Identification of Best Practices for Resident Aesthetic Clinics in Plastic Surgery Training: The ACAPS National Survey

Abstract

Introduction: Resident aesthetic clinics (RACs) have demonstrated good outcomes and acceptable patient satisfaction, but few studies have evaluated their educational, financial, or medicolegal components. We sought to determine RAC best practices.

Methods: We surveyed American Council of Academic Plastic Surgeon members (n = 399), focusing on operational details, resident supervision, patient safety, medicolegal history, financial viability, and research opportunities. Of the 96 respondents, 63 reported having a RAC, and 56% of plastic surgery residency program directors responded.

Results: RACs averaged 243 patient encounters and 53.9 procedures annually, having been in existence for 19.6 years (mean). Full-time faculty (73%) supervised chief residents (84%) in all aspects of care (65%). Of the 63 RACs, 45 were accredited, 40 had licensed procedural suites, 28 had inclusion/exclusion criteria, and 31 used anesthesiologists. Seventeen had overnight capability, and 17 had a Life Safety Plan. No cases of malignant hyperthermia occurred, but 1 facility death was reported. Sixteen RACs had been involved in a lawsuit, and 33 respondents reported financial viability of the RACs. 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%). Of 63 respondents, 14 have presented or published RAC-specific research; 80 of 96 of those who were surveyed believed RACs enhanced education.

Conclusions: 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.

Fig. 1.

Role of ACAPS member at parent institution.

Fig. 2.

Distribution of years in practice for respondents: x axis represents length of practice in years, and y axis represents number of respondents for that time point.

Fig. 3.

Ratio of clinical practice, in terms of reconstructive vs aesthetic.

Fig. 4.

Length of time that RACs have been in practice at institution: x axis represents length of practice in years, and y axis represents number of respondents for that time point.

Fig. 5.

Distribution of number of patients seen in the RAC each year: x axis represents number of patients seen per year, and y axis represents number of respondents for that number of patients.

Fig. 6.

Distribution of number of procedures done in RAC each year: x axis represents number of procedures, and y axis represents number of respondents for each procedure number.

Fig. 7.

Components of RAC, in terms of locations for patient encounters.

Fig. 10.

Type of resident supervision provided in RAC.

Fig. 8.

Participation of plastic surgery residents in the RAC.

Fig. 9.

Responsible supervisor for trainees in RAC.

Fig. 11.

Type of accreditation for RAC. AAAASF indicates American Association for Accreditation of Ambulatory Surgery Facilities.

Fig. 12.

Malpractice insurance model for RACs.

Fig. 13.

Type of remuneration for attending surgeons who provide supervision of RACs.

Fig. 14.

Resources provided by practice to RAC.

Fig. 15.

Transfer location of net income, if profit/loss statement positive.

Fig. 16.

Mechanisms to assess effectiveness of RAC.

Fig. 17.

Effect of the RAC on plastic surgery training.

Fig. 18.

Impact of the RAC on the faculty practice.