New Application: Ophthalmic Plastic and Reconstructive Surgery
Review Committee for Ophthalmology
ACGME
515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000  www.acgme.org
PROGRAM PERSONNEL AND RESOURCES
Program Director
Does the program director’s clinical practice consist predominantly of ophthalmic plastic and
reconstructive surgery? [PR II.A.3.e)] ................................................................................. ☐ YES ☐ NO
If “NO,” explain.
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Other Program Personnel
Will designated faculty members in each of the following specialties supervise rotations in these
specialties? [PR II.C.1.]
a)
b)
c)
d)
e)
f)
g)
Otolaryngology ........................................................................................................ ☐ YES ☐ NO
Procedural dermatology .......................................................................................... ☐ YES ☐ NO
Craniofacial surgery ................................................................................................ ☐ YES ☐ NO
Plastic surgery......................................................................................................... ☐ YES ☐ NO
Neuroradiology ........................................................................................................ ☐ YES ☐ NO
Ocular pathology ..................................................................................................... ☐ YES ☐ NO
Neurology................................................................................................................ ☐ YES ☐ NO
Explain any ‘NO’ responses.
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Resources
1. For each participating site, provide the number of fully-equipped examining rooms available in the
outpatient area. [PR II.D.1.]
Number of examining rooms
Site #1
#
Site #2
#
Site #3
#
2. Does each participating site include at least one operating facility appropriately equipped for
ophthalmic plastic and reconstructive surgery? [PR II.D.2.] ........................................... ☐ YES ☐ NO
3. Briefly describe the inpatient facilities available to the program, including access to space and beds
for patient care. [PR II.D.3.] (Limit response to 200 words)
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EDUCATIONAL PROGRAM
Didactic Sessions
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 1 of 12
1. Briefly describe the planned fellow responsibilities for preparing and presenting teaching
conferences. [PR IV.A.3.a)]
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2. Briefly describe the planned fellow participation in teaching fellows, residents and/or medical
students. [PR IV.A.3.a); IV.A.5.a.(1).(b)]
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3. Will fellows participate in a minimum of 80 hours of didactic instruction? [PR IV.A.3.b)]
..................................................................................................................................... ☐ YES ☐ NO
4. Will at least 40 hours of didactic instruction be intramural? [PR IV.A.3.b)] ..................... ☐ YES ☐ NO
5. Will fellows attend grand rounds and actively participate in case presentation conferences and
discussions of patients with ophthalmic plastic and reconstructive surgery? [PR IV.A.3.b).(1)]
..................................................................................................................................... ☐ YES ☐ NO
If “NO,” explain.
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6. Is fellow attendance at regularly scheduled case presentation conferences mandatory?
[PR IV.A.3.b).(2)]........................................................................................................... ☐ YES ☐ NO
If “NO,” explain.
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7. Will fellows prepare and present a minimum of two case presentations per year? [PR IV.A.3.b).(2)]
..................................................................................................................................... ☐ YES ☐ NO
8. Will fellows attend a minimum of six lecture hours per year on ophthalmic plastic and reconstructive
surgery topics given by members of the faculty? [PR IV.A.3.b).(3)] ............................... ☐ YES ☐ NO
If “NO,” explain.
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9. Will fellows prepare and present a minimum of two didactic lectures per year on the
diagnosis/treatment of entities afflicting the eyelids, tear system, orbit, or face? [PR IV.A.3.b).(3)]
..................................................................................................................................... ☐ YES ☐ NO
10. Will fellows present these lectures to faculty members, other fellows, and residents? [PR
IV.A.3.b).(3)] ................................................................................................................. ☐ YES ☐ NO
If “NO,” explain.
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11. Will fellows be responsible for the preparation of case presentation for at least one ophthalmic
plastic and reconstructive surgery visiting professor conference? [PR IV.A.3.b).(4)] ..... ☐ YES ☐ NO
If “NO,” explain.
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 2 of 12
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12. Will fellows attend and participate in at least two courses devoted to ophthalmic plastic and
reconstructive surgery, tumor resection, lacrimal disease, or cosmetic surgery? [PR IV.A.3.b).(5)]
..................................................................................................................................... ☐ YES ☐ NO
If “NO,” explain.
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13. Briefly describe how fellowship preceptors emphasize and teach the principles of ethical and
humane treatment of patients. [PR IV.A.3.c)]
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Patient Care
1. How will the program ensure that all fellows directly evaluate and provide diagnosis and treatment
plans in the care of a minimum of 1200 patient encounters per year (not 1200 new patients)?
[PR IV.A.5.a).(1).(a)]
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2. How will the program ensure that a fellow is able to demonstrate that a patient’s history and physical
were accurate and appropriate, the use of laboratory and imaging tests was directed by the history
and physical examination, and that the differential diagnosis and management were appropriate?
[PR IV.A.5.a).(1).(a)]
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3. Indicate the settings and activities in which fellows will demonstrate competence in each of the
following areas of patient care. Also indicate the method(s) used to assess competence.
Proficiency Area
Teaching ophthalmic plastic
and reconstructive surgery to
ophthalmology residents
[PR IV.A.5.a).(1).(b)]
Settings/Activities
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Assessment Method(s)
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4. Indicate the settings and activities in which fellows will demonstrate competence in each of the
following procedures. Also indicate the method(s) used to assess competence.
Proficiency Area
Enucleation, evisceration,
exenteration, and secondary
implants of the orbit
[PR IV.A.5.a).(2).(a)]
Orbitotomy for exploration,
biopsy, and tumor removal;
anterior, lateral, medial and
superior and orbital
Settings/Activities
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Assessment Method(s)
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Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 3 of 12
Proficiency Area
reconstruction for periorbital
anomalies
[PR IV.A.5.a).(2).(b)]
Eyelid retraction repair
[PR IV.A.5.a).(2).(c)]
Blepharoptosis repair
[PR IV.A.5.a).(2).(d)]
Ectropion and entropion repair
[PR IV.A.5.a).(2).(e)]
Blepharoplasty (upper and
lower eyelids, functional and
aesthetic)
[PR IV.A.5.a).(2).(f)]
Eye lid reconstruction (following
congenital defects, trauma or
tumor excision)
[PR IV.A.5.a).(2).(g)]
Repair or treatment of trichiasis
(lid split, mucous membrane
graft)
[PR IV.A.5.a).(2).(h)]
Conjunctivoplasty
[PR IV.A.5.a).(2).(i)]
Trauma and laceration repairs
[PR IV.A.5.a).(2).(j)]
Rhytidectomy limited to
periorbital tissues
[PR IV.A.5.a).(2).(k)]
Dacryocystorhinostomy and
other lacrimal procedures
[PR IV.A.5.a).(2).(l)]
Excision of tumors involving the
periorbital and adjacent regionsbenign and malignant
[PR IV.A.5.a).(2).(m)]
Facial flaps and grafts related to
the management of periorbital
processes
[PR IV.A.5.a).(2).(n)]
Management of upper face and
brow conditions (e.g., brow
ptosis repair)
[PR IV.A.5.a).(2).(o)]
Nasal endoscopy, partial inferior
turbinectomy, and procedures
related to the management of
lacrimal and periorbital
processes
[PR IV.A.5.a).(2).(p)]
Settings/Activities
Assessment Method(s)
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Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 4 of 12
Proficiency Area
Settings/Activities
Use of neuromodulators
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(botulinum toxin), dermal fillers,
other technologies (e.g., laser)
and chemical/pharmaceutical
agents for the management of
contour and skin quality
abnormalities (functional and
aesthetic)
[PR IV.A.5.a).(2).(q)]
Assessment Method(s)
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Practice-based Learning and Improvement
1. Briefly describe one learning activity in which residents demonstrate the ability to investigate and
evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and life-long learning. [PR IV.A.5.c)] (Limit
response to 400 words)
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2. Briefly describe one planned learning activity in which fellows engage to identify strengths,
deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set
learning and improvement goals; and identify and perform appropriate learning activities to achieve
self-identified goals (life-long learning). [PR IV.A.5.c).(1)-(3)] (Limit response to 400 words)
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3. Briefly describe one planned quality improvement activity or project that will allow fellows to
demonstrate the ability to analyze, improve, and change practice or patient care. Describe planning,
implementation, evaluation, and provisions of faculty member support and supervision that will
guide this process. [PR IV.A.5.c).(4)] (Limit response to 400 words)
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4. Briefly describe how fellows will receive and incorporate formative evaluation feedback into daily
practice. (If a specific tool is used to evaluate these skills, have it available for review by the site
visitor.) [PR IV.A.5.c).(5)] (Limit response to 400 words)
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5. Briefly describe one example of a learning activity in which fellows engage to develop the skills
needed to use information technology to locate, appraise, and assimilate evidence from scientific
studies and apply it to their patients' health problems. [PR IV.A.5.c).(6)-(7)] (Limit response to 400
words)
The description should include:
 Locating information
 Using information technology
 Appraising information
 Assimilating evidence information (from scientific studies)
 Applying information to patient care
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 5 of 12
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6. Briefly describe how fellows will develop teaching skills necessary to educate patients, families,
students, and other health professionals. [PR IV.A.5.c).(8)] (Limit response to 400 words)
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Interpersonal and Communication Skills
1. Briefly describe one learning activity in which residents demonstrate interpersonal and
communication skills that result in the effective exchange of information and collaboration with
patients, their families, and health professionals. [PR IV.A.5.d)] (Limit response to 400 words)
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2. Briefly describe one learning activity in which fellows develop competence in communicating
effectively with patients and families across a broad range of socioeconomic and cultural
backgrounds, and with physicians, other health professionals, and health-related agencies.
[PR IV.A.5.d).(1)-(2)] (Limit response to 400 words)
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3. Briefly describe one learning activity in which fellows develop their skills and habits to work
effectively as a member or leader of a health care team or other professional group. In the example,
identify the members of the team, responsibilities of the team members, and how team members
communicate to accomplish responsibilities. [PR IV.A.5.d).(3)] (Limit response to 400 words)
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4. Briefly describe how fellows will be provided with opportunities to act in a consultative role to other
physicians and health professionals. [PR IV.A.5.d).(4)] (Limit response to 400 words)
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5. Briefly describe how fellows will be provided with opportunities to maintain comprehensive, timely,
and legible medical records, if applicable. [PR IV.A.5.d).(5)] (Limit response to 400 words)
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Professionalism
Briefly describe the learning activity(ies), other than lecture, by which fellows demonstrate a
commitment to carrying out professional responsibilities and an adherence to ethical principles,
including: compassion, integrity, and respect for others; responsiveness to patient needs that
supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society,
and the profession; and sensitivity and responsiveness to a diverse patient population, including to
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation [PR IV.A.5.e).(1)-(5)]
(Limit response to 400 words)
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Systems-based Practice
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 6 of 12
1. Briefly describe the learning activity(ies) through which residents demonstrate an awareness of and
responsiveness to the larger context and system of health care, as well as the ability to call
effectively on other resources in the system to provide optimal health care. [PR IV.A.5.f)] (Limit
response to 400 words)
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2. Describe the learning activity(ies) through which fellows achieve competence in the elements of
systems-based practice: working effectively in various health care delivery settings and systems,
coordinate patient care within the health care system; incorporating considerations of costcontainment and risk-benefit analysis in patient care; advocating for quality patient care and optimal
patient care systems; and working in interprofessional teams to enhance patient safety and care
quality. [PR IV.A.5.f).(1)-(5)] (Limit response to 400 words)
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3. Describe an activity that fulfills the requirement for experiential learning in identifying system errors
and implementing potential systems solutions. [PR IV.A.5.f).(6)] (Limit response to 400 words)
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4. Describe how fellows will participate in planned rotations to procedural dermatology,
otolaryngology, neuro-ophthalmology, and plastic surgery in order to understand how other
specialties approach the management of diseases of the head and neck that directly affect the
management of ocular and periocular disease, with a set of measurable goals and objectives to be
attained at the end of each rotation. [PR IV.A.5.f).(7)] (Limit response to 400 words)
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Patient Care Curriculum
1. Will fellows participate in the pre-operative care of surgical cases for which they are part of the
surgical team? [PR IV.A.6.d)] ........................................................................................ ☐ YES ☐ NO
If “NO,” explain.
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2. Will fellows participate in the post-operative management of surgical cases for which they are part
of the surgical team? [PR IV.A.6.d)] .............................................................................. ☐ YES ☐ NO
If “NO,” explain.
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Medical Knowledge Curriculum
1. Indicate how fellows will be provided with instruction in each of the following areas. Indicate all that
apply.
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 7 of 12
Conference (List
title date, and
Topic
lecturer)
Anatomy and physiology Conference
of the orbit, eyelids,
lacrimal system, nose,
sinuses, and head and
neck as they relate to the
orbit and adnexa
[PR IV.A.7.a).(1)]
Common orbital problems Conference
of children, including
congenital anomalies,
cellulitis, benign and
malignant tumors, and
orbital inflammations
[PR IV.A.7.a).(2).(a)]
Common orbital disorders Conference
of adults, including orbital
cellulitis, thyroid
orbitopathy, and
pseudotumor vasculitis,
congenital tumors,
vascular tumors, neural
tumors, lacrimal gland
tumors, fibro-osseus
tumors, histiocytic
diseases, lymphoid
tumors, metastatic
tumors, trauma,
ophthalmic socket
problems, and skull base
disease
[PR IV.A.7.a).(2).(b)]
Eyelid, including
Conference
congenital syndromes,
inflammation, trauma,
ectropion, trichiasis,
blepharoptosis, eyelid
retraction,
dermatochalasis,
blepharochalasis, eyelid
tumors, blepharospasm,
facial nerve palsy,
eyebrow, midface, and
lower face function and
aesthetics
[PR IV.A.7.a).(3)]
Lacrimal system,
Conference
including congenital
Grand
Rounds
☐
Other
Learning
Experiences
Online
(Journal
Learning Simulation Club, etc.)
Other
☐
☐
☐
☐
☐
Other
☐
☐
☐
Other
☐
☐
☐
Other
☐
☐
☐
Other
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 8 of 12
Conference (List
title date, and
lecturer)
Topic
tearing, acquired tearing,
and trauma
[PR IV.A.7.a).(4)]
Ocular surface pathology, Conference
including cicatricial
processes affecting the
bulbar and palpebral
conjunctiva, management
of corneal and
conjunctival exposure,
and relationship of the
lids, mid-face and brow to
ocular exposure
[PR IV.A.7.a).(5)]
Regional anatomy,
Conference
including graft sites
frequently used, such as
cranial bone, ear, nose,
temporal area, mouth and
neck, abdomen, buttocks,
legs, supraclavicular
area, and arm
[PR IV.A.7.a).(6)]
Fundamentals of ocular Conference
and orbital anatomy,
chemistry, physiology,
microbiology,
immunology, and wound
healing
[PR IV.A.7.a).(7)]
Histology and pathology Conference
to interpret ocular,
cutaneous, and
periocular pathology and
dermatopathology
[PR IV.A.7.a).(8)]
Diagnostic and
Conference
therapeutic procedures
with comprehensive
examination of the
eyelids and periorbital
region
[PR IV.A.7.a).(9)]
Examination of the
Conference
lacrimal system; nasal
exam with speculum and
endoscope
Grand
Rounds
Other
Learning
Experiences
Online
(Journal
Learning Simulation Club, etc.)
☐
☐
☐
Other
☐
☐
☐
Other
☐
☐
☐
Other
☐
☐
☐
Other
☐
☐
☐
Other
☐
☐
☐
Other
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 9 of 12
Conference (List
title date, and
lecturer)
Topic
[PR IV.A.7.a).(10)]
Examination of the
Conference
eyebrow and face,
including assessment of
the eyebrow position for
brow ptosis, paralysis,
and its relation to upper
eyelid dermatochalasis,
for facial paralysis and
evaluation of the effects
of mid-face cicatricial,
paralytic, and involutional
changes on lower eyelid
position, and assessment
of the face for the
harmonious aesthetic
units, and evaluation of
the interrelationships of
each
[PR IV.A.7.a).(11)]
Examination of
Conference
measurement of orbital
structures and functions
[PR IV.A.7.a).(12)]
The principles of plain
Conference
films, CT, MRI, and
ultrasound imaging
relating to the head and
neck, with particular
emphasis on the orbit
[PR IV.A.7.a).(13)]
Grand
Rounds
Other
Learning
Experiences
Online
(Journal
Learning Simulation Club, etc.)
☐
☐
☐
Other
☐
☐
☐
Other
☐
☐
☐
Other
2. Will each fellow participate in at least one orbital dissection during the program? [PR IV.A.7.b)]
..................................................................................................................................... ☐ YES ☐ NO
3. Briefly describe how fellows will learn the fundamentals of cosmetic surgery and its complications,
with emphasis on brows and mid-face, as well as alloplastic inserts. [PR IV.A.7.c)] (Limit response
to 200 words)
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4. Briefly describe how fellows will learn the team approach to orbital and periorbital trauma.
[PR IV.A.7.d)] (Limit response to 200 words)
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Scholarly Activity
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 10 of 12
1. Will fellows and faculty members actively participate in a journal club at least three times per year?
[PR IV.B.2.c)] ................................................................................................................ ☐ YES ☐ NO
2. During the journal club, will faculty members and fellows present and critically discuss selections
from the current literature? [PR IV.B.2.c)]...................................................................... ☐ YES ☐ NO
Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
Page 11 of 12
INSTITUTIONAL DATA
Provide all procedures performed by the ophthalmic plastic and reconstructive surgery service during a
recent 12-month period at each participating site identified in ADS.
12-month Period
From:
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AlloDerm
Blepharoplasty
Blepharoptosis
Biopsy of eyelid
Botox
Brow
Canthotomy
Conjunctival surgery
Conjunctivoplasty
DCR and lacrimal
Dermis-fat graft
Drainage of lid abscess
Ectropion and entropion
Enucleation, evisceration, exenteration, secondary
implant
Excision of eyelid lesion
Eyelid reconstruction
Eyelid retraction repair
Flaps and grafts
Grafting (such as burns, exuberant scars, etc.)
Integument (skin)
Laceration and trauma repair
Nasal endoscopy (for management of periorbital
and lacrimal processes only)
NOE and tripod repairs
Optic nerve sheath fenestration
Orbitotomy with reconstruction
Repair of orbital wall fractures (not floor)
Revision/removal of orbital implant
Rhitidectomy (for periorbital areas only)
Tarsorrhaphy
Trichiasis
Tumor excision
To:
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Ophthalmic Plastic and Reconstructive Surgery
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 5/2015
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