Residency Rotation Descriptions
Integrated Pathway: The six-year Integrated Residency Program is structured such that the first 18 months are dedicated to core surgical training with the remainder of the time dedicated to plastic surgery-specific training, all under the supervision of the Department of Plastic Surgery. During these first two years, approximately 12 months will be spent completing RRC-required rotations in general surgery, breast surgery, emergency medicine, pediatric surgery, surgical critical care, surgical oncology, transplant, trauma surgery, and vascular surgery. Another 4 months will be spent on “strongly suggested” rotations, including burn surgery, anesthesia, and orthopaedic surgery. The remaining 8 months during the first two years will be spent on Plastic Surgery and Hand Surgery rotations prior to entering the four years of dedicated plastic surgery training.
Independent Pathway: The three-year Independent Residency Program is identical to the fourth, fifth, and sixth years of the Integrated Pathway.
Reconstructive Surgery Service: R1, R2, R4, and R5 Integrated Rotation / R1 and R2 Independent Rotation
The Reconstructive Surgery Service rotation at Presbyterian and Montefiore University Hospitals provides a comprehensive experience in the broad spectrum of reconstructive surgery. Working collaboratively with sister surgical services is an essential part of this rotation and will acquaint residents with a much larger body of surgical knowledge and experience.
Residents will interact principally with Drs. Oguz Acarturk, Ernest Manders, Mario Solari and James Russavage at PUH-MUH. All of the other staff of the Department will have patients on the service from elective admissions or via consultations and on-call coverage.
The PUH-MUH center is a Level I Trauma Center and regional quaternary referral center. A wide variety of problems will appear, often cared for in concert with the other surgical services, including General Surgery/Trauma, Neurosurgery, Cardiothoracic Surgery, Orthopedic Surgery, Vascular Surgery, Transplantation, Urology, and Otolaryngology-Head and Neck Surgery. Our collaboration with the last service is particularly valuable as we do the vast majority of the head and neck reconstructions in the Medical Center.
The rotation will also provide the resident with experience in assessing chronic wounds and the patients who bear them. The resident will have a primary role in solving the reconstructive problem with the guidance of fellow residents, fellows, and the supervising staff. Independence in decision-making and skillful execution of the operative plan is expected. A graded increase in responsibility is permitted as competence is demonstrated. The independence and responsibility afforded the resident is greater on this service than on any other in the system. Here the resident will have a prime opportunity to become a competent and confident independent operator. The patients are more co-morbid, frequently requiring care in the ICU setting, and the challenge of caring for them will greatly increase the clinical fund of knowledge of every resident.
The formal didactic component of the rotation will be obtained through weekly Grand Rounds and Morbidity & Mortality conferences on Wednesdays, and Monday Core Curriculum conferences requiring reading in preparation. During a two-year cycle, all of the major topics of plastic surgery will be covered in the didactic conferences and in the weekly Grand Rounds with the Plastic Surgery Education Network Resident Education Center as a primary resource materal. There is an abundance of clinical material, and residents are encouraged to prepare presentations and manuscripts describing their clinical experience.
Children’s Hospital of Pittsburgh: R3 and R5 Integrated Rotation / R2 Independent Rotation
The plastic surgery rotation at Children’s Hospital of Pittsburgh is designed as an intense and comprehensive exposure to and experience with Pediatric Plastic surgery and Craniomaxillofacial surgery. The rotation lasts 12 weeks during the R3 year and again for 10 weeks during the R5 Integrated / R2 Independent year. Residents will clinically interact with four primary, full-time, academic faculty members: Alexander Davit, Jesse Goldstein, Lorelei Grunwaldt, and Joseph Losee.
The Children’s Hospital of Pittsburgh of UPMC is a Level I Pediatric Trauma Center and Regional quaternary referral center. Patients seen in this rotation will include the full range of congenital and acquired anomalies seen in the pediatric population.
While on the Children’s Hospital rotation, residents will participate in the Cleft-Craniofacial clinic that meets for one full day a week, as well as the Pediatric Hand clinic. These outpatient clinics will provide the resident with an excellent continuity of care through preoperative evaluation and preparation for the surgical procedure, as well as postoperative management.
The Children’s Hospital rotation will provide the residents with the opportunity to learn the unique psychosocial skill set needed to adequately care for pediatric patients and attend to the needs of their entire family. Residents will learn how to assist families with preoperative teaching and counseling as well as postoperative care.
The rotation will provide the resident with experience in primary and secondary cleft lip and palate, as well as congenital and traumatic craniofacial surgery. The unique experience of functioning within a multidisciplinary cleft-craniofacial team caring for syndromic patients will be the expectation and will provide competence in Interpersonal and Communication skills as well as Systems-Based Practice. A detailed experience with congenital and traumatic pediatric hand will be obtained. Additionally, exposure to the full range of diagnoses pertinent to pediatric plastic surgery will be obtained, including, vascular anomalies, congenital nevi, congenital ear anomalies, and congenital breast anomalies including gynecomastia. The formal didactic component of this Children’s Rotation will be obtained through a weekly Indications Conference.
Magee Women’s Hospital: R3 and R5 Integrated Rotation / R2 Independent Rotation
The Magee breast surgery rotation is a four-month rotation for the plastic surgery resident during the R3 year and a 10-week rotation during the R5 Integrated / R2 Independent year, located at our free-standing Magee-Womens hospital. Residents will interact with Drs. Carolyn De La Cruz, Michael Gimbel, Vu Nguyen, and Kenneth Shestak while on the Magee breast service.
During this time the resident participates in the preoperative and postoperative management of a broad spectrum of breast and aesthetic problems. It includes both a junior and senior clinic experience that allows each resident a comprehensive approach to patient care, including the pre-operative evaluation, intra-operative management, and post-operative inpatient and outpatient care of the plastic surgery breast patient. In addition, residents will gain experience working in a multi-disciplinary approach to the breast cancer patients, in collaboration with surgical oncology, medical oncology, radiation oncology, radiology, pathology, medical genetics, fertility, and counselling.
The educational component of the rotation also includes participation in the multi-disciplinary breast conference, followed by our plastic surgery indications conference. At the completion of these rotations the resident is expected to be familiar with the management of patients with a broad spectrum of both cosmetic and reconstructive breast procedures including management of complications. The operative experience encompasses the spectrum of reconstructive breast cases, in addition to aesthetic breast surgeries, and includes an extensive exposure to microsurgical reconstruction of the breast.
VA Hospital of Pittsburgh: R3 Integrated Rotation
The plastic surgery rotation at the Veteran’s Administration Hospital of Pittsburgh is designed as an intense and comprehensive exposure to and experience with reconstructive plastic surgery and hand surgery. The rotation lasts 12 weeks and occurs during the plastic surgery Integrated R3 year. The resident will clinically interact with Drs. Jignesh Unadkat and Kia Washington who are on the full-time academic faculty and clinically practice at the VA.
The VA Hospital of Pittsburgh is a regional referral center. The rotation will provide the resident with an experience in general plastic and reconstructive surgery. The multidisciplinary approach, working closely with other services (primary care, otolaryngology, urology, general surgery, vascular surgery, neurosurgery, orthopedic surgery, dermatology, and podiatry) in the hospital, will provide competence in Interpersonal and Communication skills as well as Systems-Based Practice.
A detailed experience in the evaluation and management of malignant and pre-malignant skin lesions and reconstructive options for the closure of Mohs defects will be obtained. Experience with the reconstruction of head and neck defects after ENT ablative procedures, post-sternotomy defects, wounds of the trunk and lower extremity, and exposed hardware from orthopedic and neurosurgical interventions will be obtained. Additionally, both Drs. Unadkat and Washington are fellowship trained in Hand Surgery, and a significant amount of operative experience in elective as well as traumatic hand surgery will be gained. The formal didactic component of VA Rotation will be obtained through the Core Curriculum Conference. This conference consists of interactive sessions and assigned reading from the Plastic Surgery Education Network, Resident Education Center.
Hand Surgery Service: R2, R4, and R6 Integrated Rotation / R1 and R3 Independent Rotation
Education in hand surgery is provided throughout the plastic surgery training program, but accentuated in a dedicated three-month rotation during the plastic surgery R4 Integrated / R1 Independent year. The rotation combines outpatient clinic, emergency room, and operating room experience at the Presbyterian/Montefiore Hospital and the Western Pennsylvania Hand and Upper Extremity Center.
Presbyterian/Montefiore are the main teaching hospitals in the University of Pittsburgh Medical Center and represent the largest level I trauma center and quaternary referral center in western Pennsylvania. The Western Pennsylvania Hand and Upper Extremity Center is a specialized, privately-owned surgery center and outpatient clinic located in the suburb of Wexford, PA. Through these varied settings, rich clinical volume is provided across the entire spectrum of traumatic and elective hand and upper extremity surgery.
Skills in diagnosis, treatment options, technical execution, and postoperative care are developed under close mentorship by the faculty in the plastic surgery and orthopedic hand services, including Drs. Joseph Imbriglia, Glenn Buterbaugh, Aaron Grand, Marshall Balk, William Hagberg, Alexander Spiess, and Kia Washington. All faculty members are hand and upper extremity fellowship-trained specialists. Drs. Imbriglia and Buterbaugh are orthopaedic hand surgeons with decades of experience.
In addition to teaching conducted at bedside, clinic, and in the OR, there is a weekly Hand Conference, attended by both the Plastic and Orthopaedic Hand services, where fellows present cases and the faculty present on select hand and upper extremity topics.
Body Contouring Service: R4 Integrated Rotation / R1 Independent Rotation
Residents will rotate through the Body Contouring Service during the R4 Integrated / R1 Independent year of residency. A focused experience is offered in treating the unique aspects of the massive weight loss patient, including preoperative evaluation and pre-surgical preparation, intraoperative technique, and postoperative care.
While on the rotation, the resident will work with Drs. Peter Rubin and Jeffrey Gusenoff, who co-direct the Life After Weight Loss Center. While on service, the resident will participate in the full spectrum of body contouring procedures, including brachioplasty, male and female breast contouring, panniculectomy, thighplasty, upper and lower body lifts, and total body lifts. Procedures will take place at Magee-Womens Hospital, as well as at UPMC Shadyside Hospital.
Outpatient clinical experience is provided at the Isaly Clinic, where the resident will work as a member of the multi-disciplinary team involved in treating this specific patient population. Preoperative evaluation will focus on the comprehensive evaluation of the post-bariatric patient, including for example nutritional and psychosocial issues. Postoperatively, residents will familiarize themselves with the issues particularly pertinent to the body contouring patient, including for example DVT prophylaxis and wound care.
As with other rotations, the formal didactic component of the rotation will be obtained through the weekly Grand Rounds on Wednesdays, Morbidity and Mortality Conferences, and Monday Core Curriculum conferences.
UPMC Mercy Hospital: R4 Integrated Rotation / R1 Independent Rotation
Each resident rotates for 10 weeks at UPMC Mercy Hospital, a level one trauma center and comprehensive burn center. The principal preceptor on this rotation is Dr. Guy Stofman, who completed an Otolaryngology as well as a Plastic Surgery Residency. He is dual board certified by the American Board of Otolaryngology, as well as the American Board of Plastic Surgery.
A broad spectrum of cosmetic and reconstructive cases is available to the resident, including complex lower extremity reconstruction, rhinoplasty, and burn reconstruction.
The resident is given the opportunity to run the service and operate as independently as he/she is capable in order to allow his/her development as an autonomous surgeon. Participation in the attendings’ clinics is encouraged to provide follow-up as well as exposure to preoperative planning.
The formal didactic program is carried out as a part of the overall University program. Informal operating room and bedside teaching on this rotation is a continuous process.
Allegheny General Hospital: R5 Integrated Rotation / R2 Independent Rotation
The rotation at Allegheny General Hospital occurs during the R5 Integrated / R2 Independent year of the Plastic Surgery Residency, lasting 10 weeks. The resident will interact with Drs. Michael White, Rafael Diaz-Garcia, and Daniel Murariu. All of these surgeons are fellowship trained in either hand or microsurgery.
Allegheny General Hospital is a 750 bed level I Trauma Center and major regional referral center. It houses its own independent residencies in medicine, surgery, cardiothoracic surgery, vascular surgery, neurosurgery, orthopaedics, anesthesia, radiology, emergency medicine, ob-gyn, and additionally sponsors post-graduate fellowships in many of the above disciplines of medicine and surgery.
This rotation, arguably more than any other, provides a comprehensive experience in the broad spectrum of reconstructive, hand, and aesthetic surgery. The majority of the clinical load at AGH is drawn from patients requiring reconstruction secondary to trauma, cancer of the head and neck as well as breast, or post-infection defects. Residents interact with the patients of all the attendings and are included in their preoperative planning, surgical management, and postoperative care.
While on the Allegheny General Hospital rotation, the plastic surgery resident is assisted by rotating residents from surgery, orthopaedics, and emergency medicine. Additionally, third year medical students rotate on the service, as do fourth year students who may elect a one-month time frame to gain additional experience in this specialty. Allegheny General Hospital serves as a regional medical campus for third- and fourth-year medical students from Drexel University College of Medicine and as a clinical affiliate site for Temple University School of Medicine.
Formal didactic rounds are conducted weekly for four hours (i.e., Sunday School) and, in addition, clinical teaching rounds are conducted daily. The AGH Division participates in all teaching conferences sponsored by the University of Pittsburgh parent program.
UPMC Shadyside Hospital: R6 Integrated Rotation / R3 Independent Rotation
The Shadyside Hospital rotation is a 10-week rotation experienced by R6 Integrated / R3 Independent plastic surgery residents. During this rotation, residents work primarily with Dr. Michael Gimbel. Additionally, the resident is exposed one to two times per week to community-based plastic surgeons, including Drs. Marc Liang and James O’Toole. Clinical material during this rotation includes reconstruction of the scalp, breast, abdominal wall, and lower extremities, as well as aesthetic surgery. As Shadyside has historically had a busy geriatrics service, the rotation maintains emphasis on wound care, both medical and surgical. Also, because the Orthopedic Oncology service and the Hillman Cancer Center are centered at Shadyside, residents frequently participate in major reconstructions following limb-sparing extirpative procedures.
The resident rounds daily with the plastic surgery team consisting of Dr. Gimbel and a physician assistant. During these rounds, new patient consults are evaluated, preoperative planning is discussed, and postoperative care is administered and critiqued. Emphasis is placed on effective communication with multiple medical and surgical services, nursing, paramedical services, and administrative figures within this broad tertiary care hospital system. In addition to operative training, the resident also attends one to two days of outpatient clinic per week.
The formal didactic component of the rotation will be obtained through the weekly Grand Rounds on Wednesdays, Morbidity and Mortality Conferences, and Monday teaching conferences.
Aesthetic Surgery Rotation: R5 and R6 Integrated Rotation / R2 and R3 Independent Rotation
The Aesthetic Surgery Rotation is a 10-week rotation during both the R5 and R6 Integrated / R2 and R3 Independent years. Here the resident evaluates, operates on, and manages their own aesthetic surgery patients, and also participates in aesthetic surgery with volunteer faculty including Drs. Dennis Hurwitz, Marc Liang, and Leo McCafferty,
One afternoon a week, the resident runs his/her own clinic where they see patients and administer in-office procedures. Resident Clinic patients are independently evaluated and presented to an attending (most frequently Dr. Shestak or Dr. Gusenoff) regarding their suitability for any desired surgical procedures. If they are felt to be surgical candidates, procedures are planned and carried out with the resident as the primary surgeon under attending supervision at Magee-Womens Hospital.
The other three to four days of the week, the resident will work in the operating room and clinic of the above-mentioned volunteer faculty. Of note, Dr. Hurwitz is an internationally-recognized leader in body contouring and Dr. McCafferty is a past-president of American Society of Aesthetic Plastic Surgeons. This rotation affords the resident focused exposure to the full spectrum of aesthetic surgery, including face, breast, and body contouring procedures. At the completion of the rotation, the resident should have an understanding of the approaches to aesthetic surgery, including indications, contra-indications, surgical techniques and management of complications.
ENT/Mohs/Oculoplastics/OMFS: R4 Integrated Rotation / R1 Independent Rotation
During the R4 Integrated / R1 Independent year, this 10-week rotation will encompass the Plastic Surgery RRC “strongly recommended” experiences in Dermatology/Mohs Surgery, Oculoplastic Surgery, and Oral & Maxillofacial Surgery, as well as ENT.
Two to three weeks will be spent on each service. During the Dermatology/Mohs portion of the rotation, the resident will work primarily with Dr. John Zitelli, who trained under Frederic Mohs and is widely recognized as a leader in the field.
While rotating with Oculoplastic Surgery, the resident will work with Drs. Tonya Stefko and Jenny Yu. Here the resident can expect a good balance of clinic and surgical activities on a daily basis. Exposure will be gained in reconstructive eyelid, lacrimal, and orbital surgeries of the adult and child. This program offers a unique exposure to endoscopic and open procedures of the orbit and skull base in a multi-disciplinary setting.
During the OMFS portion of this rotation, the resident will interact with a number of faculty, including Drs. Mark Ochs and Bernard J. Costello. Exposure will be gained with utilizing advanced 3-D imaging and traditional surgical techniques to treat cleft and craniofacial disorders, oral cancer, jaw reconstruction, snoring and sleep apnea, dental implants, and facial cosmetic surgery.
The Otolaryngology and Plastic Surgery departments work closely together in a combined Head & Neck reconstructive team. The goal of this team is to combine the expertise of both surgical services to provide quality care for our patients, educate our residents and fellows, and to pursue high-impact research endeavors. The experienced surgeons on this team will focus on head and neck microvascular reconstruction, loco-regional reconstruction, and trauma in a busy tertiary-care environment. Residents and fellows from the two departments will be represented equally and are expected to have a robust reconstructive experience.
Float Rotation: R6 Integrated Rotation / R3 Independent Rotation
The Float Rotation is a 10-week block in the R6 Integrated / R3 Independent year during which the resident will be asked to “float” to any of the above services if additional assistance is needed, or as the resident otherwise chooses. Given the volume of the above surgical services, it is not uncommon, for example, for multiple free flaps to be occurring across various sites on any given day. In this case, additional senior resident coverage may be requested by one of the services, as our program only matches one microsurgery fellow per year. When not needed elsewhere, this block can also be used to obtain further experience in areas that individual residents may have a particular interest or feel the need for additional education and exposure.
Elective Rotation: R6 Integrated Rotation / R3 Independent Rotation
At the R6 Integrated / R3 Independent level, a 10-week elective rotation block will be provided, conferring the senior resident the flexibility to pursue an experience tailored to individual interests. If desired, away rotations will be individually arranged for a concentrated experience in specialized areas of interest. Coordinated and advanced preparation with significant oversight, under the direct supervision of the Program Director, will be provided to ensure a valuable educational experience for each resident. This time may be utilized to confirm interest in pursuing further education with fellowships in a specialized area of plastic surgery. Alternatively, this elective block can be used to obtain further experience in areas that individual residents may feel the need for additional education and exposure. Finally, for residents committed to pursuing an academic career, this time may be at least partially spent in scholarly pursuit of research.
Meet a Resident: Francesco Egro, MD
Francesco Egro, MD, talks about how alumni support through the Futrell Society has helped him during his time at the University of Pittsburgh Department of Plastic Surgery.