Trends in Training: fellowship vs. integrated route?

[DZT]

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Hey guys, I was curious as to how the plastics training route is going. I heard speculation that a few medical schools are revoking integrated programs b/c uncertainty in med student manual skills, but these integrated programs are cropping up all over the place. What is the prospectus for ppl who will apply to plastics spots in say 5-6 yrs after doing either Gen Surg/ENT training? Are more or less fellowship spots going to open up? Is it getting more competitive or is it dropping off?

One more thing. What are the current numbers for fellowship vs. integrated spots?

 

[ms697]

Hey guys, I was curious as to how the plastics training route is going. I heard speculation that a few medical schools are revoking integrated programs b/c uncertainty in med student manual skills, but these integrated programs are cropping up all over the place. What is the prospectus for ppl who will apply to plastics spots in say 5-6 yrs after doing either Gen Surg/ENT training? Are more or less fellowship spots going to open up? Is it getting more competitive or is it dropping off?

One more thing. What are the current numbers for fellowship vs. integrated spots?

speaking as a current applicant for integrated/combined, i would predict that there will be more integrated/combined programs and less traditional fellowships 5 years from now. though UCLA stands out as a program that potentially will revert from combined -> traditional only, most programs realize that continual exposing residents to plastic surgery leads to a more comprehensively trained surgeon.

for example, the big programs in plastics such as utsw, pitt, hopkins are in the process of changing their curriculum to one more weighted in plastic surgery rotations (i.e. 1.5-2 years gen surg/3.5-4 years plastics). the reason being that some gen surg rotations are just not that applicable or useful to the plastic surgeon to be. if you follow that logic, you can take the next step and say that these programs (as well as the RRC which granted the curriculum change) view the traditional route as being an inefficient way to train a plastic surgeon. as more programs realize the benefits of an integrated programs, some of them will switch from traditional to integrated/combined or from offering both routes to just an integrated/combined route.

just my 2 cents.

 

[thatguyagain]

speaking as a current applicant for integrated/combined, i would predict that there will be more integrated/combined programs and less traditional fellowships 5 years from now. though UCLA stands out as a program that potentially will revert from combined -> traditional only, most programs realize that continual exposing residents to plastic surgery leads to a more comprehensively trained surgeon.

for example, the big programs in plastics such as utsw, pitt, hopkins are in the process of changing their curriculum to one more weighted in plastic surgery rotations (i.e. 1.5-2 years gen surg/3.5-4 years plastics). the reason being that some gen surg rotations are just not that applicable or useful to the plastic surgeon to be. if you follow that logic, you can take the next step and say that these programs (as well as the RRC which granted the curriculum change) view the traditional route as being an inefficient way to train a plastic surgeon. as more programs realize the benefits of an integrated programs, some of them will switch from traditional to integrated/combined or from offering both routes to just an integrated/combined route.

just my 2 cents.

I am in the process of doing some long-range planning and found your post extremely helpful.

Let's try to keep this one going so that we can get a diverse perspective!

 

[droliver]

most programs realize that continual exposing residents to plastic surgery leads to a more comprehensively trained surgeon.

While more didactic exposure is helpful, junior level surgical experience is pretty marginal for the integrated models in the scheme of developing as a surgeon. Actually this is much more an issue of manpower then it is one of providing more comprehensive training. Work-hour rules have only magnified the labor deficiencies on services at many teaching hospitals. This is what in fact is driving the change to the integrated models at many programs.

 

[Plastikos]

While more didactic exposure is helpful, junior level surgical experience is pretty marginal for the integrated models in the scheme of developing as a surgeon. Actually this is much more an issue of manpower then it is one of providing more comprehensive training. Work-hour rules have only magnified the labor deficiencies on services at many teaching hospitals. This is what in fact is driving the change to the integrated models at many programs.

I thought the government had some sort of influence on decreasing the amount of time doctors were in training. As for the point i do believe its better in the end (integrated model) b/c you are learning to think and manage problems from a plastic surgeons point of view, and nothing can be equated to gross familiarity and having been a junior surgeon many times on plastics cases as opposed to general surgery.

 

[droliver]

nothing can be equated to gross familiarity and having been a junior surgeon many times on plastics cases as opposed to general surgery.

I think this is where people who've never trained have this misconception about how much difference there is in training. There is a HUGE amount of overlap b/w surgery and plastic surgery, especially with breast, body, burn, wound care, soft tissue infection, and reconstructive surgery cases (pediatric and hand cases not so much).

This past week I did maybe 8 skin cancers, two breast reductions, a skin graft, two abdominplasties, and took back an infected total knee prosthesis twice for debridements. All of these areas were pretty much part and parcel of my surgery training (a reduction and a mastectomy are fairly similar) before I ever did Plastic Surgery. I do some of these operations <i>better</i> now, but the point is how much of an overlap there is.

The trade-off with the integrateds (as I see it) is that

1.you're getting thrust into some pretty technically advanced procedures while having signifigantly less technical experience (compared to fully trained surgeons or ENT's) prior. Junior-level plastic surgery resident technical endeavors is just not the same thing

2. in the traditional model you've pretty much eliminated most of the marginal people thru their preliminary training. With the integrateds you have a lot less data to look at to pick you residents. This is more a problem for the programs then the applicants

The integrated model is clearly superior to me for the length of didactics. There is just such a collection of peripherally-related areas in Plastic Surgery to be familiar with. However, this is really something I think is important only in the sense of passing the initial board exams. It is impossible to really practice the whole range of Plastic Surgery anymore. The recert. exam that is now mandated every 10 years has recognized this and allowed the people taking select one of 3-4 modules that focuses on their area (cosmetic, hand, reconstructive)

 

[Plastikos]

I think this is where people who've never trained have this misconception about how much difference there is in training. There is a HUGE amount of overlap b/w surgery and plastic surgery, especially with breast, body, burn, wound care, soft tissue infection, and reconstructive surgery cases (pediatric and hand cases not so much).

This past week I did maybe 8 skin cancers, two breast reductions, a skin graft, two abdominplasties, and took back an infected total knee prosthesis twice for debridements. All of these areas were pretty much part and parcel of my surgery training (a reduction and a mastectomy are fairly similar) before I ever did Plastic Surgery. I do some of these operations <i>better</i> now, but the point is how much of an overlap there is.

The trade-off with the integrateds (as I see it) is that

1.you're getting thrust into some pretty technically advanced procedures while having signifigantly less technical experience (compared to fully trained surgeons or ENT's) prior. Junior-level plastic surgery resident technical endeavors is just not the same thing

2. in the traditional model you've pretty much eliminated most of the marginal people thru their preliminary training. With the integrateds you have a lot less data to look at to pick you residents. This is more a problem for the programs then the applicants

The integrated model is clearly superior to me for the length of didactics. There is just such a collection of peripherally-related areas in Plastic Surgery to be familiar with. However, this is really something I think is important only in the sense of passing the initial board exams. It is impossible to really practice the whole range of Plastic Surgery anymore. The recert. exam that is now mandated every 10 years has recognized this and allowed the people taking select one of 3-4 modules that focuses on their area (cosmetic, hand, reconstructive)

I do agree with you, i was thinking more along the lines of just the learning and spreading out the didactics. Nothing can compare to being fully trained when learning your specialty, it would be like four years of college ball-->NFL, as opposed to one/two and a slower entrance into NFL. I sure dont want to be in training any longer than is necessary though. LOL.