plastic Surgery textbooks, Volumes 1‐6, at the beginning of your residency training; however, these are not
yours to keep and must be returned to the Division at the end of your training. As an incentive, if you score at or
above the 50th percentile on the In‐Service Examination during all three years of your training, you will be
permitted to keep the books as your own.
33. RESIDENT GRIEVANCES
Resident grievances will be addressed using the process outlined by the UofL School of Medicine, House
Staff Policies and Procedures Manual, Section XXIII, Page 44. If discussion with the person involved does not
provide resolution, the person’s supervisor should be involved. The Program Director and/or the faculty may be
asked to become involved at this point. If this does not resolve the issue, the student Grievance Officer may be
requested to mediate. If the issue still persists, the formal process will then be used as outlined by the University
of Louisville, School of Medicine, House Staff and Procedures Manual involving a written statement to the
Academic Unit Grievance Committee through the Office of the Dean, as outlined in the House Staff Policies and
Procedures Manual, Section XXIII, Page 44.
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34. DISCIPLINARY ACTIONS AND GROUNDS FOR DISMISSAL
Disciplinary actions include probation, non‐advancement to the next semester or year, dismissal and
non‐award of a certificate of completion.

A. Probation involves heightened scrutiny, increased monitoring and specific reporting requirements by
the resident, but without loss of clinical privileges.
B. Non‐advancement ends training at an annual or semi‐annual point short of program completion and
prevents eligibility to sit for the certification examination of the American Board of Plastic Surgery.
Annual advancement and program completion are confirmed by a formal letter.

C. Grounds for dismissal from the training program include, but are not limited to the following
infractions:

o Theft.
o Sexual harassment as defined by the University (House Staff Policy and Procedures, page 32‐
33).
o Cheating on the in‐service training examination.
o Lying.
o Gross acts of insubordination, as determined by Program Director and the full‐time academic
faculty.
o Negligence or incompetence in patient care.
o Criminal acts.
o Drug, alcohol or substance abuse or dependence.
o Medical practice or other employment outside the residency program (“moonlighting”),
without the express consent of the Program Director.
o Failure to complete medical records and dictations and failure to comply with Medicare
compliance regulations.
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o Any other infraction specifically named as grounds for dismissal by the Department of Surgery
or the University of Louisville.
Actions leading to dismissal will be handled with full due process, as defined in the United States
Constitution. The process outlined in the Department of Surgery House Staff Manual and the University of
Louisville School of Medicine Resident Policies and Procedures Manual will be followed.
D. Non‐award of the certificate of completion. It is the right of the Program Director, based upon your
performance and/or faculty evaluations, to not sign the certificate of residency training completion.
Without this certificate, a resident is ineligible to sit for the written and oral examinations of the
American Board of Plastic Surgery and he/she cannot claim graduation from this program, or be certified
by the American Board of Plastic Surgery.

35. POLICY ON RESIDENT RECUITMENT
I. Purpose
To insure a fair and equitable process in the evaluation of prospective trainees and the selection of
highly qualified individuals for subspecialty training in Plastic Surgery.
II. Eligibility and Residency Application
A. The Plastic Surgery Residency Program will adhere to all Department of Surgery and University of
Louisville institutional policies regarding eligibility for participation in residency training programs at the
University of Louisville.
B. Resident selection is made without unlawful discrimination in terms of age, color, disability status,
national origin, race, religion or sex, in keeping with UofL standards as an Affirmative Action/Equal
Opportunity Employer.
C. Applicants will complete all of the following prior to entry in to the program:
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a. M.D. or D.O. degree at an Accredited Medical School in the United States of America or
recognized international medical school with similar accreditation.
b. Successful completion of residency training in general surgery, orthopedic surgery,
otolaryngology, urological surgery, neurosurgery or oral maxillofacial surgery.
c. Ability to obtain and maintain licensure to practice medicine in the states of Kentucky.
d. Ability to obtain and sustain a current unrestricted DEA certificate for the prescribing of
controlled substances.
e. Graduates of the medical schools outside of the United States and Canada who have current
valid certificates from the Educational Commission for Foreign Medical Graduates (ECFMG)
must:
i. Be officially recognized in good standing in the country where they are located;
ii. Be registered as a medical school, college or university in the International Medical
Education Directory;
iii. Require that all courses must be completed by physical on‐site attendance in the
country in which the school is chartered;
iv. Possess a basic course of clinical and classroom medical instruction that is:
1. not less than 32 months in length; and
2. under the educational institution’s direct authority
III. Procedures
The Division of Plastic Surgery at the University of Louisville participates in the Plastic Surgery Matching
Program (PSMP) which was established by the American Council of Academic Plastic Surgeons to coordinate
appointments for Plastic Surgery Residency programs and to relieve the pressure on applicants and program
directors resulting from early appointments and uncoordinated appointment dates. The PSMP is administered
by the San Francisco Residency and Fellowship Matching Services. All residents are selected through the SF
Match. In the event of transfer of residents in to fill a vacant position, the policies of the Common Program
Requirements of the ACGME and the Residency Review Committee in Plastic Surgery will be strictly adhered to.
To file for the match, the applicant must meet the American Board of Plastic Surgery requirements.
Residents will apply to the SF Match within the specified deadlines for the anticipated academic year in which
they will begin as a junior resident. Once SF Match applications are received for a given year, the Faculty
Residency Selection Committee will select candidates for an interview. The committee consists of the Program
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Director and two full time faculty members. Consideration for interviewing is based institutional guidelines.
Criterion for interview selection depends on completion of pre‐requisite training, quality of training program,
quality of medical school, letters of recommendation, USMLE scores, In‐Service scores, research quality and
quantity. Non‐U.S. citizens can apply and will be evaluated based on other qualifications with other applicants.
Approximately 25 candidates will be selected for an interview each year to fill 2 open positions.
Interviews are conducted by full‐time faculty. All residents will have the opportunity to meet and talk to the
candidates. They will provide input and feedback to the Program Director and faculty members. Once all
interviews are concluded, the faculty and residents will meet to discuss the candidates. Each will submit a rank
order list to the Program Director. The Program Director will weigh each faculty member and resident rank list
equally. A final rank order list will be generated and transmitted to the SF Match prior to the program deadline.
IV. The Match
Once the match process has occurred, the Program Director will contact the matched candidates both
formally in writing and informally by phone. A letter of intent and a resident contract will be sent to the
candidate in keeping with the institutional policy of the University of Louisville School of Medicine.
V. Resident Compliment
The Plastic Surgery Residency Program at the University of Louisville School of Medicine is approved by
the Accreditation Council for Graduate Medical Education (ACGME) for 2 residents in each of 3 years for a total
compliment of 6 residents.
VI. Falsification of Application or Other Materials
Falsification of information on the NRMP application, Resident Contract, or supporting documents for
these aforementioned forms may result in termination of the resident from employment by the University of
Louisville School of Medicine. All terminations are subject to the policies and regulations of the University of
Louisville Redbook, the School of Medicine, the Department of Surgery and the ACGME.

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VII. Conclusion
The system of future resident selection that we use is quite democratic and well thought out. It assures
the Program, the University, and the specialty that we have taken every initiative in selecting the finest
representatives of the class.
36. APPLICATION FOR EXAMINATION BY THE AMERICAN BOARD OF
PLASTIC SURGERY
The acceptability of a candidate does not depend solely upon the completion of an approved program of
education but also upon information available to the Board regarding his professional maturity, surgical
judgment, technical competence, and ethical standing. A candidate who has submitted an Application for
Examination will be notified by the Board as to his/her admissibility for examination.
37. STRESS AND FATIGUE IN THE WORKPLACE
The Plastic Surgery Residency Program is committed to a healthy supportive environment for all. The
faculty continually strives to provide the residents with a superior educational environment. The residency will
not discriminate based on age, sex, nationality, religion, or sexual orientation. Sexual harassment will not be
tolerated or condoned. It is essential that each resident maintain a healthy diet, sleep, and exercise program. A
stable, healthy personal life is valuable to the workplace. There are, however, circumstances that can prove
difficult and stressful situations for Plastic Surgeons. The program has opportunities for each resident to discuss
and resolve stressful situations. It is essential that we work to change and improve the environment. To that end
we ask all residents discuss any stressful situation with a faculty member as soon as they occur. This should be
followed up with a discussion with the Program Director. The quarterly evaluation meeting, the 6‐week end of
rotation evaluation meeting, and the frequent faculty meetings that residents attend are additional
opportunities to discuss and get feedback on stressful situations.
o All isolated events will be handled in the strictest confidence. In the event that a trend is noted by the
Program Director, steps will be taken to change the offending situation for the betterment of all
residents.
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RESIDENT STRESS AND FATIGUE MONITORING POLICY
Long and strenuous operations are not infrequent occurrences in Plastic Surgery. Fatigue and its role in
medical errors are regarded as a challenge to providing quality medical training and care. As such, prevention of
fatigue, its recognition, and the early recognition of professional and personal stress reactions are regarded as
critical to the safe and effective practice of our specialty.
PREVENTION STRATEGIES
The following policies have been implemented because of their impact on workplace stress and fatigue.
o Work hour limitations – All rotations will adhere to the eighty‐hour clinical workweek limitation,
including moonlighting.
o Moonlighting time is restricted and will be granted only in unusual circumstances.
o Didactic education on the related topics of the effective regulation of wakefulness; the neurocognitive
performance consequences of a disrupted circadian timing system, a disrupted sleep‐wake homeostasis
with sleep debt; and sleep inertia is provided. Fatigue management strategies and countermeasures are
included.
o Didactic education on the signs and symptoms of substance abuse is provided.
o Workplace harassment policies and procedures are reviewed regularly.
o Plastic Surgery faculty promotes the culture of healthy lifestyle strategy and shared responsibility.
MONITORING STRATEGIES
The following monitoring strategies are intended to detect stress and fatigue problems before they have
a negative impact on patients and the provider:
o Program Director reviews planned work schedules and moonlighting schedules to assure duty
hour requirements are met and circadian scheduling principles are demonstrated.
o House‐staff take responsibility to communicate off‐service rotation schedules believed to be out
of compliance with the ACGME eighty‐hour workweek over four week average.
o Faculty or Resident direct observation of the signs and symptoms of fatigue, stress, substance
abuse, or mental health disorder are discussed and confidentially addressed individually with
the Program Director.
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o Some examples of behaviors that are worth mentioning include irritability,
distractibility, social isolation, rapid weight shifts, excessive sleepiness, lack of interest in
educational offerings, shift tardiness, and acute clinical decision‐making difficulty.
o Direct resident feedback regarding resident stressors is sought via 6‐week evaluations of
rotations, at the semi‐annual performance review, and review of the program’s ACGME resident
survey results.
o The Program Director will refer/cooperate with resident involvement in the Kentucky Physicians
Health Foundation, The Counseling Center, and other health services as the need dictates.
In case of fatigue or for security issues, a Cab Voucher System has been instituted. For details, consult:
http://louisville.edu/medschool/gme/hsc_files/cabprogram.htm or the sheet provided in your orientation
packet.
38. PERSONAL AND UPFRONT
Residents will rapidly determine that the plastic surgery faculty will not only treat you like a Plastic
Surgeon, but also like a colleague, and most often like a friend. That is the way this program is run. We expect
meticulous adherence to the principals, rules and purposes of this manual and of your chosen profession. And in
return, you will be nourished by us, you will learn from us and others, and you will be held in the highest esteem
of any medical professional. The goal of this faculty is to make you the best plastic surgeon. One who will take
immense pride in the institution, your instructors, your fellow residents, and in your specialty.
If there is anything that any of us can do for you on a personal level, do not hesitate to ask. We are
available at any time of the day or night. You are one of us, and we expect that relationship to survive this
residency training program, well into all of our professional careers and perhaps further.
Welcome to the Program!

‐ 89 ‐

39. GUIDE TO THE APPENDICES
Curriculum
Appendix 1: The Comprehensive Plastic Surgery Curriculum (ACAPS) (Distributed with Manual)
Appendix 2: The Plastic Surgery Operative Log (PSOL) and instructions for use (www.acgme.org)
Appendix 3: University of Louisville Hospitals House Staff Manual (Distributed with Manual)
Appendix 4: University of Louisville Resident Policies and Procedures (Distributed with Manual)
Appendix 5: The Resource Books for Plastic Surgery Residents (ASPS)
Appendix 6: Legal Handbook for Kentucky Physicians (Available in Resident’s office)
Appendix 7: ACGME Core Competency Conference Schedule (Posted in Resident’s office and distributed at
Orientation)
Attachments
Attachment 1: Block Outline of the Rotation Schedule
Attachment 2: Principles of Medical Ethics (AMA)

‐ 90 ‐

GUIDE TO SUPPLEMENTAL REFERENCE MANUALS
These Reference manuals provide information and self‐study courses in ethics, medico legal topics,
practice management and continuing education. Appropriate sections may be photocopied. Most of these
publications are available on‐line or directly from the publishing organizations.
Ethics
o Code of Medical Ethics (AMA)
Medico legal
o Legal Handbook for Kentucky Physicians (KMA and KMIC)
o Patient Consultation Resource Book (ASPS)
Practice Management
o Establishing Yourself in Medical Practice (AMA)
o Marketing Strategies for Private Practice (AMA)
o Basics of Managed Care (JCMS)
o CPT03 (AMA) (Available in resident’s office, Medical Records Department, and Operating Room Doctor’s
Lounge)
o Billing and Documentation Guidelines (UofL Compliance Office) (Available in Resident’s Office)
Academic Basis for Practice and Continuing Medical Education
o The Resource Book for Plastic Surgery Resident (ASPS)
o ASPS/PSEF Catalogue
‐ 91 ‐

40. CONFIRMATION OF UNDERSTANDING

Plastic Surgery Resident Manual
By your signature, you indicate that you have fully read and understand all of this UofL Plastic Surgery
Resident Manual, revised June 2018. If there is anything you do not understand or if you have any questions, ask
the Program Director, and you will receive answers prior to signing. In addition, it is understood that your plastic
surgery residency training will terminate on June 30 in the year of your graduation.

Resident Signature: _____________________________________ Date: ____________

Program Director Signature: ______________________________ Date: ____________
Department of Surgery House Staff Manual
By your signature, you indicate that you have fully read and understand all of UofL Department of
Surgery’s House Staff Manual, revised June 2018. If there is anything you do not understand or if you have any
questions, ask the Program Director, and you will receive answers prior to signing.

Resident Signature: _____________________________________ Date: ____________

Program Director Signature: ______________________________ Date: ____________
‐ 92 ‐

Attachment 1: Block Rotation and Description of Services
University Reconstructive
o Responsible for University Ward Service o Covers cases with Dr. McCurry or Dr.
Case, i.e. those that have been Tobin.
evaluated or will follow‐up at ACB. o Encouraged to attend office hours
Covers University Trauma, Burn, and ER whenever possible.
patients. o Thursday – allocated to pursue elective
o Direct Monday office hours at ACB cases.
clinic.
o Will discuss all new patients with the
VAMC
on‐call attending that week to discuss
treatment plan. o At VAMC every day.
o Wednesday – office hours all day.

o Friday – Dr. Kasdan may decide to have
Hand/University
you break for some other unique cases.
o Primarily works with Dr. Wilhelmi.

o Takes Hand Call on Tuesdays.
Head & Neck
o Monday – covers the ACB for hand
follow‐ups. o Works with Dr. Little’s private patients.
o Tuesday – HCOC office. o Tuesday – works with Dr. Chariker.
o Wednesday and Thursday – OR o Friday – covers Dr. Little’s office hours.
o Friday – covers hand cases with Dr.
Scheker, Dr. Tien, or Dr. O’Daniel.
Electives

o Oculoplastic Surgery, Dermatology,
Orthopedics, Maxillofacial, Anesthesia,
and chosen elective.
‐ 93 ‐

Attachment 2: Principles of Medical Ethics
I. A physician shall be dedicated to providing competent medical care, with compassion and
respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all professional
interactions, and strive to report physicians deficient in character or competence, or engaging in
fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in those
requirements which are contrary to the best interest of the patient.
IV. A physician shall respect the right of patients, colleagues, and other health professionals, and
shall safeguard patient confidences and privacy within the constraints of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a
commitment to medical education, make relevant information available to patients, colleagues,
and the public, obtain consultation, and use the talents of other health professionals when
indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to
choose whom to serve, with whom to associate, and the environment in which to provide
medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the
improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
IX. A physician shall support access to medical care for all people.
Adopted by the AMA’s House of Delegates, June 17, 2001.
‐ 94 ‐

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G. A summary of Medicare Compliance Regulations is available through the University of Louisville

Randolph Sherman, M.D. (2017) Robert J. Allen, M.D. (2017) Joseph P. Hunstad, M.D. (2017)

Steven C. Haase, M.D. (2016) James R. Payne, M.D. (2016) Stephen B. Baker, M.D. (2016)

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Robert M. Kellman, M.D. (2014) W. P. Andrew Lee, M.D. (2014) M. Nahabedian, M.D. (2014)

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Neil F. Jones (2013) Navin K. Singh, M.D. (2013) William H. Bowers, M.D. (2012)

Dean S. Louis, M.D. (2012) Jeffrey Janis, M.D. (2012) V. Leroy Young, M.D. (2012)

Peter C. Amadio, M.D. (2012) Richard A. Mladick, M.D. (2012) M. Yaremchuk, M.D. (2012)

Charles J. Eaton, M.D. (2012) Scott L. Spear, M.D. (2011) Peter C. Amadio, M.D. (2011)

Paul S. Cederna, M.D. (2011) Richard A. Mladick, M.D. (2011) J. Peter Rubin, M.D. (2010)

Diego Ribuffo, M.D. (2010) Maurice Nahabedian, M.D. (2010) David P. Green, M.D. (2010)

Charles N. Verheyden, M.D. (2010) Maurice Nahabedian, M.D. (2009) Charles Butler, M.D. (2009)

Paul N. Manson, M.D. (2009) Joachim Prein, M.D., D.M.D. (2009) Randal Rudderman, M.D. (2009)

Warren Schubert, M.D. (2009) Lt. Col. Robert Hale, D.D.S. (2008) Ian T. Jackson, M.D. (2008)

Ron Silverman, M.D. (2008) Gregory Evans, M.D. (2007) David Elliot, M.D. (2005)

G Patrick Maxwell, M.D. (2005) Fu‐Chen Wei, M.D. (2004) Wayne Morrison, M.D. (2003)

Frank D. Burke MB, MS, FRCS (2003) Julio Taleisnik, M.D. (2002) Martin Robson, M.D. (2002)

David Evans, MB, BS, FRCS (2001) James May, M.D. (2001) Thomas J. Krizek, M.D. (2001)

Richard Wassermann, M.D. (2000) Harry Buncke, M.D. (1999) Richard Roberts, Ph.D. (1999)

Hyrar Shahianian, M.D. (1999) Alan Dimick, M.D. (1999) C. Lin Puckett, M.D. (1999)

Helmuth Goepfert, M.D. (1999) H. Bruce Williams, M.D. (1999) Christopher Colton, M.D. (1999)

Henry Steve Byrd, M.D. (1998) Maurice Jurkiewicz, M.D. (1998) Suzanne Ildstad, M.D. (1998)

Milomir Ninkovic, M.D. (1998) Michael Chancellor, M.D. (1998) Arnuf Stenzel, M.D. (1998)

Steve Aryian, M.D. (1997) Goran Lunborg, M.D. (1998) Dennis Lynch, M.D. (1997)

Eduardo Zancolli, M.D. (1996) James Strickland, M.D. (1997) James May, M.D. (1996)

Susumi Tamai, M.D. (1996) Jim Urbaniak, M.D. (1997) Jesse Jupiter, M.D. (1997)

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