• Program Director
• Associate Program Director
• Chief Resident
• Program Coordinator

The training is going to be a combination of didactic lectures, clinical case discussions and supervised operative experience.

Resident lectures and journal club

The residents will present lectures from the core curriculum on a weekly basis. This will be followed by a case discussion of patients with similar problems. Once a week in the journal club recent articles published in the premier journal of the specialty will be discussed.

Morning ward rounds will be an opportunity to discuss pre-operative assessment and post-operative care of the patients.

OPD/ Clinics Will be thrice a week. All Clinics will be supervised by a consultant and residents will learn firsthand the art of an efficient and thorough physical evaluation and ordering appropriate investigations to reach a diagnosis. Residents will be able to see the results of surgery in the follow-up patients.

CPCs and Morbidity and Mortality Meetings Weekly department of surgery CPCs are mandatory for all residents and consultants in the department of surgery. In the monthly M&M meetings all serious complications and deaths are discussed and strategies made to improve protocol and prevent, if possible such complications in the future.

Interdepartmental and National Meetings The residents will participate in the monthly meeting of the Rawalpindi/ Islamabad chapter of PAPS. In addition, the will attend and present at the Annual PAPS and PSSH meetings.

This will be on the basis of performance in resident presentations, journal clubs and clinical practice. The progress of the residents will be assessed quarterly by both consultants using a hospital pro forma for clinical performance evaluation A formal written examination will be held quarterly to assess the theoretical knowledge and the results of the exam will be discussed with the residents. If a resident fails one examination, he or she will be put on probation and counseled to try to improve. Failure in two consecutive exams will result in termination of training.

This is based on CPSPs regulations regarding attaining of core competencies in Plastic Surgery.

Year 1 Objective:

During the first year of training, the junior resident will spend six months with each of the two consultants in the unit. The resident will gain experience in the breadth of paediatric and adult plastic and hand surgery. He or she will learn by observation and patient interaction the presentation of the majority of diseases, deformities and aesthetic discomfitures seen by plastic surgeons. Thorough history taking and a comprehensive physical examination with particular reference to plastic surgery will be an essential part of this year.

They will be taught and be expected to and demonstrate the proper use of sterile techniques when performing or assisting with operative procedures. The resident will gain, by assisting or performing surgery under supervision – a hands-on experience of the surgical management of these conditions, and assist in their follow-up in the out-patient clinics. The resident will be expected to research the literature on a case-by-case basis and thoroughly understand the anatomy, the pathology and the surgical principles underlying the management of his or her patients.

The basic care of wounds will be stressed throughout the first year and the resident must learn how to diagnose and formulate an approach to the treatment of different soft tissue defects. It is particularly important that the resident be trained to ascend the reconstructive ladder appropriately.

He or she will be expected to become familiar with the basic techniques of wound closure, skin grafting, local flap elevation, tendon suture, nerve repair, as well as fracture reduction-fixation in the hand and face. He or she will acquire the skills required to surgically expose the facial structures and approach any pathological process occurring in the hand. This is in particular reference to acute hand and facial trauma.

The resident will learn by direct observation the advantages and limitations of the grafting skin, bone, fat, cartilage, nerve, fascia and tendon. He or she will become familiar with the various synthetic implants used in plastic surgery.

During this first year the resident will learn how to use most of the surgical instruments employed in plastic surgery including the dermatome, the operating microscope, microsurgical instruments, micro drills and liposuction equipment.

The resident will be expected to be able to act as first assistant during the commonly performed procedures. He or she will gain experience in working with other specialties as part of a multidisciplinary team in the treatment of conditions like Head and Neck cancer, Breast Cancer and complex Limb trauma.

Demonstrate the development of cost consciousness in the use of diagnostic and therapeutic technology when caring for the surgical patient and appreciate and discuss with team members the ethical aspects of surgical intervention.

Last but not least, he or she will start to apply aesthetic principles in all aspects of plastic surgery and make that vital transition from a General to a Plastic Surgeon.

Year 2 Objectives:

In the second year of training, the residents will spend a total of six months in various rotations, both internal and external. The internal rotations will be orthopedics and maxillofacial surgery for one month each and the external rotation will be Four months at the Plastic Surgery unit at PIMS. This rotation will include one month spent at the Burn Centre. at PIMS.

At the same time, the resident will be expected to refine his or her skills in the more general aspects of plastic surgery encountered during the first year such as: wound care, skin grafting, flap reconstruction and microvascular surgery. The resident should be able to act as first assistant in more complicated surgical interventions like microvascular or micro neural anastomosis.

Consultants will closely monitor the resident’s assessment of various deformities and defects, his or her formulation of a treatment plan and the skills required for its execution. They should be able to plan and perform more complex plastic surgery under appropriate supervision and provide complete follow up care until the patient is fully recovered. The goal is for the residents to acquire a level of skill sufficient to equip them to deal comfortably with the common problems seen in a plastic surgery practice.

At the same time, the resident will come to realize that complications will always be with us and that the art of plastic surgery is not just in knowing how to correct them when they occur, but how to manage the patient during the process. The acquisition of this art is one of the goals for the second year.

The residents will assist junior residents in assuming, planning and managing pre- and post-operative care for patients with common surgical disorders.

During the maxillofacial rotation he or she will learn to accept the input of differing health care professionals and synthesize a common treatment plan based on a multitude of interests and priorities. The resident will appreciate the vital importance of dental occlusion, orthodontics and speech therapy in cleft and craniofacial surgery. In this rotation the residents will become more comfortable reading complex CT scans of the skull and mandible and defining the extent of the craniofacial deformities encountered.

During the rotation in the Burns unit the resident will become proficient in assessing and managing a serious burn injury and be vigilant to the dangers of inhalation injury and full-thickness circumferential burns. He or she will develop the skills necessary for early excision of burns and the handling of smaller full-thickness burns in critical areas.

The rotation in orthopedics is meant to familiarize the residents with assessment of bone and joint injury, basic orthopedic techniques like closed and open fracture reduction and fixation, application of external fixators and the use of various drills and fixation equipment.

Year 3, Objectives:

At the end of the third year, the resident should be able to:

Be competent and comfortable to conduct independent plastic surgery consultations, order appropriate investigation make sound diagnoses and counsel patients about the treatment plan. It should be with a reasonable expectation that, should the surgery be indicated, the patient will have the confidence to book it.

Demonstrate a high level of scientific, clinical and technical knowledge and skill during operative procedures. He or she should be able to deal with the majority of common plastic surgical problems independently but also be conscientious enough to seek help from seniors when required. The emphasis should be on demonstrating not only surgical ability but also safety of the patient.

The third year will have concerned with the acquisition of the skills and knowledge essential for the major subspecialties of plastic surgery, namely hand surgery, head and neck surgery, breast surgery, pediatric plastic surgery, and. aesthetic surgery. The resident will be encouraged to develop special interest in one of the sub-specialties.

• Demonstrate effective decision making in the management of care for all types of surgical patients and their families.
• Evaluate the clinical and teaching skills of junior residents and provide guidance for improving these skills.
• Evaluate knowledge gained from continuing education and its relationship to professional development.
• Conduct independent research and assist junior residents in planning clinical research proposals.
• Evaluate the cost effectiveness of present and future surgical care of patients and families.
• Become adept at the administrative tasks of the unit like organizing on call rotas, theatre lists, grand rounds, and training / rotation schedules. He or she should be able to organize local and national level scientific meetings.

Weekly Training Schedule:

Surgery Core Curriculum for Resident Presentations /Journal Club Schedule General Principles of Plastic Surgery:

• Wound Healing
• Flaps I – Principles, Physiology, Angiosomes
• Flaps II – Muscle and Musculocutaneous
• Microsurgery I – Principles and Replantation
• Grafts - Skin and Other Tissue
• Microsurgery II – Tissue Transfer
• Tissue Expansion
• Alloplastic Implants
• Anesthesia and Critical Care
• Transplantation/Immunology
• Pharmacology/Therapeutics

Skin and adnexa:

• Burns I – Thermal, Electrical, Chemical, Frostbite
• Burns II - Late Reconstruction and Rehabilitation
• Malignant Tumors of the Skin - BCC and SCC
• Vascular Anomalies - Pathology, Classification, and Treatment
• Malignant Tumors of the Skin II – Melanoma

Head and Neck:

• Head and Neck – Anatomy and Embryology and Facial Growth
• Cleft Lip 1 - Primary Deformities
• Laser Treatment, Biophysics, Applications and Complications
• Cleft Lip II - Secondary Deformities
• Craniofacial Anomalies I
• Craniofacial Anomalies II
• Facial Injuries - Soft Tissues
• Facial Fractures I – Upper 2/3rds of Face
• Facial Fractures II – Midface
• Facial Fractures III - Lower Face
• Deformities of the Forehead, Scalp, Cranial Vault, Orbit and Zygoma
• Tumors of the Salivary Gland, Oropharynx, Jaw and Facial Skeleton
• Eyelid Reconstruction
• Reconstruction of Lip and Cheek
• Nasal Reconstruction
• Intraoral, Pharyngeal, and Esophageal Reconstruction
• Auricular Anomalies and Reconstruction
• Mandible and TM Joint, Osseo integration
• Aesthetic Surgery of the Face
• Blepharoplasty
• Rhinoplasty
• Facial Implants/Hair Transplantation

Hand and Upper Limb:

• Hand Anatomy and Examination
• Hand Embryology and Congenital Anomalies
• Hand Trauma I – Soft Tissues/Compartment Syndrome/Injection Injury
• Hand Trauma II – Fractures and Joint Injury
• Hand – Tendons
• Hand – Nerves – Repair and Reconstruction, Tendon Transfer
• Hand Vascular Abnormalities and Tumors
• Hand Infections and Burns
• The Arthritic hand/Hand Contractures
• Hand Pain Syndromes/Prosthetics/Rehabilitation

Breast and Trunk:

• Breast – Anatomy, Physiology and Pathology
• Aesthetic Breast Surgery
• Breast Reconstruction
• Chest Wall Reconstruction
• Abdominoplasty
• Abdominal Wall Reconstruction
• Body Contouring
• Pressure Sores

Lower Limb and Genitalia:

• Lymphedema – Upper and Lower Limbs
• Lower Extremity Anatomy, Embryology, and Pathology
• Lower Extremity Reconstruction - Local, Regional and Free Flaps
• Reconstruction of Male and Female Genital Defects/Transsexualism
• Medico-Legal Aspects of Plastic Surgery - The Dissatisfied Patient
• Hand Embryology and Congenital Anomalies
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
    

Residents are evaluated by faculty every month, based on their rotation. Feedback is provided by the Programme Director and Coordinator, every 3 months.

Annual TOACS and Year end PGME exams are conducted. In addition, formative assessments based on assorted topics may be arranged every 2-3 months.

Candidates are required to fill on-line application form. Please follow the steps mentioned below:
1. Register yourself by defining user name and password.
2. After your account is created, you will need to login to fill the Application Form. Programs offered will be displayed after registration.
3. A candidate can apply for only one program at a time.
4. Candidate may partially fill the form and save it on-line for resuming filling out the form later using login credentials.
5. Once the on-line application form is filled and submitted, candidate would be able to take a printout.
6. The hard copy of the on-line application form along with the required documents mentioned in the Application Form must be submitted to the PGME Office, Medical Staff Affairs either personally, through friends/relatives or through reliable courier service.

7. Check your junk emails (in case of email not received).

If there is still confusion, then follow these Steps

Step 1. Register yourself
Step 2. Check your email address and click on the received link
Step 3. Login
Step 4. Fill the Profile necessary information
Step 5. Submit
Step 6. Ok
Step 7. Online Application Form
Step 8. Select Program or Medical Officer
Step 9. Select specialty
Step 10. Submit
Step 11. Print application form.

All residents are encouraged to get involved in audits and research projects, however research project as per CPSP requirements is mandatory for all.

• MBBS or equivalent
• One-year House Job
• Two years training in General Surgery
• Eligible to appear in Surgery Intermediate Module examination (IMM)