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Together, We Achieve More: A Multidisciplinary Approach to the Surgical Training of Residents

Pollack, Karlyn E. M.D.; Blake, Amy K. M.D.; Parr, Karina M.D.; Hersh, Robert E. M.D.

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Plastic and Reconstructive Surgery: August 2020 - Volume 146 - Issue 2 - p 246e-247e
doi: 10.1097/PRS.0000000000007031
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Collaboration among medical specialties has become customary, leading to better patient outcomes, more cost-effective care, and higher job satisfaction among clinicians.1,2 Lending an expertise in complex wound closures and cosmetic procedures, plastic surgeons stand as natural partners to dermatologists when providing the most comprehensive care to patients with complex skin diseases. Given the steady rise in the incidence of skin cancer, the potential synergism between these two specialties must be appreciated.

Over the past several years, the curricula for both plastic surgery and dermatology residency programs have evolved in ways that highlight the need for exposure to both specialties throughout the course of a resident’s training.3–5 Thus, in an effort to explore new models of teaching, the Department of Dermatology and the Department of Plastic Surgery at the Hampton VA Medical Center adopted a multidisciplinary approach to the surgical training of dermatology residents at Eastern Virginia Medical School in 2017. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.

Beginning in their first year, Eastern Virginia Medical School dermatology residents participated in an excision clinic that was co-directed by a dermatologist and a plastic and reconstructive surgeon. Efforts were made to optimize the surgical workflow and standardize the management of surgical complications within the clinic. Providing coordinated surgical and medical management of complex cutaneous conditions offered dermatology residents the opportunity to train one-on-one with both specialists and to receive feedback at regular intervals.

Through the use of this model, the authors have observed a higher level of patient satisfaction, which may stem from the increased access to multispecialty care and a reduction of outside referrals. Dermatology residents have also benefited; their frequent exposure to a variety of techniques have reportedly enabled trainees to adopt more flexibility within their surgical repertoire and to acquire strategies for optimizing their surgical workflow.

As this cross-specialty training model is still in its infancy, the authors are actively working to optimize its features. A survey study will be conducted to formally quantify its effects on both patient care and residents’ education. We also anticipate the eventual integration of plastic surgery residents into the clinic. The experience should enable trainees to attain a higher level of expertise in the medical management and follow-up care for patients with complex skin cancers. In addition, as fiscal constraints have led to less opportunity for residents within the operating room, we see this approach as a potential means to augment residents’ surgical skills.5 Finally, in line with the Accreditation Council for Graduate Medical Education Core Competencies, early immersion in a collaborative environment with a related specialty fosters the degree of interprofessional skills that enable residents to thrive throughout their training and beyond.

In the context of an increasingly collaborative health care environment, and a growing population of patients in need of both medical and surgical management of their cutaneous diseases, we encourage others to consider the benefits of adopting this multidisciplinary approach to residents’ training. Its widespread integration into programs hinges on the willing participation of both dermatologists and plastic surgeons with a strong interest in teaching and a desire to work with residents of both specialties.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

REFERENCES

1. Goldman MP. Engaging all specialities for advancement of patient care. Clin Plast Surg. 2013;40:xix–xx.
2. National Academy of Medicine. Implementing optimal team-based care to reduce clinician burnout.Available at: https://nam.edu/implementing-optimal-team-based-care-to-reduce-clinician-burnout/. Accessed July 1, 2019.
3. Rifkin WJ, Cammarata MJ, Kantar RS, et al. From “coordinated” to “integrated” residency training: Evaluating changes and the current state of plastic surgery programs. Plast Reconstr Surg. 2019;143:644e–654e.
4. Hanke CW, Moy RL, Roenigk RK, et al. Current status of surgery in dermatology. J Am Acad Dermatol. 2013;69:972–1001.
5. Wanzel KR, Fish JS. Residency training in plastic surgery: A survey of educational goals. Plast Reconstr Surg. 2003;112:723–729; discussion 730.

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