1
The Hospital for Sick Children: Plastic and Reconstructive Surgery
Senior Resident Goals and Objectives
The Hospital for Sick Children senior rotation is four blocks (16 weeks) in duration. The senior rotation is
designed to be a review of previously covered topics (burns, hand trauma, skin lesions and soft tissue
growths, and cleft lip and palate) with an emphasis now on techniques of surgical repair in these
conditions. In order to expand the knowledge and surgical skills in pediatric plastic surgery, as a senior
resident, this rotation emphasizes both primary and secondary repair of cleft lip, pediatric craniofacial
trauma and craniofacial surgery, congenital hand, vascular lesions, brachial plexus and microsurgery.
The patient demographic at HSC allows the residents to develop skills in dealing with family dynamics,
interacting with multiple health care personnel, being exposed to rare and complex disease conditions
and syndromes, in addition to the primary and secondary care of a pediatric emergency department
Goals
This rotation emphasizes the development and evaluation of the Medical expert, Collaborator and
Professional CanMEDS roles.
Sills will be taught and evaluated primarily in the ambulatory clinics, emergency room, inpatient
services, and the consult service.
Medical Expert
By the end of the rotation the senior resident will be able to
1. Classify vascular lesions and outline diagnostic workup
2. Demonstrate an understanding of the treatment of burn hypertrophic scars and the use of
lasers in their treatment
3. Complete accurate and well organized history and physical examinations and recognize all major
significant findings, taking into account developmental age
4. Diagnose and prepare intraoperative planning for nevus excision and reconstruction
5. Classify a burn injury, perform an admission with orders for pediatric burn, including pain
management and fluid resuscitation, perform a burn dressing change, including choice of
dressing for wound, carry out tangential excision and grafting and manage the post-burn
rehabilitation of these patients
6. Describe and illustrate the normal anatomy and function of the brachial plexus.
7. Establish the diagnosis and demonstrate an understanding of the pathophysiology of obstetrical
brachial plexus palsy.
2
8. Demonstrate an understanding of the treatment principles involved in the primary management
of obstetrical brachial plexus palsy and demonstrate an understanding of the treatment
principles involved in the secondary management of obstetrical brachial plexus palsy
9. Demonstrate an understanding of the mechanism of pediatric facial trauma, the incidence of
various fractures, classification schema, and unique aspects of dealing with the growing
pediatric craniofacial skeleton. Recognize and treat post-traumatic secondary deformities.
Correctly interpret CT scans to assess pertinent injuries
10. Establish the diagnosis of common pediatric congenital hand anomalies such as syndactyly,
polydactyly, hypoplastic thumb, trigger digit, overgrowth and undergrowth anomalies.
11. Treat simple congenital hand anomalies such as polydactyly, syndactyly and trigger digit and
demonstrate an understanding of treatment philosophies for the management of complex
congenital hand anomalies such as hypoplastic thumb, radial and ulnar ray anomalies
12. Describe the pathophysiology, embryology and anatomy of the unilateral and bilateral cleft lip
and palate; recognize and become familiar with the nutritional, airway, speech, growth, and
psychosocial aspects of managing the cleft child; demonstrate an understanding of the
functional issues facing the newborn baby with cleft lip and/or palate and participate in cleft
palate/cleft lip repair.
13. Explain the pathophysiology of bone growth as it relates to craniosynostosis .
14. Explain the principles of treatment of a child with craniosynostosis, including both surgical and
non-surgical treatments.
15. Demonstrate competence in surgical skills. Handle instruments and tissues carefully with
appropriate skill to assist efficiently for this level of training. Handles instruments appropriately
and carefully. Handles the tissues carefully and minimizes tissue trauma.
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, families and health team members (nurses, physicians, rehab therapists etc.),
using verbal presentation, documentation and/or consult letters.
2) Obtain informed consent for diagnostic and therapeutic plans, providing sufficient information
of the risks and benefits of the proposed procedure and being understandable to patients.
3) Communicates effectively with patients and families. Uses voice, body language, translators to
good effect.
4) Demonstrates skills in working and patients to overcome communication challenges including
anger, confusion, sensory or cognitive impairment, socio-economic or ethno-cultural differences
5) Communicates a succinct clinical impression and plan in a consultation letter, including clear
delineation of responsibilities between the specialist and the referring physician in the ongoing
care of the patient.
6) Utilize appropriate interpersonal skills when dealing with patients and families particularly in
cases of interpersonal conflict, ethical dilemmas and breaking bad news
3
Collaborator
By the end of the rotation the senior plastic surgery resident will:
1) Participate effectively and appropriately in an inter-professional health care team, including
personnel on the ward, clinic, emergency and operating room environments.
2) Recognize and demonstrate the use of the team members for the care and treatment of cleft lip
and palate patients, craniofacial and burn care
3) Consult and work effectively with other medical specialists, particularly the pediatric associates
service and the emergency room physicians
4) Dictate a letter to a service that has consulted the service where the pre hospital care can be
improved in order to demonstrate the skill of sending useful feedback to non plastic surgery
colleagues.
Manager
By the end of the rotation the senior plastic surgery resident will:
1) Effectively contribute to the health care team, delegate and distribute tasks fairly; use time
wisely.
2) Effectively organize junior residents and medical students
Health Advocate
By the end of the rotation the senior plastic surgery resident will:
1) Support the health of patients/families by providing appropriate referrals, support and
information on health maintenance, as well as community/home resources.
2) Demonstrate an understanding of the use of the SCAN team as it relates to pediatric patients
3) Arrange appropriate follow up, including the use of telemedicine consultations for pediatric
patients encounter in the emergency room
Scholar
By the end of the rotation the senior plastic surgery resident will:
1) Maintain and enhance professional activities through ongoing learning by reviewing the relevant
seminars for pediatric plastic surgery
2) Demonstrate knowledge of all the seminar content related to the topics of burns, cleft lip and
palate, embryology of the head and neck, obstetrical plexus injury, craniofacial anomalies,
vascular lesions and syndromes, craniosynostosis, and congenital hand .
3) Identify a gap in knowledge (and indicate to a staff member) relevant to three surgical
cases/month and rectify this by self-study. Present the new knowledge in the form of a brief
three minute discussion of the topic to a staff member.
4) Give one didactic oral presentation to the Divisional members of 30 mins in length on a topic of
choice at the weekly Divisional rounds during the four month rotation.
4
Professional
The senior plastic surgery resident will, throughout the rotation:
1. Maintain and complete a procedural case log that accurately reflects the resident’s surgical
experience.
2. Exhibit appropriate personal and inter-personal professional behaviours with colleagues (other
residents and fellows) and health care team members.
3. Exhibit proper professional behavior.
4. Adhere to legal and ethical codes of practice.