Top Ranked Initiatives
Practical education of plastic surgery techniques using webinar delivery was considered the highest priority by respondents. Specific initiatives of interest included advice on “How I do it” and “Things that work” (75.7%) and “Hot topics” (65.4%). Patient safety initiatives supported by international consensus statements were considered a priority by 71.8%. Standardization of care by generating peer-reviewed guidelines of international significance features strongly at 64.6%. Additionally, enhancing patient safety by alerting governments to the cost burden of complications associated with surgical tourism was also ranked highly at 53.1% (Table 4).
An interactive ICOPLAST website (65.8%) was ranked strongly by respondents, as was the concept of reviewing existing plastic surgery articles via a peer-reviewed ICOPLAST e-publication (51.4%). International efforts to advocate the benefits of plastic surgery and humanitarian endeavors were initiatives of high importance to 54.6% and 50.0%, respectively. Credentialing guidelines and endorsement of plastic surgeon qualifications (50.4%) and data management strategies such as audits and registries to improve patient outcomes (47.7%) were also considered priorities of importance and ranked accordingly (Table 4).
The demographic profile of respondents highlights the need for ICOPLAST to be a responsive organization and sensitive to a broad spectrum of ages and cultures. Further, the high value placed on the abovementioned initiatives reflects the need for ICOPLAST to plan a comprehensive portfolio of professional deliverables in several domains.
Although there are several limitations including an unknown response rate (due to the secondary dissemination of the survey by national ICOPLAST delegates) and the potential for selection bias based on the distribution method, the diverse demographic data provide some reassurance that we have sourced representative information from ICOPLAST member societies. Although there was an unequal spread of respondents geographically, the fact that all major regions were represented to a varying degree suggests that the findings can be generalized to the growing ICOPLAST community.
On the basis of the survey results, strategic planning was assigned in an effort to accomplish the priorities identified within the top 13 ranked initiatives. An implementation strategy was formulated via consensus by those co-authors who also hold the position of ICOPLAST Director. Timeframes of immediate (2017 to mid-2018), short-term (2018), and longer term (2019–2020) were allotted based on ICOPLAST resources.
Immediate Priorities (2017 to mid-2018)
Funding was the highest priority to enable the committees to accomplish their assigned tasks. It was determined that each member country would be required to contribute according to the number of active plastic surgeons within their country’s national society. An annual fee of 10 Euros per active national society member was the standard level of dues; however, a reduced fee was made available to those countries recognized as low income.
Five committees have been established; these include a Website Development Committee, a Patient Safety Committee, an Education Committee, a Humanitarian Committee, and a Professional Standards Committee. Each committee has been populated with a balanced group of members from each of the major regions including representation from North America, South America, Middle East, Europe, Asia, and Oceania.
Short-term Priorities (2018)
Fundamental to the interconnectedness of ICOPLAST is an effective website with which to interact, to deliver online learning topics, and to store the content of webinars for future access by members. This will enable a monitored and interactive website, online learning webinars for hot topics and the provision of teaching using a “Case of the week” format (initiatives 3, 4, and 8, respectively). The website will also be the future portal for standardizing pre- and postoperative guidelines and best practices for common procedures (initiative 5) and peer-reviewed ICOPLAST e-publication (initiative 9).
Patient Safety Projects
Patient safety was considered one of the highest priorities as evidenced by the interest in development of an international consensus statement to protect patients from unscrupulous and under-qualified practitioners (initiative 2). Standardization of care through peer-reviewed pre- and postoperative guidelines and best practices for common procedures (initiative 5) and enhancing patient safety by alerting governments to the risks and cost burden associated with surgical tourism complications (initiative 7) also featured. To that end, a project has been commenced to explore the process of Informed Consent, with a particular emphasis on surgical tourism where evidence is mounting that the consenting processes would fall short of that recommended by most national plastic surgical societies.4–6
By using a collaborative approach from member countries, ICOPLAST is uniquely placed to generate an international best practice informed consent guide for dissemination globally in an effort to address initiatives 5 and 7. In response to the latest international consensus statement on Breast Implant Associated Anaplastic Large Cell Lymphoma, the Patient Safety Committee has disseminated practical guidelines for members, which is consistent with initiative 5. ICOPLAST will also look to build on the recent work by Brightman et al.7 entitled “Cosmetic tourism for breast augmentation: a systematic review,” which highlighted themes consistent with initiative 7.
Within the remit of the Educational Committee will be techniques that work, “How I do it” and “Things to avoid” (initiative 1). Although ICOPLAST is not planning to hold stand-alone conferences, it is planning short symposia on specific topics to be held in conjunction with the national meeting of a member society. This model was trialed at the 2017 Australian Society of Plastic Surgeons where the ICOPLAST Directors presented their chosen educational topic. In a more targeted fashion, a symposium on recent advances in plastic surgery of the breast was combined with the meeting of the Egyptian Society of Plastic and Reconstructive Surgeons Egyptian Society in Luxor, March 2018.
Longer Term Priorities (2019–2020)
Public Education and Plastic Surgery Advocacy
An annual event showcasing the positivity of plastic and reconstructive surgery in the lives of everyday citizens was ranked favorably (initiative 6). To address this initiative, ICOPLAST has formed a “Wake Up to Plastic Surgery Campaign Task Force” to profile unique stories and digital content that showcases the level of impact and innovation from plastic surgery globally. This is being planned as an annual campaign to be themed to increase the public’s awareness of the wide range of plastic surgery involvement in the wider community. The “Wake Up to Plastic Surgery” theme for 2018 is “Prevent the Bite” to promote better awareness of the impact of animal bites on patients world-wide. Plastic surgeons reconstruct 10s of 1000s of patients annually after animal bites so this campaign will inform the public with simple key messages about the impact of the plastic surgery specialty.
ICOPLAST in its efforts to set standards and promote the work of plastic surgeons and related charitable care organizations providing volunteer services to areas of need has published a position paper “Best practices and standards for humanitarian initiatives” (available at www.icoplast.org). The Humanitarian Committee will now start to collaborate with the World Health Organization on a common document regarding standards for humanitarian initiatives. In addition, a Visiting Humanitarian Professorship has been created. On an annual basis a professor, upon request from a local plastic surgery society, will teach skills and empower plastic surgeons and local health care professionals to provide care to their communities.
Among other activities the Humanitarian Committee will be addressing the development of a register of active members willing to join a rapid response team to assist in the event of international crises (initiative 11) and optimizing future ICOPLAST efforts by seeking advice from members previously involved in disaster relief programs (initiative 12).
The development of credentialing guidelines for the endorsement of plastic surgery qualifications (initiative 10) will fall within the scope of the Professional Standards Committee and will involve the longer term objective of defining “What is a plastic surgeon?”. The purpose of this initiative is to educate the public rather than ICOPLAST becoming an arbiter of determining qualifications, which will continue to remain within the scope of existing professional organizations.
Registries and Audit
Registries and audits for the purpose of recording procedures performed and device types implanted (initiative 13) will aim to assist current efforts8,9 to monitor implantable device performance at an international level, especially, in the first instance, breast implants for both reconstructive and aesthetic purposes. Audits will ultimately facilitate international benchmarking of plastic surgical procedure outcomes.
This study has helped to identify overarching domains and individual initiatives of importance to ICOPLAST members. This, in turn, has provided the basis for a strategic framework upon which ICOPLAST can work toward delivering outcomes to benefit patients, plastic surgeons and the field of plastic surgery more broadly. Priorities have been set and goals have been outlined according to realistic timeframes and ICOPLAST resources. Immediate priorities include funding of key committees for website development, patient safety, education, humanitarian endeavors and professional standards. Short-term priorities will expand on the delivery an interactive website, the provision of education to ICOPLAST members and commencement on several patient safety projects. Longer term priorities will focus on delivering public education, plastic surgery advocacy, humanitarian planning, professional standards, and data management strategies.
ICOPLAST is an evolving confederation that welcomes global participation and collaboration. Those who would like to be involved are encouraged to contact us on email@example.com or e-mail/call your regional Board Member.1
The authors acknowledge Carol Lazier and Jacqueline Luna for their executive assistance with the survey, along with Lucie Lessard, Sean Carrol, and Andrzej Piatkowski for their ongoing efforts to help ICOPLAST implement the initiatives delineated in this article. The authors also acknowledge Hassan Badran, Julio Daniel Kirschbaum, and Takashi Nakatsuka. Finally, the authors are grateful to Ingrid Hopper for her assistance with drafting and editing the article.
1. International Confederation of Plastic Surgery Societies. About ICOPLAST. International Confederation of Plastic Surgery Societies. 2017. Available at http://www.icoplast.org/about
. Accessed September 2017.
2. Rakhorst HA, Badran H, Clarke HM, et al. Introducing the International Confederation of Plastic Surgery Societies: ICOPLAST. Plast Reconstr Surg. 2017;140:627–633.
4. Penney K, Snyder J, Crooks VA, et al. Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites. BMC Med Ethics. 2011;12:17.
6. Jeevan R, Birch J, Armstrong AP. Travelling abroad for aesthetic surgery: informing healthcare practitioners and providers while improving patient safety. J Plast Reconstr Aesthet Surg. 2011;64:143–147.
7. Brightman L, Sze N, Ahern S, et al. Cosmetic tourism for breast augmentation: a systematic review. ANZ J Surg. 2017; DOI: 10.1111/ans.14326.
8. Cooter RD, Barker S, Carroll SM, et al. International importance of robust breast device registries. Plast Reconstr Surg. 2015;135:330–336.
9. Rakhorst HA, Mureau MAM, Cooter RD, et al. The new opt-out Dutch National Breast Implant Registry—lessons learnt from the road to implementation. J Plast Reconstr Aesthet Surg. 2017;70:1354–1360.
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Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.