Women’s College Hospital (WCH) -Plastic Surgery – Senior Resident
Women’s College Hospital rotations are 4 months in duration. Senior residents are at different
levels (PGY-3,4,5). The focus of clinical activity at WCH is breast surgery, breast reconstruction,
breast cancer and familial (high risk) cancers, aesthetic surgery and lymphedema surgery. All
surgery is done in an ambulatory setting. There are no in-patient beds. At WCH the resident
assumes the role of chief resident. All residents participate in ambulatory clinics, and have
extensive exposure in the OR. The patient demographic at WCH allows the residents to develop
skills in medical expert related to breast surgery/breast reconstruction, health communicator
with women with cancer, and health manager skills for utilizing ambulatory resources and
being aware of the quality of recovery to help these patients after discharge. On this rotation
there is particular emphasis on the development and evaluation of the Medical Expert,
Communicator and Health Manager CanMEDS roles.
Medical Expert: By the end of the rotation the resident will:
1) Demonstrate an appropriate fund knowledge of normal physiology and pathobiology of the
breast
2) Perform a competent history and physical examination and interpret relevant clinical data
for patients presenting with a breast condition/problem.
3) Demonstrate advanced knowledge and understanding of the different treatment and
reconstruction options for both patients with breast cancer and those with a high risk of
breast cancer
4) Formulate management plans for patients presenting with breast condition/problems.
5) Manage emergency and post op plastic surgery patients in an ambulatory setting.
6) Overall is proficient and efficient in technical and procedural skills. Minimizes risks and
discomforts to the patient. Handles instruments appropriately and carefully. Handles the
tissues carefully and minimizes tissue trauma. Understands the operation and performs the
operation proficiently and efficiently with supervision.
7) Function as a surgeon for Unilateral two stage breast reconstruction with tissue expanders
and gel implants, bilateral breast reduction, nipple areolar reconstruction.
Demonstrate introductory skills with the use of direct to implant/ expander techniques with
gel implants and acellular dermal matrix (ADM) following prophylactic mastectomy, both
skin preserving, areolar sparing and nipple sparing.
8) Plan and assist for different techniques of breast reconstruction such as; different
techniques of fat grafting, TRAM flap breast reconstruction or elevation of a latissimus dorsi
flap.
9) Describe relevant clinical issues for patients presenting breast problems including; chest
wall anatomy, management and complications, congenital and developmental forms of
breast asymmetry such as tubular breast deformity, Poland’s Syndrome, options for breast
reconstruction, effects of radiotherapy, DVT prophylaxis, post-operative complications,
management of the patient with breast cancer.
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10) Draw or mark out relevant anatomy including: chest wall and breast.
Communicator: By the end of the rotation the senior plastic surgery resident will:
1) Exhibit effective and timely verbal and written communication skills including:
communicating with patients and families, verbal presentations, documentation and
consult letters.
2) Establish a therapeutic relationship with patients and communicate well with family.
3) Provide clear and thorough explanations of diagnosis, investigations and management in
a professional manner. Demonstrate empathy.
4) Provide patients and families with sufficient information of the risks and benefits of
treatment alternatives
5) Obtain informed consent, providing sufficient information of the risks and benefits of
the proposed procedure.
6) Write or dictate orders, progress notes and consult notes that are well organized and
timely.
COLLABORATOR By the end of the rotation the resident will be able to:
1) Develop and maintain a professional team interaction with Oncological Surgical team
members in combined procedures.
2) Participate effectively within an interprofessional healthcare team
3) Collaborate with community agencies and other professionals
Manager By the end of the rotation the resident will:
1) Effectively lead the health care team being aware of the unique aspects of the
ambulatory nature of the hospital, delegating and distributing tasks fairly; use time
wisely.
2) Demonstrate management skills to reflect and balance priorities for patient care,
sustainable practice and personal life.
3) Create a collaborative team call schedule
4) Demonstrate effective team leadership
5) Demonstrate an understanding of effective practice management
HEALTH ADVOCATE
By the end of the rotation the resident will be able to:
1) Demonstrate familiarity with important determinants of health affecting patients
undergoing anesthesia (e.g. smoking, obesity, drug or alcohol dependence, cervical disc
problems, family history anesthetic problems) and address preventative measures with
patients
2) Discuss the barriers to patients in obtaining surgical reconstruction
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SCHOLAR
By the end of the rotation the resident will be able to:
1) Recognize gaps in knowledge and develop strategies to correct these
2) Develop a strategy for self-directed learning and demonstrate the spirit of continuous
improvement
3) Demonstrates effective presentations on breast reconstruction and general topics
4) Create a team education plan
5) Demonstrate an ability to enhance the education of others
PROFESSIONAL
During the rotation the resident will:
1) Recognize limitations and seek advice and consultation when needed
2) Demonstrate a commitment to excellence in clinical care and personal ethical conduct.
3) Maintain and complete a procedural case log that accurately reflects the resident’s surgical
experience
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