The following information is offered in an attempt to clarify the different models for entry into post-graduate medical training in Plastic Surgery following medical education in an allopathic, osteopathic or foreign medical school. The medical or osteopathic degree must be granted in the United States or Canada by an institution accredited by the Liaison Committee for Medical Education (LCME) or the American Osteopathic Association (AOA). Foreign medical graduates must hold a standard certificate from the Educational Commission for Foreign Medical Graduates (ECFMG).
There are two approved educational (training) models for Plastic Surgery, the Independent model and the Integrated model. A plastic surgery program director may choose to have both training models in a single training program. Several organizations provide governance for these models. These are the Residency Review Committee for Plastic Surgery (RRC-PS) of the Accreditation Council for Graduate Medical Education (ACGME), which sets educational requirements and accredits training programs in Plastic Surgery; the American Council of Academic Plastic Surgeons (ACAPS), which helps coordinate the training activities of the programs; and The American Board of Plastic Surgery, Inc. (ABPS), which sets educational requirements, examines and certifies the graduates of those programs. In both the integrated and the independent models, plastic surgery training is divided into two parts:
- The acquisition of a basic surgical science knowledge base and experience with basic principles of surgery (PREREQUISITE TRAINING).
- Plastic surgery principles and practice, which includes advanced knowledge in specific plastic surgery techniques (REQUISITE TRAINING).
In the independent model, the residents complete the PREREQUISITE TRAINING outside of the plastic surgery residency process, whereas in the integrated model, residents complete their training in the same training program. In a combined or coordinated program, residents complete the prerequisite training at the general surgery training program in the same institution as the plastic surgery program.
This model includes programs with two or three years of plastic surgery training. The Independent Model has two options. The first option has two variations. Each of the pathways described satisfy the requirements of the ABPS for entry into the certification process.
- Option 1, variation A requires at least three years of clinical general surgery residency training to complete the PREREQUISITE requirements of the ABPS. Candidates must complete a minimum requirement of 36 months of training including specific rotations, which are noted in the ABPS Booklet of Information. This requirement of ABPS stipulates that a minimum of three years of clinical training in general surgery, with progressive responsibility, in the same program must be completed before the resident enters a plastic surgery residency.
- Option 1, variation B is the "combined" or "coordinated" residency. This option is the same as option #1A, with the exception that medical students are matched into a general surgery training program with a non-contractual understanding that they will become plastic surgery residents at the same institution after satisfactorily completing the three-year minimum PREREQUISITE requirement in general surgery. During this time they are considered residents in general surgery with an "expressed" interest in plastic surgery, but are not considered plastic surgery residents by the RRC-PS, ACAPS, or ABPS until completing the PREREQUISITE training program and entering the requisite years. These programs are not differentiated in the ACGME's Graduate Medical Education Directory (the "Green Book"), but rather are found listed among general surgery and independent plastic surgery programs. PREREQUISITE AND REQUISITE requirements are completed at the same institution in this model.
- Option 2 is available for residents who have satisfactorily completed a formal training program (and are board admissible or certified) in general surgery, otolaryngology, neurosurgery, orthopedic surgery, urology, or oral and maxillofacial surgery (the latter requiring 2 years of general surgery training in addition to an M.D./DDS). Successful completion of these ACGME or ADA accredited programs fulfills the PREREQUISITE training requirement.
Residents can officially begin a plastic surgery training program (REQUISITE TRAINING) after completion of any of these PREREQUISITE options, which all require confirmation by the ABPS (Evaluation of Training Form with confirmation letter regarding the acceptability of the prerequisite training for the ABPS certification process).
In the Independent model options, only the REQUISITE period of training in the Independent Model is under the supervision of the RRC-PS. Note that the education in the Independent model is accredited by the RRC-PS. However in the "combined" model, the general surgery years are accredited by the RRC for General Surgery and not the RRC-PS.
Training in the Integrated model requires five or six years of RRC-PS accredited residency under the authority and direction of the plastic surgery program director. The curriculum is determined by the plastic surgery program director and accredited by the RRC-PS. No less than two years of this program must be concentrated in plastic surgery, and the final 12 months must entail senior clinical plastic surgery responsibility. This Integrated model is accredited by the RRC-PS and accepted for entry into the certification process of the ABPS.
The distinctions between the Integrated and the Independent "combined" model curriculum are the content of the PREREQUISITE years and whether the RRC-PS or the RRC for General Surgery accredits the program. There are approximately 20 accredited integrated programs. The number of combined programs is not tabulated by the RRC-PS because the prerequisite training is accredited by the RRC for General Surgery. A list of programs can be obtained on the ACAPS website. All residents for the independent, combined or integrated model of training, must obtain the ABPS Request for Evaluation of Training Form and receive a confirmation letter of approval of their prerequisite general surgery training before beginning the REQUISITE plastic surgery residency.
The medical student who desires to enter plastic surgery training after graduation may elect one of two pathways:
- The combined variation of the Independent model (which may be called coordinated) begins with the resident matching with a general surgery program for completion of at least three years of general surgery PREREQUISITE training. The resident is eligible to enter the independent program at the same institution for REQUISITE training in plastic surgery upon successful completion of the training. The general surgery program director must confirm successful completion of the PREREQUISITE years to satisfy the ABPS requirements. After satisfactory completion of the independent plastic surgery program (REQUISITE TRAINING), the resident is admissible to the examinations of the ABPS.
- The Integrated plastic surgery model begins with a match directly into a plastic surgery program for five or six years under the direction of the plastic surgery program director. All training is completed in the same program. After satisfactory completion of the training, the resident is admissible to sit for the examinations of the ABPS.
Current policy of the NRMP states that if a resident has matched into a PGY-1 categorical General Surgery position and has attended the first year of that program the resident’s ability to be released from that program would be handled between the resident and the program subject to the institutional contract. This would not be a violation of the NRMP match.
For a resident who is only able to qualify for a PGY-1 position in Integrated Plastic Surgery they would have to go through (or re-apply through) the NRMP Match.
For residents that qualify for PGY-2 and above transfers the rules according to the ACGME are as follows:
- Beginning PGY-2: A transfer is permitted after completion of an internship in any ACGME-accredited or Royal College of Physicians and Surgeons of Canada (RCPSC) surgical specialty.
- Beginning PGY-3: Only residents who have completed at least two years of ACGME-accredited or Royal College of Physicians and Surgeons of Canada (RCPSC) general surgery, integrated thoracic surgery, or another integrated plastic surgery residency may transfer.
- Beginning PGY-4: Only residents who have completed their graduate medical education in one of the traditional surgical pathways for the independent programs may transfer.
Vacancies in the receiving program must be documented and approved by the RRC. The transferring resident must assume the responsibility of requesting approval from the ABPS, and must provide the following to the Board for consideration:
- A verification of education from the original program director, documenting education provided; and,
- Verification from the receiving program director that the education received will be acceptable for the curriculum at the requested level of transfer.
- The requesting program must provide block diagrams of all completed rotations to the RRC.
If a temporary increase in complement is needed by the receiving program in order to accept the transferring resident, the request must be entered into the ACGME’s Accreditation Data System (ADS). Approval from the RRC must be received before the transferring resident enters the program, as noted in the document Requests for Changes in Resident Complement, also available for reference on the Review Committee web page.