A Model for Malpractice Preparedness for Plastic Surgery Residents

Abstract

Background: Plastic surgery has the fifth largest number of malpractice claims among all specialties. In 2023 alone, 73% of plastic surgeons across several states reported being involved in a medical malpractice case. Lawsuits are costly and disrupt physicians' personal and professional lives for years. Despite this, plastic surgeons are underprepared to face lawsuits, and most learn as they go. We aim to identify basic medicolegal tenets that plastic surgeons must know and propose a training model for residents.

Methods: PubMed, Cochrane, Web of Science, and National Practitioner Data Bank databases were searched using relevant keywords related to plastic surgery and malpractice/medicolegal education. Relevant literature on medicolegal education was screened. Guidelines from surgical professional organizations were reviewed alongside internet sources. Using these materials, a comprehensive educational summary of relevant medicolegal principles was compiled.

Results: Barely 3 of the 219 articles identified directly addressed malpractice education in plastic surgery-and none offered clear guidelines. Nonmedical sources such as YouTube provided more descriptive insight than many professional organizations. Some case-based modules were identified for general surgical trainees, but they were not useable for plastic surgery. An educational module is proposed to guide residents through each phase of a lawsuit, help them identify key strategic mitigation measures, and understand settlement options in simple terms that a clinician can easily understand. Relevant risk-mitigation strategies to avoid lawsuits via practical "pain-point case scripts" are included.

Conclusions: Medicolegal education is essential to prepare plastic surgeons for clinical practice. Integrating this in their curriculum will bridge the current gap.

Fig. 1.

Practical aspects of medical malpractice. A, Percentage of plastic surgeons who self-reported involvement in a medical malpractice case in 2023. B, Statewide distribution showing most litigious states (in red). OB GYN, obstetrics/gynecology.

Fig. 2.

Common medicolegal myths (in red) and their clarifications (in green).

Fig. 3.

Necessary modules to build a medicolegal curriculum.

Fig. 4.

Practical aspects of medical malpractice. A, Basic requirements that a malpractice suit needs to meet for it to proceed. B, What constitutes and does not constitute establishment of patient–physician relationship. ER, emergency room.

Fig. 5.

Steps of a lawsuit—from start to resolution.

Fig. 6.

Practical aspects of medical malpractice. A, Technical preparation for a lawsuit. B, Preparing yourself for the lawsuit.

Fig. 7.

Asset protection strategies against a lawsuit. FLP, family limited partnership; LLC, limited liability corporation.

Fig. 8.

Workflow to begin implementing medicolegal education into the curriculum.

Fig. 9.

Practical aspects of medical malpractice. A, Case-based example 1: a clinical scenario of a patient who is a smoker and has vasculitis, underwent a breast reduction, and experienced nipple congestion and loss. B, Case-based example 2: flap loss after immediate free flap reconstruction on day 0 after a complex orthopedic injury, leading to amputation.