Identification of Best Practices
for Resident Aesthetic Clinics in Plastic Surgery Training:
The ACAPS National Survey
C. Scott Hultman, MD, MBA, FACS;1
Cindy Wu, MD;1 Michael L. Bentz, MD;2 Richard J. Redett, MD;3 Bruce R. Shack, MD4;
Lisa R. David, MD;5 Peter J. Taub,6 and Jeff E. Janis, MD7
From the Divisions and Departments of Plastic Surgery at
University Of North Carolina, Chapel Hill, NC1
University of Wisconsin, Madison, WI2
Johns Hopkins University, Baltimore, MD3
Vanderbilt University, Nashville, TN4
Wake Forest University, Winston-Salem, NC5
Icahn School of Medicine at Mt. Sinai, New York, NY6
The Ohio State University, Columbus, OH7
Presented in part at the Annual Scientific Meeting of the American Society of Plastic
Surgeons, San Diego, CA, October 2013; and the Annual Winter Retreat of the
American Council of Academic Plastic Surgeons, Chicago, IL, December 2014
Funding: The UNC Ethel and James Valone Plastic Surgery Research Endowment
Conflicts of Interest: no financial or commercial conflicts of interests
Key Words: surgical education, aesthetic surgery
Running Head: Best Practices for Resident Aesthetic Clinics
Correspondence/Proofs/Inquiries/Reprints:
C. Scott Hultman, MD, MBA, FACS
Ethel and James Valone Distinguished Professor of Surgery
Chief and Program Director, Division of Plastic Surgery
Suite 7038, Burnett-Womack, CB#7195
University of North Carolina
Chapel Hill, NC 27599-7195
Office: 919-966-2300; Fax: 919-966-3814
Email: cshult@med.unc.edu
2
ABSTRACT
Introduction: Resident aesthetic clinics (RACs) have demonstrated good outcomes,
reasonable patient satisfaction, and acceptable safety profiles, but few studies have
evaluated their educational, financial, or medico-legal components. We sought to
determine RAC best practices.
Methods: We surveyed ACAPS Members (n=399), focusing on operational details,
resident supervision, patient safety, medico-legal history, financial viability, and
research opportunities. Of the 96 respondents, 63 reported having a RAC. 56% of
plastic surgery residency Program Directors responded.
Results: RACs averaged 243 patient encounters and 53.9 procedures annually, over
a mean period of 19.6 years. Full-time faculty (73%) supervised chief residents
(84%) in all aspects of care (65%). Of the 63 RACs, 71% of facilities were
accredited, 40 had a licensed procedural suite, 28 had inclusion/exclusion criteria,
and 31 used anesthesiologists. 17 had overnight capability. 17 had a life safety
plan. No cases of malignant hyperthermia occurred, but there was one facility death
reported. 16 RACs (25%) had been involved in a lawsuit. 33 respondents reported
financial viability of the RACs (52%). Net revenue was transferred to both the
residents’ educational fund (41%) and divisional/departmental overhead (37%).
Quality measures included: case logs (78%), morbidity/mortality conference (62%),
resident surveys (52%), and patient satisfaction scores (46%). 14/63 (22%) of
respondents have presented or published research specific to RACs. 80/96 (83.3%)
of those surveyed believed RACs enhanced education.
Conclusion: RACs are an important component of plastic surgery education. Most
clinics are financially viable, but carry high malpractice risk and consume significant
resources. Best practices, to maximize patient safety and optimize resident
education, include use of accredited procedural rooms and direct faculty
supervision of all components of care.
word count: 268
3
INTRODUCTION
Many plastic surgery training programs include a resident aesthetic clinic, in
which trainees have increased autonomy in decision-making and patients have
improved access to aesthetic surgery, through reduced charges. While many studies
have demonstrated good outcomes,1-6 reasonable patient satisfaction,7,8 and an
acceptable safety profile,9,10 few reports have rigorously evaluated the operational,
financial, and medico-legal components of these programs.11-13
Even though most plastic surgery educators recognize the value of having a
resident aesthetic clinic, many different models for such a learning environment
exist,14-18 and best practices for this teaching paradigm have not yet been defined.
As the surgical trainee gains experience in aesthetic surgery, this learner must also
become an autonomous practitioner, mastering key competencies of not only
patient care and medical knowledge, but also systems-based practice,
communications, practice-based learning, and professionalism. The resident
aesthetic clinic, in which trainees evaluate patients, form an operative plan, execute
the procedure, and provide follow-up care, represents an ideal setting for gaining
increased independence, under the close observation of supervising faculty
members.
This paper attempts to move our educational framework “one step closer” to
knowing the optimal learning experience in aesthetic surgery. We hypothesize that
resident aesthetic clinics represent a valuable, unique paradigm for surgical
education, provided that clinical results are acceptable, patient and provider
satisfaction remains high, and patient safety is given highest priority. The authors
4
will describe the current status of resident aesthetic clinics in plastic surgery
training and will provide best-practice guidelines to achieve superior outcomes.
MATERIALS AND METHODS
We conducted an anonymous, 41-question, internet-based survey of all
members of the American Council of Academic Plastic Surgeons (n=399). Our
questionnaire (designed by the first author and constructed by PRRI, Beverly, MA)
focused on the following components: demographic information about the
respondents, operational details of the clinic, resident training and supervision,
patient safety, medico-legal history, financial considerations, and research
opportunities.
The questionnaire was sent to ACAPS members three times, from October
through December 2012. Overall response rate for ACAPS members was 24%
(n=96). Response rate for Program Directors was 56% (49 PDs from 87
institutions), representing over half of all training programs. Of the 96 respondents,
63 reported that their institution included a resident aesthetic clinic (66%). It
should be noted that some institutions had more than one respondent. Thus, this
survey reflects the opinions of ACAPS members who are involved with resident
education, not specific programs.
Using information obtained by this survey, and combining these data with
their own experience, the authors developed a list of best practices for resident
aesthetic clinics. These best practices were further refined, as a result of the
discussion between panelists and attendees, at the 2013 ACAPS Annual Spring
5
Retreat, and further refined by the ACAPS Aesthetic Surgery Task Force at the 2014
Annual Winter retreat of ACAPS.
RESULTS
Demographics of Respondents. Overall response rate was 96 out of 399
ACAPS members, or 24%. Of the 96 respondents, 49 were program directors and 31
were chiefs or chairs of plastic surgery (Figure 1). Only 5 residency coordinators
participated in the survey. Mean length of time in practice was 20 years, with a
range of 0-40 years (Figure 2). Regarding type of practice, the vast majority of
respondents had mostly reconstructive practices (n=76), compared to a minority of
respondents who had mostly aesthetic practices (n=9) (Figure 3).
In terms of the training programs, respondents reported the following mix of
residency programs: integrated, n=35; independent, n=34; integrated and
independent, n=27. The following organizational structure was reported for the
plastic surgery practices: Division of Surgery at a Medical School, n=72; Department
of a Medical School, n=19; Private Practice, n=5. Sixty-three out of 96 respondents,
or 66%, reported the presence of a RAC, in which “plastic surgery residents had a
focused cosmetic experience with some degree of autonomy.”
Operational Details. RACs have been in practice for a mean of 19.6 years,
with a range of 1-50 years (Figure 4). In terms of clinical volume, respondents
reported a median of 88 patients and an average of 243 patients treated each year,
with a range of 2-2000 encounters per year (Figure 5). When asked about
procedures done at the RAC, respondents noted a median of 25 and an average of
6
53.9 procedures done each year, with a range of 0-300 cases per year (Figure 6).
Components of the RACs, specific to location of patient encounters, include a
combination of examination rooms and surgical suites (Figure 7), with 40 of the 63
clinics including access to a licensed operating room.
Resident Supervision. Thirty-five out of 64 respondents (54%) who
reported having a RAC indicated that Resident Aesthetic Clinic was a formal rotation
in their residency program. Although respondents noted that chief residents
represented the largest group of participants (n=53), lower level residents also have
some degree of participation in the RAC (Figure 8). Nearly all residents (60 out of
64) provide continuity of care for their patients. According to the respondents,
residents receive supervision mostly by full-time core faculty (Figure 9), who
usually oversee all components of perioperative and intraoperative care (Figure 10).
Patient Safety. Although the majority of RACs have some type of
accreditation, 18 out of 63 respondents with RACS reported no accreditation (Figure
11). Furthermore, 28 out of 63 respondents with RACs reported a list of
inclusion/exclusion criteria for cases, and only 17 respondents having a Life Safety
Plan for the RAC. An anesthesiologist administers anesthesia in 31 out of 38 RACs
with operative capability, whereas other personnel are used for this function in the
remaining RACs (CRNA, 3; nursing staff, 2; surgeon, 2). Seventeen of the 35 clinics
with operative capability reported the ability to recover patients overnight.
Medico-legal History. Of the 64 respondents who indicated that their
institution had a RAC, one ACAPS member reported a patient death in the facility,
and two ACAPs members reported patient deaths within 30 days of the procedure.
7
Our cohort of ACAPS members observed no cases of malignant hyperthermia.
Sixteen of the 62 ACAPS members (26%) indicated that their RAC has been involved
in a lawsuit. Regarding malpractice insurance models, most groups are self-insured
and pay premiums to a group trust (Figure 12). Three of the 63 respondents with
RACs noted that patients must sign a waiver, releasing residents from malpractice
liability or to limit award for damages.
Financial Viability. Although 18 respondents did not know if their RACs
were financially viable, 33 respondents indicated that their RACs were, compared to
13 respondents who reported that the RACs were not financially viable. The large
majority of attending surgeons do not receive any financial remuneration, but some
of the respondents do receive compensation from professional fees, teaching
stipend, or a medial directorship. Almost all RACs offer discounted fees (59 out of
63, or 94%), and most RACs charge for the initial consultation (39 out of 63, or
62%). The most effective method for patient recruitment was listed as “word of
mouth” (61 out of 63, or 97%). Faculty practices contribute various types of
resources to the RACs, in addition to resident supervision (Figure 14), such as clinic
space, scheduling, nursing support, and disposable supplies. If profitable, net
income is primarily transferred to a residents’ education fund, but some of the gains
are transferred back to the Division or Department, presumably to cover overhead
costs (Figure 15). Only a small fraction of the positive net income is directed toward
incentive plans for the faculty, to the Dean or the hospital, or toward an operating
reserve.
8
Research and Outcomes Effectiveness. Respondents indicated that RACs
use a number of different methodologies to measure the effectiveness of the
educational experience, with review of resident case logs and morbidity and
mortality conferences as the most popular techniques (Figure 16). Fourteen of the
64 respondents with RACs have presented related data at national scientific
meetings, and 12 respondents have published their research in peer-reviewed,
scientific journals. The overwhelming perception is that RACs have a positive effect
on plastic surgery training (Figure 17). The majority of respondents were neutral
when asked about the impact of the RAC on their practice (n=36), but only a
minority of respondents reported that the RAC was a liability for the practice (n=7)
(Figure 18).
DISCUSSION
Resident aesthetic clinics serve as an important component of graduate
medical education in plastic surgery. Most clinics are financially viable but carry a
high malpractice risk and consume considerable resources. Best practices, to
maximize patient safety and optimize resident education, include use of accredited
procedural rooms, having anesthesiologists provide anesthesia, and providing
appropriate faculty supervision at all stages of patient care.
The educational concept and implementation of Resident Aesthetic Clinics is
not new, and has been implemented in various specialties including plastic surgery,
otolaryngology,19 and dermatology.20 In fact, the literature is replete with
manuscripts addressing the mechanics of administrating Plastic Surgery Resident
9
Aesthetic Clinics, their educational benefit, and analyses of outcomes data.
According to Neaman in 2010, 71% of plastic surgery residencies had a cosmetic
surgery clinic, with 44% of the respondents noted that 100% of the cases performed
there were cosmetic in nature.3
In 2006, the University of Kentucky group noted that the resident cosmetic
surgery clinic contributed 82% of the resident’s total aesthetic procedures. This was
completed with a 3.1% reoperative complication rate and no medicolegal litigation.4
Pyle and colleagues at Wake Forest reported that not only do residents gain added
experience as surgeon in a resident driven clinic, but that patients are able to
receive cosmetic surgery that they might not otherwise be able to access. They had
no major complications, but did report a minor complication rate of 8%, and a
revision rate of 14.4%.10
Freiburg and associates at the University of Toronto examined a
retrospective survey of 265 patients with a 49% response rate, where 93% of
patients said they would recommend the clinic (after a slightly lower rate the first
year), and 93% would undergo the same procedure again if required. The highest
patient satisfaction was seen in augmentation mammoplasty (9.1/10.0) and
blepharoplasty (9.0/10.0), while rhytidectomy and rhinoplasty were lower at
7.8/10.00 and 6.9/10.0, respectively.8 At Georgetown University, Baker and
colleagues evaluated satisfaction with resident injected fillers using a FACE-Q
survey. They demonstrated a 91% rate of being satisfied or very satisfied with this
evolving less invasive and highly popular injection in ten patients.7
10
At the American Association of Plastic Surgeons meeting in 2012, a two-year
retrospective review of patient care from 2009-2011 at the Johns Hopkins Resident
Cosmetic Surgery Clinic was presented. Rad and colleagues noted complications
rates consistent with the mainstream cosmetic surgery literature, breaking down
the procedures by type and body location. Their study sample included 115 patients
who underwent 132 primary body-contouring procedures, and 53 patients who
underwent 84 facial aesthetic procedures.9
Based on the published literature, as well as the ACAPS national survey, it is
clear that resident education in aesthetic surgery must be grounded in principles of
informed consent, appropriate patient selection, patient safety, teamwork, and
critical assessment of outcomes. Fortunately, qualitative and quantitative
instruments have been recently developed to assess outcomes, in terms of patient
satisfaction, as well as objective measures.21-23 Furthermore, surgical educators are
focusing on how to teach trainees aesthetic surgery—and reporting these results—
within the framework competency- and milestone-based graduate medical
education.24-26 Additional efforts have been pursued to educate residents about the
importance of strategic marketing, accounting and finance, economic forces of
competition, the supply chain, and regulatory/legal considerations, in the context of
office-based surgery and aesthetic services.27-31
The Aesthetic Surgery Task Force of the American Council of Academic
Plastic Surgeons endorses the concept a properly supervised Resident Aesthetic
Clinic, provided that the following guidelines are considered and followed, to the
greatest extent possible, within training programs accredited by the ACGME:
11
1. The educational experience should maximize resident autonomy,
appropriate to level of training, as permitted by ACGME guidelines
a. Residents must obtain a complete history and physical examination,
with preoperative evaluation to include patient photographs
b. Residents must discuss case with attending regarding operative plan
c. Attendings must be present for planning and execution of procedure
d. Residents must be involved with postoperative management,
including complications
e. Residents must be available for 24-7 coverage, with adequate faculty
backup
2. Longitudinal, complete continuity of care is critical; no post-rotation
handoffs should occur
3. The RAC must have a medical director for the Resident Aesthetic Clinic
4. The RAC must establish screening processes to eliminate inappropriate
patients, using such pre-defined parameters as BMI, smoking status,
uncontrolled diabetes or hypertension
5. The RAC must establish operative criteria such as inclusion/exclusion lists,
length of case
6. Surgery must performed in accredited facilities only
7. The RAC must have close faculty supervision in both the clinic and operating
room, including presence at the key components of procedure
8. The faculty must establish goals, objectives, targets for residents, track
outcomes, provide regular review, and offer timely feedback
12
9. Real-time evaluation of competencies and milestones must be performed
10. The program director should review of operative logs to ensure diversity of
cases, surgeons, and locations
11. The RAC must combine a robust clinic and operative experience with strong
educational modules focused on aesthetic surgery, including lectures,
indications and outcomes conferences, and a journal club
12. The medical director should moderate a formal Resident Clinic Outcomes
Conference for entire division/department
13. The division/department should reinvest net income back into the aesthetic
curriculum/program
14. The RAC can consider reduced fees to stimulate demand, by decreasing
professional fees and charging facility fees high enough to cover overhead
15. The RAC should involve residents with strategic marketing of the practice
16. The RAC should have a dedicated administrative assistant to help run the
program
17. Although aesthetic education should begin early in the training program, the
RAC should be limited to Chief or Senior residents in Plastic Surgery
18. The educational curriculum should phase in the complexity of the cases as
the resident skill set grows (for example, the trainee could start with breast
and body procedures, then move to facial procedures)
19. Trainee experience at the RAC should occur after more traditional aesthetic
surgery rotations have been completed and should be considered separate
and distinct from faculty practices
13
20. Residents should not be allowed to perform botox, fillers, peels in the RAC,
which instead should be used as an operative experience, for surgical
procedures
14
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15. Linder SA, Mele JA, Capozzi A. Teaching aesthetic surgery at the resident
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17
FIGURES
Figure 1. Role of ACAPS member at parent institution.
35
30
25
20
15
10
5
0
program core faculty chief/chair chief/chair residency
private
director
member
and
coordinator practitioner
program
director
fellow
18
Figure 2. Distribution of years in practice for respondents. X-axis represents
length of practice in years, Y-axis represents number of respondents for that time
point.
7
6
5
4
3
2
1
41
38
35
31
28
26
24
22
20
18
16
14
12
10
7
5
2
0
0
19
Figure 3. Ratio of clinical practice, in terms of reconstructive vs. aesthetic.
>90% reconstructive
: <10% aesthetic
75% reconstructive :
25% aesthetic
50% reconstructive :
50% aesthetic
25% reconstructive :
75% aesthetic
<10% reconstructive
: >90% aesthetic
0
10
20
30
40
50
20
Figure 4. Length of time that RACs have been in practice at institution. X-axis
represents length of practice in years, Y-axis represents number of respondents for
that time point.
14
12
10
8
6
4
2
0
1
2
6
7
9
10
12
15
19
20
22
25
28
30
33
45
50
21
Figure 5. Distribution of number of patients seen in the RAC each year. X-axis
represents number of patients seen per year, Y-axis represents number of
respondents for that number of patients.
12
10
8
6
4
2
2,000
1,500
500
300
250
225
200
180
150
120
85
100
80
75
60
50
48
40
35
30
20
15
7
14
2
0
22
Figure 6. Distribution of number of procedures done in RAC each year. X-axis
represents number of procedures, Y-axis represents number of respondents for
each procedure number.
9
8
7
6
5
4
3
2
1
30
0
15
0
10
0
70
60
40
30
25
24
20
17
15
7
5
0
0
23
Figure 7. Components of RAC, in terms of locations for patient encounters.
examination rooms
licensed operating
room
minor procedure room
skin care center
non-licensed surgical
suite
0
10
20
30
40
50
60
70
24
Figure 8. Participation of plastic surgery residents in the RAC.
chief residents
senior residents
junior residents
fellows
interns
0
10
20
30
40
50
60
25
Figure 9. Responsible supervisor for trainees in RAC.
full-time core faculty
private practice
volunteer faculty
private practice paid
faculty
fellows
0
10
20
30
40
50
26
Figure 10. Type of resident supervision provided in RAC.
45
40
35
30
25
20
15
10
5
0
preoperative preoperative preoperative
planning,
planning,
planning,
surgical time surgical time surgical time
out, all
out, key
out, all
components, components components
post-operative
care
none
preoperative preoperative
planning,
planning only
surgical time
out
27
Figure 11. Type of Accreditation for RAC.
Joint Commission
none
Other
AAAASF
0
5
10
15
20
25
30
35
40
28
Figure 12. Malpractice Insurance Model for RACs.
50
45
40
35
30
25
20
15
10
5
0
we are self-insured we pay for standard we pay for standard
and pay premiums
malpractice
and supplemental
to a group trust
insurance from a
malpractice
commercial carrier insurance from a
commercial carrier
we do not have
malpractice
insurance
29
Figure 13. Type of remuneration for attending surgeons who provide
supervision of RACs.
35
30
25
20
15
10
5
0
nothing
professional
fee
teaching
stipend
I don't know combination
medical
of stipend, directorship
professional
fee,
directorship
30
Figure 14. Resources provided by practice to RAC.
60
50
40
30
20
10
0
clinic space
scheduling
nursing support
disposable
supplies
capital
equipment
31
operating reserve for
the clinic
back to the Dean of
the Medical School
back to the Hospital
back to the
Department of
Surgery
incentive plan for
faculty to participate
in the Clinic
we are not profitable
back to the
Division/Department
of Plastic Surgery
residents'
educational fund
Figure 15. Transfer location of net income, if profit/loss statement positive
30
25
20
15
10
5
0
32
0
employee
satisfaction
surveys
we do not
assess the
effectiveness
of the clinic
in-service
exmination
scores
patient
satisfaction
surveys
resident
satisfaction
surveys
mortality and
morbidity
conference
resident case
logs
Figure 16. Mechanisms to assess effectiveness of RAC.
60
50
40
30
20
10
33
Figure 17. Effect of the RAC on plastic surgery training.
90
80
70
60
50
40
30
20
10
0
enhances resident education
no effect on resident
education
detracts from resident
education
34
Figure 18. Impact of the RAC on the faculty practice.
40
35
30
25
20
15
10
5
0
neutral
enhances the stature we do not have such
of our practice
a clinic
serves as a liability
for our practice
35
APPENDIX
Resident Aesthetic Clinic: Best Practices Project
ACAPS National Survey
Distributed October, November, December 2012
The American Council of Academic Plastic Surgeons (ACAPS) would like to develop a
set of guidelines that 1) define best practices of Resident Aesthetic Clinics and 2) provide
recommendations on how to start and maintain such clinic, for residency programs that are
interested in pursuing such an endeavor. The goal of this project is to outline the principles
and practices of a successful venture, focusing on the pillars of patient safety, clinical
outcomes, financial viability, research opportunities, and resident education.
To help us with this important project, would you please answer the following
questions? This survey should take you no longer than 10 minutes to complete. We will share
the results of this project at the 2013 Spring Meeting of ACAPS.
Thank you.
GENERAL INFORMATION
1. What is your role as an ACAPS member (please pick the single best answer)?
a. residency coordinator
b. fellow
c. private practitioner
d. core faculty member
e. program director
f. chief/chair
g. chief/chair and program director
2.
How many years have you been in practice? _________________
3.
What ratio best describes the mix of your personal clinical practice?
a. >90% reconstructive : <10% aesthetic
b. 75% reconstructive : 25% aesthetic
c. 50% reconstructive : 50% aesthetic
d. 25% reconstructive : 75% aesthetic
e. <10% reconstructive : >90% aesthetic
4.
What type of residency program do you have?
a. independent
b. integrated
c. independent and integrated
5.
What type of organizational structure does your practice have?
a. Division of Surgery at a Medical School
b. Department of a Medical School
c. Private Practice
6.
Do you have a Resident Aesthetic Clinic, in which plastic surgery residents have a focused
cosmetic experience with some degree of autonomy?
Yes
No
(NOTE: if respondent answers “No” then go to survey end)
OPERATIONAL DETAILS
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7.
How many years has the clinic been in practice? _____________________
8.
How many patients are seen in the Resident Aesthetic Clinic each year? _________________
9.
How many procedures are done in the Resident Aesthetic Clinic each year? _________________
10. What are the components of your Resident Aesthetic Clinic? Please check all that apply.
a. examination rooms
b. skin care center
c. minor procedure room
d. non-licensed surgical suite
e. licensed operating room
EDUCATION
11. Is the Resident Aesthetic Clinic a formal rotation for your residency program?
a. yes
b. no
12. Which residents participate in the clinic? Please check all that apply.
a. interns
b. junior residents
c. senior residents
d. chief residents
e. fellows
13. Do residents provide continuity of care for their patients?
a. yes
b. no
14. Who supervises your Resident Aesthetic Clinic?
a. no one
b. fellows
c. private practice volunteer faculty
d. private practice paid faculty
e. full-time core faculty
15. What type of resident supervision do you provide?
a. none
b. preoperative planning only
c. preoperative planning, surgical time out
d. preoperative planning, surgical time out, key components
e. preoperative planning, surgical time out, all components
f. preoperative planning, surgical time out, all components, post-operative care
PATIENT SAFETY
16. What type of accreditation does your Resident Aesthetic Clinic have?
a. none
b. Joint Commission
c. AAASF
d. AAAHC
e. Other
17. Does the Resident Aesthetic Clinic have a list of inclusion/exclusion criteria for procedures
done there?
a. not applicable, because we do not do procedures at our center
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b.
c.
yes
no
18. Who primarily provides anesthesia for the procedures done at the Resident Aesthetic Clinic?
a. not applicable, because we do not do procedures at our center
b. the surgeon
c. the nursing staff
d. CRNA
e. Anesthesiologist
19. For procedures done at the Resident Aesthetic Clinic, do patients ever stay overnight?
a. not applicable, because we do not do procedures at our center
b. yes
c. no
20. Does the Resident Aesthetic Clinic have a Life Safety Plan?
a. yes
b. no
c. I am not sure what that is
21. Has the Resident Aesthetic Clinic ever had a patient death in the facility?
a. yes
b. no
22. Has the Resident Aesthetic Clinic ever had a patient death within 30 days of the procedure?
a. yes
b. no
23. Has the Resident Aesthetic Clinic ever had a case of malignant hyperthermia?
a. yes
b. no
24. Has the Resident Aesthetic Clinic or one of its surgeons ever been involved in a lawsuit,
regarding a patient treated at the clinic?
a. yes
b. no
25. Please describe your malpractice insurance model
a. we do not have malpractice insurance
b. we are self-insured and pay premiums to a group trust
c. we pay for standard malpractice insurance from a commercial carrier
d. we pay for standard and supplemental malpractice insurance from a commercial carrier
26. Do patients sign a waiver releasing the residents from malpractice liability or limiting
damages that can be obtained?
a. yes
b. no
FINANCIAL CONSIDERATIONS
27. Is your Resident Aesthetic Clinic financially viable?
a. yes
b. no
c. I don’t know
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28. What type of remuneration do the attending surgeons receive for providing oversight and
supervision of the Resident Aesthetic Clinic?
a. nothing
b. teaching stipend
c. professional fee
d. medical directorship
e. combination of stipend, professional fee, directorship
f. I don’t know
29. Which type of patients can receive discounted fees for services provided?
a. none
b. employees only
c. patients who respond to an advertisement or special promotional deal
d. all
30. Do you charge for the initial patient consultation?
a. yes
b. no
c. I don’t know
31. The best method for patient recruitment at our Resident Aesthetic Clinic is:
a. word of mouth
b. advertising
c. employee discounts
d. search–engine optimization
e. hospital marketing
f. other
32. What resources does your practice commit to the Resident Aesthetic Clinic? Please check all
that apply.
a. nursing support
b. clinic space
c. scheduling
d. disposable supplies
e. capital equipment
33. If profitable, where do you transfer the net income? Please check all that apply.
a. we are not profitable
b. operating reserve for the clinic
c. back to the Division/Department of Plastic Surgery
d. back to the Department of Surgery
e. back to the Hospital
f. back to the Dean of the Medical School
g. residents’ educational fund
h. incentive plan for faculty to participate in the Clinic
RESEARCH AND OUTCOMES
34. How do you assess the effectiveness of the Resident Aesthetic Clinic? Please check all that
apply.
a. we do not assess the effectiveness of the clinic
b. patient satisfaction surveys
c. employee satisfaction surveys
d. resident case logs
e. in-service exmination scores
f. resident satisfaction surveys
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g.
mortality and morbidity conference
35. Have you ever presented research, derived from the Resident Aesthetic Clinic, at a national
scientific meeting?
a. yes
b. no
36. Have you ever published research, derived from the Resident Aesthetic Clinic, in a peerreviewed, scientific journal?
a. yes
b. no
OVERALL SUMMARY
37. What is impact of a Resident Aesthetic Clinic on your practice?
a. enhances the stature of our practice
b. neutral
c. serves as a liability for our practice
38. What is the effect of a Resident Aesthetic Clinic on surgical training?
a. enhances resident education
b. no effect on resident education
c. detracts from resident education
39. If you do not have a Resident Aesthetic Clinic, are you interested in starting one?
a. we already have a clinic
b. yes
c. no
d. not sure
40. Please provide any additional comments regarding this project.
_____________________________________________
41. If you would like to be contacted, to be interviewed as part of a focus group, please leave
your email address.
_____________________________________________
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