About Board Certification and The American Board of Plastic Surgery

About Board Certification and The American Board of Plastic Surgery Below is select educational text taken directly from the website for the American Board of Plastic Surgery, the highest authority of plastic surgery in the United States. This will help you glimpse the world of plastic surgery and specifically, what makes Board Certification an important thing to consider when choosing a plastic surgeon:

Description of Plastic Surgery Plastic Surgery deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, cranio-maxillofacial structures, hand, extremities, breast and trunk, and external genitalia. It uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. Special knowledge and skill in the design and surgery of grafts, flaps, free tissue transfer and replantation is necessary. Competence in the management of complex wounds, the use of implantable materials, and in tumor surgery is required. Plastic Surgery has been prominent in the development of innovative techniques such as microvascular and cranio-maxillofacial surgery, liposuction, and tissue transfer. The foundation of surgical anatomy, physiology, pathology, and other basic sciences is fundamental to this specialty. Competency in plastic surgery implies a special combination of basic knowledge, surgical judgment, technical expertise, ethics, and interpersonal skills in order to achieve satisfactory patient relationships and problem resolution.

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The American Board of Plastic Surgery, Inc. Purposes The essential purposes of the Board are:

  1. To establish requirements for the qualifications of applicants who request a certificate of their ability in the field of plastic surgery in its broadest sense.
  2. To conduct examinations of approved candidates who seek certification by the Board.
  3. To issue certificates to those who meet the Board’s requirements and pass the respective examinations.
  4. To do and engage in any and all lawful activities that may be incidental or reasonably related to any of the foregoing purposes.

The Board is not an educational institution, and certificates issued by the Board are not to be considered degrees. The certificate does not confer on any person legal qualifications, privileges, or license to practice medicine or the specialty of plastic surgery. Standards of certification are clearly distinct from those of licensure; possession of a Board certificate does not indicate total qualification for practice privileges, nor does it imply exclusion of others not so certified. The Board does not purport in any way to interfere with or limit the professional activities of any licensed physician nor does it desire to interfere with practitioners of medicine or any of their regular or legitimate activities. It is not the intent nor has it been the function of the Board to define requirements for membership on the staff of hospitals, or to define who shall or shall not perform plastic surgical operations. The Board is not a primary source of censure or primary review of ethical problems. Policies It is the Board’s prerogative to determine the professional, ethical, moral, physical, and mental fitness of any candidate for its certificate. The Board will consider opinions expressed concerning an individual’s credentials only if they are in writing and signed. It is the policy of the Board to maintain its autonomy and independence from political and economical considerations that might affect plastic surgery. The Board recognizes the role of legitimate advertising in the changing medical scene; but it does not approve of advertising which arouses unrealistic expectations, which is false or misleading, which minimizes the magnitude and possible risks of surgery, or which solicits patients for operations that they might not otherwise consider. Such advertising is improper and inconsistent with the high standards of professional and ethical behavior implied by certification by The American Board of Plastic Surgery, Inc. The Board takes statements regarding Board status seriously and may penalize persons misstating their status. Certification After Candidates have met the requirements for admissibility and passed the examinations, the Board will issue certificates attesting to their qualifications in plastic surgery. A surgeon who is granted certification by the Board is known as a Diplomate of the Board. It shall be the prerogative of the Board to determine the fitness, professionally and ethically, of any candidate for a certificate; and the Board, for cause, may defer or deny certification to any candidate. General Requirements The following requirements for admissibility are in agreement with those promulgated by the American Board of Medical Specialties.

  1. The Board will accept only those persons whose major professional activity is limited to the field of plastic surgery.
  2. Must maintain an ethical standing in the profession and moral status in the community acceptable to The American Board of Plastic Surgery, Inc. in conformity with the Code of Ethics of The American Society of Plastic and Reconstructive Surgeons, Inc. (ASPS). Moral and ethical practices that do not conform with the ASPS Code of Ethics may result in rejection of an application or in deferral of examination until such matters have been resolved satisfactorily.

The Board may deny a candidate the privilege of sitting for an examination, or may refuse issuance of a certificate, if additional disclosures or a recent change in status finds that the candidate no longer meets the general or professional requirements. Professional Requirements The Board considers the requirements detailed in Prerequisite Training and Requisite Training to be minimal. Candidates are encouraged to take advantage of broadening experiences in other fields. The Board reserves the right:

  1. To request lists of operations performed solely by the candidate for a designated period of time.
  2. To request special and extra examinations: written, oral or practical.
  3. To request any specific data concerning the candidate that may be deemed necessary before making a final decision for certification.
  4. To consider evidence that a candidate’s practice after completion of training is not in accord with generally accepted medical or ethical standards, which may result in rejection of the application or deferral of the examination until such time as the matter has been satisfactorily resolved.

Undergraduate Medical or Osteopathic Education Before prerequisite training, candidates must have graduated from a medical school in a state or jurisdiction of the United States which is accredited at the date of graduation by the Liaison Committee for Medical Education (LCME), a Canadian Medical School accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS), or from a United States osteopathic school accredited by the American Osteopathic Association (AOA). Graduates of medical schools located outside the jurisdiction of the United States and Canada must possess a currently valid standard certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) or have completed a Fifth Pathway program in an accredited school of medicine in the United States.

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Official Evaluation of Prerequisite Training An official evaluation of prerequisite training by the Board is required prior to the initiation of residency training in plastic surgery. This simple preliminary step will prevent later disappointment. It is the responsibility of all prospective trainees in plastic surgery to secure this evaluation. Each prospective trainee must obtain a request for evaluation of training form from the board office prior to completion of prerequisite training. The completed Request for Evaluation of Training Form, a $150.00 nonrefundable processing fee (made payable to The American Board of Plastic Surgery, Inc., in U.S. Funds) and a copy of the physician’s Medical School Diploma is required for submission of this evaluation. Directors of accredited residency training programs in plastic surgery must require all prospective trainees to have an official evaluation and approval of their prerequisite training by the Board before they begin training. Approval for residency training in plastic surgery will be provided to those individuals who clearly meet the Board’s established training requirements. Further information for detailed credential review will be obtained on all other individuals where training was in other than accredited programs. Prospective candidates who do not meet the Board’s established training requirements may request special consideration by the Board (refer to page 58). The Credentials and Requirements Committee will make official evaluations. Individual officers or Directors of the Board cannot and will not make such estimates or rulings. It should be emphasized that the answers to many questions require a decision by one or more of the committees of the Board. This applies particularly to evaluation of training and questions of admissibility. Decisions are referred to the entire Board at the next scheduled Board meeting. The process of reaching a final decision may require several months, since the full Board meets only twice annually. March 1 and September 1 are the last postmarked date for written submission of special requests and documentation for consideration by the Credentials and Requirements Committee. The Board will issue neither a letter verifying prerequisite training nor an Application for Examination and Certification Form until the Request for Evaluation of Training Form has been received and approved. Training Requirements There are two (2) major pathways toward obtaining acceptable graduate level training in plastic surgery; the Independent Model and the Integrated Model. In an independent model, the resident must complete both prerequisite training and requisite training (plastic surgery). In an integrated model, no such distinction exists. Residents may transfer, prior to the last two (2) years, from an independent type of program to another independent program and from an integrated type of program to another integrated program, but they may not exchange accredited years of training between the two (2) different models without specific prior approval by the Residency Review Committee for Plastic Surgery. The minimum acceptable residency year, for both prerequisite and requisite training, must include at least forty-eight (48) weeks of full-time experience. Independent Model This consists of at least three (3) years of general surgery residency training followed by two (2) or three (3) years of plastic surgery residency training. Prerequisite Training For Physicians with Medical or Osteopathic Degrees granted in the United States or Canada, and for International Medical Graduates, one of the following pathways must be taken:

    1. A minimum of three (3) years of clinical training in general surgery, with progressive responsibility, in the same program is required. Rotating internships will not be accepted in lieu of a clinical year in general surgery. Broad surgical training experience is required. Therefore, no more than six (6) months of training may be spent on any single subspecialty surgical service.This program must be approved by the Residency Review Committee for Surgery and accredited in the United States by the Accreditation Council for Graduate Medical Education (ACGME) or in Canada by the Royal College of Physicians and Surgeons for full training. The minimum of three (3) 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. The satisfactory completion of this requirement must be verified in writing by the general surgery program director (see Verification of Prerequisite Training).

OR

  1. An accredited residency training program in neurological surgery, orthopedic surgery, otolaryngology or urology is required. 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 Neurological Surgery, the American Board of Orthopedic Surgery, the American Board of Otolaryngology, or the American Board of Urology. They 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 the respective specialty board’s examination process in the United States is required.

For prospective candidates with a combined D.M.D. or D.D.S./M.D. Degree obtained in the United States or Canada 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 must include the integration of a medical school component resulting in a Doctor of Medicine (MD) degree. This combined training must also include a minimum of twenty-four (24) months of progressive responsibility on surgical rotations under the direction of the general surgery program director after receipt of the MD degree. The general surgery program director must verify in writing the completion of twenty-four (24) months of general surgery training, the level of responsibility held, inclusive dates and specific content of rotation. Rotations in general surgery during medical school, prior to the MD degree, will not be considered as fulfilling any part of the twenty-four (24) months minimum requirement. If the general surgery component 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 all twenty-four (24) months spent in the same general surgery program which has been reviewed by the Residency Review Committee 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. It is the resident’s responsibility to determine that the form has been completed and returned to the Board Office.

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Requisite Training Graduate Education in Plastic Surgery Training in plastic surgery for not less than two (2) years is required, and the final year must be at the senior level. Prospective candidates entering a plastic surgery residency accredited for three (3) years of training must complete the entire three (3) years, with one (1) year of senior responsibility. Prospective candidates beginning plastic surgery residency on or after July 1, 1995 will be required to complete both years of a two (2) year program in the same institution or the last two (2) years of a three (3) year program in the same institution. In either instance, the final year must be at the senior level. Training in plastic surgery must be obtained in either the United States or Canada. The Board recognizes training in those programs in the United States that have been reviewed by the Residency Review Committee for Plastic Surgery and accredited by the Accreditation Council for Graduate Medical Education (ACGME) or those programs in Canada approved by the Royal College of Physicians and Surgeons of Canada. Content of Training Residents must hold positions of increasing responsibility for the care of patients during these years of training. For this reason, major operative experience and senior responsibility are essential to surgical education and training. An important factor in the development of a surgeon is an opportunity to grow, under guidance and supervision, by progressive and succeeding stages to eventually assume complete responsibility for the surgical care of the patient. It is imperative that a resident hold positions of increasing responsibility when obtaining training in more than one (1) institution, and one (1) full year of experience must be at the senior level. The normal training year for the program must be completed. No credit is granted for part of a year of training. The Board considers a residency in plastic surgery to be a full-time endeavor and looks with disfavor upon any other arrangement. The minimum acceptable training year is forty-eight (48) weeks. Should absence exceed four (4) weeks per annum for any reason, the circumstances and possible make-up time of this irregular training arrangement must be approved by the Residency Review Committee for Plastic Surgery and documentation of this approval must be provided to the Board by the program director. Training in plastic surgery must cover the entire spectrum of plastic surgery. It should include experience in both the functional and aesthetic (cosmetic) management of congenital and acquired defects of the head and neck, trunk, and extremities. Sufficient material of a diversified nature should be available to prepare the trainee to pass the examination(s) of the Board after the prescribed period of training. This period of specialized training should emphasize the relationship of basic science – anatomy, pathology, physiology, biochemistry, and microbiology – to surgical principles fundamental to all branches of surgery and especially to plastic surgery. In addition, the training program must provide in-depth exposure to the following subjects: the care of emergencies, shock, wound healing, blood replacement, fluid and electrolyte balance, pharmacology, anesthetics, and chemotherapy.

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Accredited Residency Programs Information concerning accredited training programs for the Independent Model may be found in the Directory of Graduate Medical Education Programs (“the green book”) published by the American Medical Association (AMA) under the aegis of the Accreditation Council for Graduate Medical Education. Copies of this directory are available at many medical schools and libraries, or “the green book” may be ordered directly from the AMA by calling toll free 1-800-621-8335, or by writing to: Order Department OP416793, American Medical Association, P.O. Box 109050, Chicago, Illinois 60610-9050. The Board does not inspect or approve residencies. The Residency Review Committee for Plastic Surgery (RRC) inspects and makes recommendations for or against approval of a residency training program in plastic surgery only after the director of the residency has filed an application for approval with the Secretary of the Residency Review Committee for Plastic Surgery, Doris A. Stoll, Ph.D., 515 North State Street, Chicago, Illinois 60610; Phone: (312) 464-5505. The RRC consists of nine (9) members, three (3) representatives from each of the following: The American Board of Plastic Surgery, Inc., the American College of Surgeons, and the American Medical Association. Neither the Board nor its individual members can be responsible for the placement of applicants for training. The Board does not maintain a list of available openings in programs. Prospective candidates seeking accredited training in plastic surgery should correspond directly with the directors of those training programs in which they are interested. Most plastic surgery residencies participate in the Plastic Surgery Matching Program. For information, contact Plastic Surgery Matching Program, P. O. Box 7584 San Francisco, CA 94120-7584 Phone: (415) 447-0350 Fax: (415) 561-8535. Non Approved Residencies No other residencies in either the United States or Canada or other countries are acceptable in lieu of those specified above. This in no way implies that quality training cannot be acquired elsewhere, but the Board has no method of evaluating the quality of such programs and must be consistent in its requirements. The Board grants no credit for training, residency and/or experience in disciplines other than those named.

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Integrated Model United States Program Prospective candidates must have a medical or osteopathic degree granted in the United States or Canada by an institution accredited by the Liaison Committee for Medical Education (LCME) or the American Osteopathic Association (AOA). Accreditation by the Accreditation Council for Graduate Medical Education (ACGME) is required for all years of the training program. Training of no less than five (5) years of clinical residency under the authority and direction of the plastic surgery program director is required. No less than twenty-four (24) months of this program must be concentrated plastic surgery training and the final twelve (12) months must entail senior clinical plastic surgery responsibility. The last two (2) years of training must be completed in the same program. Canadian Combined Program This requirement will pertain to all those applying for admission to The American Board of Plastic Surgery, Inc. examination process beginning in the year 2000, but residents may begin such a course of training before then if they so desire. The third year of training in the Canadian five (5) year combined program must consist of varied rotations of a general surgery nature demonstrating progressive responsibility at a third year level. The Royal College of Physicians and Surgeons of Canada must approve this program for full training. Rotations may include: the alimentary tract; the abdomen and its contents; the breast, skin and soft tissue; the head and neck, including trauma, vascular, endocrine, congenital, and oncologic disorders – particularly tumors of the skin, salivary glands, thyroid, parathyroid, and the oral cavity; the vascular system, excluding the intracranial vessels, the heart and those vessels intrinsic and immediately adjacent thereto; the endocrine system; surgical oncology, including coordinated multimodality management of the cancer patient by screening surveillance, surgical adjunctive therapy, rehabilitation, and follow-up; comprehensive management of trauma, including musculoskeletal, hand and head injuries (the responsibility for all phases of care of the injured patient is an essential component of general surgery); and complete care of critically ill patients with underlying surgical conditions, in the Emergency Room, Intensive Care Unit, and Trauma/Burn Units. No more than six (6) months of this training may be spent on any single subspecialty surgical service such as a burn unit. Please note the information on the required Request for Evaluation of Training Form , and the Verification of Prerequisite Training Form , which must be completed. It is the responsibility of all prospective trainees in plastic surgery to insure these forms are completed. For Canadian Programs, after completion of plastic surgery training, the Director of Post Graduate Surgical Education and the Plastic Surgery program director will be required to complete and sign the last page of the Application for Examination and Certification Form.

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Frequently Asked Questions about The American Board of Plastic Surgery Q: How does a doctor become Board Certified? By choosing a plastic surgeon who is certified by The American Board of Plastic Surgery, Inc., you can be assured that the doctor has graduated from an accredited medical school and has completed at least five years of additional training as a resident surgeon. This includes a minimum three-year residency in an accredited general surgery program and a minimum two-year residency in plastic surgery. To become certified, the doctor then must successfully complete comprehensive written and oral exams. Board Certification is a voluntary process. Q: Why is The American Board of Plastic Surgery, Inc. different from other plastic surgery (or cosmetic surgery) Boards? ABPS is one of the 24 specialty boards recognized by the American Board of Medical Specialties (ABMS). It is the only ABMS Board which certifies in the full spectrum of the entire specialty of plastic surgery. Q: What is the difference between membership in a society, association, academy and being a Diplomate of ABPS? The ABPS Diplomate is a certified physician who has met the requirements outlined above. The mission of The American Board of Plastic Surgery, Inc. is to promote safe, ethical, efficacious plastic surgery to the public by maintaining high standards for the examination and certification of plastic surgeons as specialists and subspecialists. Societies are professional associations. The specific society, association or academy should be contacted for specific membership requirements and mission. Q: Define accreditation and certification, and licensure. Licensure is designed as minimum standard necessary to practice medicine. It is a public function, administered by the states, the standards are established through a public process and all actions taken – both in granting a license and in restricting or withdrawing a license – are matters of public record. Licensure is not specialty specific and permits an individual to provide to the public any medical or surgical service he/she desires. Certification by a specialty Board attests to 1) completion of a prescribed set of education and training requirements in a specialty of medicine beyond the minimum requirements for licensure, and 2) passage of examination that test the fund of knowledge in that specialty. Most specialties now also require periodic recertification, which generally requires completion of specified continuing education and successful completion of a further examination testing the fund of knowledge in that specialty. Many health care organizations and health plans now require certification in order to provide services in the relevant specialty area. Board-certified physicians govern specialty Boards in that specialty. Accreditation is awarded to licensed physicians who have conducted their professional activities in accordance with standards set to define quality in professional practice. These standards include ethical behavior; absence of disciplinary actions by hospitals, licensing agencies, or financing programs; participation in peer review; participation in clinical self-assessment; operation of a safe, patient-centered practice that meets criteria for quality; and participation in measurement of clinical performance and patient care results, including patient satisfaction. Accreditation is not specialty specific. Accreditation reports include information on the physician’s license status and specialty board certification. The American Medical Accreditation Program can be contacted for further information.

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