Prerequisites for Plastic Surgery Training

Applicants must successfully complete prerequisite training, as required by the American Board of Plastic Surgery, before beginning the UNC Plastic Surgery Residency. Most residents who enter the program at UNC have completed five or more years of surgical training and are either board eligible or board certified. Exceptional individuals with less than five years of general surgery training will be considered for residency positions.

Prerequisite training as defined by the American Board of Plastic Surgery is as follows:

Approval for residency training in plastic surgery will be provided to those residents who clearly meet the Board's established prerequisite training requirements.
Residents who do not meet the Board’s established prerequisite training requirements may request special consideration by the Board. The Credentials and Requirements Committee will review and make official evaluations. Individual Officers or Directors of the Board cannot and will not make such estimates or rulings. It should be emphasized that answers to many questions require a decision by one or more of the committees of the Board. Decisions are referred to the entire Board at the next scheduled Board Meeting.

Training Requirements:
There are two approved educational (residency training) models for plastic surgery, the Independent Model and the Integrated Model. A plastic surgery program director may choose to have both training models in a single training program. In both the integrated and the independent models, plastic surgery training is divided into two parts:

1. The acquisition of a basic surgical science knowledge base and experience with basic principles of surgery (PREREQUISITE TRAINING in the Independent Model).
2. Plastic surgery principles and practice, which includes advanced knowledge in specific plastic surgery techniques (REQUISITE TRAINING).

In the independent model, the residents complete the PREREQUISITE TRAINING outside of the plastic surgery residency process, whereas in the integrated model, residents complete all training in the same training program. In a combined or coordinated program, residents complete the prerequisite training for the general surgery training program in the same institution as the plastic surgery program.
Residents may transfer, prior to the last two years, from an Independent Program to another Independent Program and from an Integrated Program to another Integrated Program, but they may not exchange accredited years of training between the two different models without prior approval by The American Board of Plastic Surgery, Inc. and the Residency Review Committee for Plastic Surgery. Residents must request any anticipated transfers in writing and obtain prior approval by the Board well in advance of the proposed change in programs.

Effective July 1, 2009, residents entering plastic surgery training must complete full training in general surgery or three years of general surgery at the same program as the plastic surgery residency training
The minimum acceptable residency year, for both prerequisite and requisite training, must include at least 48 weeks of full-time clinical training experience per year.
A leave of absence during training will not be included toward completion of the minimum 48 weeks requirement. This includes Military Leave and Maternity/Paternity Leave.

Independent Model
This model includes programs with two or three years of plastic surgery training. Residents can officially begin a plastic surgery training program (REQUISITE TRAINING) after completion of any of the PREREQUISITE options, which all require confirmation by the Board (Completion of the Resident Registration and Evaluation of Training Form with receipt of the Board’s Confirmation Letter regarding the acceptability of the prerequisite training for the Board’s certification process).
In the Independent Model, only the REQUISITE period of training is under the supervision of the RRC-PS. However, in the “combined” model, the general surgery years are accredited by the RRC for General Surgery and not the RRC-PS. The Independent Model has two options. The first option has two variations. Each of the pathways described satisfy the requirements of the Board for entry into the certification process.
1. Option 1, variation A requires at least three years of ACGME-approved clinical general surgery residency training in the same institution with progressive responsibility to complete the PREREQUISITE requirements of the Board. Residents must complete a minimum requirement of 36 months of training including specific rotations, which are noted later in this Booklet of Information. This requirement of the Board stipulates that a minimum of three years of clinical training in general surgery, with progressive responsibility, in the same program must be completed before the resident enters a plastic surgery residency. Residents entering Independent programs effective July 1, 2009 or later must complete this training in the same institution as the plastic surgery residency.

Option 1, variation B is the “combined” or “coordinated” residency. This option is the same as option #1A, with the exception that medical students are matched into an ACGME-approved general surgery training program with a non-contractual understanding that they will become plastic surgery residents at the same institution after satisfactorily completing the three-year minimum PREREQUISITE requirement in general surgery. During this time they are considered designated preliminary residents in general surgery, but are not considered plastic surgery residents by the RRC-PS, AACPS, or ABPS until completing the PREREQUISITE training program and entering the requisite training years. These programs are not differentiated in the ACGME’s Graduate Medical Education Directory (the “Green Book”), but rather are found listed among general surgery and independent plastic surgery programs. PREREQUISITE AND REQUISITE requirements are completed at the same institution in this model.

2. Option 2 is available for residents who have satisfactorily completed a formal training program (and are board admissible or certified) in general surgery, neurological surgery, orthopaedic surgery, otolaryngology, urology, thoracic surgery, vascular surgery, or oral and maxillofacial surgery (the latter requiring two years of clinical general surgery training in addition to an M.D./D.D.S. or D.M.D.). Successful completion of these ACGME or ADA accredited programs fulfills the PREREQUISITE training requirement.

Prerequisite Training
For Physicians with Medical or Osteopathic Degrees granted in the United States or Canada, and for the International Medical Graduates, one of the following pathways must be taken:
I.
For residents entering plastic surgery residency training in 2009 or after, a minimum of five progressive years of clinical training in general surgery sufficient to qualify for certification by ABS is required. The satisfactory completion of this requirement must be verified in writing by the general surgery program director. As previously noted, effective July 1, 2009, if completing less than full general surgery training, plastic surgery training must be completed in the same institution as the general surgery training. The Accreditation Council for Graduate Medical Education (ACGME) of Royal College of Physicians and Surgeons of Canada (RCPSC) must accredit both programs. Broad surgical training experience is required.
A total of 36 months of general surgery is required. A minimum of 18 months must be devoted to rotations in essential content areas of general surgery as listed in Categories 1 through 11 below:
1. Abdominal Surgery
2. Alimentary Tract Surgery
3. Breast Surgery
4. Critical Care
5. Emergency Medicine
6. General Surgery
7. Pediatric Surgery
8. Surgical Oncology
9. Transplant
10. Trauma
11. Vascular Surgery
During the 36 months of general surgery no more than a total of 6 months may be served in the other areas of surgical training such as:
1. Cardiothoracic Surgery
2. Gynecology
3. Neurologic Surgery
4. Surgical Pathology
5. Urology
During the 36 months of general surgery, the limitations on time spent in the specified rotations includes not more than:
• 1 month on pathology or dermatology
• 2 months on oral and maxillofacial surgery
• 3 months on a single rotation of the other subspecialties
• 6 months on the combination of plastic surgery and hand surgery
The Residency Review Committee for Plastic Surgery (RRC-PS) and the Board strongly suggest the specific clinical experiences are documented in the following areas before completion of plastic surgery training. These clinical experiences may occur during prerequisite training, if verified, and documented by the plastic surgery program director.
1. Acute burn management
2. Anesthesia
3. Dermatology
4. Oculoplastic surgery or ophthalmology
5. Oral and maxillofacial surgery
6. Orthopaedic surgery
II. Alternate Prerequisite Pathways Accepted
The Board will accept accredited residency training sufficient to qualify for certification in Neurological Surgery, Orthopaedic Surgery, Otolaryngology, Thoracic Surgery, Urology and Surgery including the Vascular Surgery Board of the American Board of Surgery.
Prospective candidates may initiate residency training in plastic surgery following satisfactory completion of the entire course of training in the United States or Canada, as prescribed for certification by the American Board of Surgery including the Vascular Surgery Board of the American Board of Surgery, American Board of Neurological Surgery, the American Board of Orthopaedic Surgery, the American Board of Otolaryngology, the American Board of Thoracic Surgery or the American Board of Urology. Prospective candidates must meet and comply with the most current requirements in these specialties. Satisfactory completion of training must be verified in writing by the training program director (see Verification of Prerequisite Training) and evidence of current admissibility to respective ABMS specialty board's examination process in the Unites States must be provided.
III. For prospective candidates with an M.D. degree obtained in the United States or Canada combined with a Dental Degree (D.M.D. or D.D.S.).
Satisfactory completion of a residency program in Oral and Maxillofacial Surgery approved by the American Dental Association (ADA) is an alternate pathway for prerequisite training prior to plastic surgery residency.
The satisfactory completion of this training must be verified in writing by the Oral and Maxillofacial Surgery program director. This program may include the integration of a medical school component resulting in a Doctor of Medicine (M.D.) degree or the Medical Degree may be obtained before or after residency training in Oral and Maxillofacial Surgery.
This combined training must also include a minimum of two years of only clinical general surgery training with progressive responsibility under the direction of the general surgery program director after obtaining the M.D. degree. These 24 months may be devoted only to those rotations in the 11 essential content areas of general surgery as listed on the previous page. The general surgery program director must verify, in writing, the completion of two years of clinical general surgery training, the levels of responsibility held, inclusive dates and specific month-by-month content of rotations and evidence of current admissibility to the American Board of Oral and Maxillofacial Surgery Board’s examination process must be provided. Rotations in general surgery during medical school, prior to the M.D. degree, will not be considered as fulfilling any part of the two-year minimum requirement. If the general surgery training is completed at an institution other than the sponsoring institution of the Oral and Maxillofacial Surgery residency, then this training must be completed consecutively with both years spent in the same general surgery program which has been approved by the Residency Review Committee (RRC) for Surgery and is accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the United States.

Verification of Prerequisite Training
To obtain written verification from the program director under whom the resident completed prerequisite training, the Board Office will mail a Verification Form to the program director for completion and return to the Board Office. Residents should notify the Board Office when prerequisite training is completed. It is the resident’s responsibility to determine that the form has been completed and returned to the Board Office.

In addition to the prerequisite requirements as set forth by the American Board of Plastic Surgery, the UNC Division of Plastic surgery has several eligibility requirements for applicants:

1. Applicants should have graduated from a US medical school or outstanding international medical school.
2. Applicants should have inservice examination scores that are stable or reflect improvement, and there should be no single-digit results.
3. Applicants should have a strong interest in research as evidenced by scholarly activity including but not limited to poster presentations, oral presentations, journal publications, and/or textbook chapters.
4. Applicants should demonstrate dedication to quality improvement, international volunteerism, and/or altruistic causes.
5. Applicants should have recommendation letters that reflect strong clinical acumen, technical skills, scientific interest, interpersonal skills, and ethical character.