Getting Better All the Time: The Acaps (American Council of Academic Plastic Surgeons) National Survey to Determine Best Practices for Resident Aesthetic Clinics in Plastic Surgery Training

Introduction:  Several studies on resident aesthetic clinics (RACs) have demonstrated good outcomes, reasonable patient satisfaction, and acceptable safety profiles, but none have evaluated operational, financial, or medico-legal components.  We sought to determine RAC best practices.

Methods:We surveyed ACAPS Members (n=399), focusing on operational details, resident supervision, patient safety, medico-legal history, financial viability, and research opportunities.  Of the 96 respondents, 63 reported having a RAC.  50% (48/96) of Program Directors responded. 

Results:  There were 63 programs (65.6%) that had RACs.  RACs averaged 243 patient encounters and 54 procedures annually, over a mean period of 17 years.  35 had integrated, 34 had independent, and 27 had both independent and integrated programs.  Full-time faculty (73%) supervised chief residents (82%), in all aspects of care (67%).  71% of facilities were accredited, 57% had a procedural suite, 44% had inclusion/exclusion criteria for procedures, and 49% used anesthesiologists.  27% had overnight capability, and only 27% had a life safety plan.  No cases of malignant hyperthermia occurred, and there was 1 facility death.  26% of RACs had been involved in a lawsuit.  52% respondents reported financially viability.  Net revenue was transferred to both a resident’s educational fund (41%) and divisional/departmental reserves (36%).  Quality measures included: case logs (75%), morbidity/mortality conference (61%), resident surveys (52%), and patient satisfaction scores (45%).  22% sites have presented/published research specific to RACs.  83% of respondents believed RACs enhanced education.  59% stated they already have a RAC, 19% are interested in starting one, 15% are not interested, and 9% were not sure.

Conclusions:  RACs are an important component of plastic surgery education.  Most clinics are financially viable, but carry high malpractice risk and consume considerable 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.