The Apprenticeship Model in Plastic Surgery Training

by Sammy Sinno, MD

apprentice-a person who is learning a trade from a skilled employer, having agreed to work for a fixed period at low wages

One of the few television shows I made an effort to watch was the first season of The Apprentice. Back in college, my friends and I would watch current Republican presidential candidate Donald Trump test the wits and patience of many highly energentic and motivated individuals competing intensely against each other for a lucrative job title. The Apprentice series did not, however, reflect the true definition of an apprentice above, or at least on the surface. The show was based more on competition and task completion rather than learning or education.

I think the apprentice model is still alive in plastic surgery training. The role of apprenticeship in teaching plastic surgery has been well-established(1). Particularly considering ACGME case requirements and the Milestone resident evaluation project, resident education will continue to rely on direct, repetitive, goal-oriented learning from surgical educators. Yet there are certain obstacles that can make a single mentor-apprentice relationship more difficult, including multiple hospital rotations, numerous residents and attendings, work hour restrictions, and the diversity and breadth of plastic surgery as a specialty.

Residency programs can work around these obstacles. For instance, last year during our 3-month reconstructive surgery rotation at Memorial Sloane Kettering Cancer Center, we initiated an apprenticeship model where each month we would be primarily working with 2 mentors. Primarily we would cover their cases, round on their patients, and go to their office hours. The “360 degree approach” was very educational, particularly in seeing the though process of an attending from pre-op to post-op. Back at NYU we also have additional several month long rotations in both breast reconstruction and craniofacial surgery, were we work with a select number of attendings and immerse ourselves in these disciplines. Having a dedicated and lengthy period of time to hone in on certain skills is an extremely powerful environment to learn. Fellowship is another extension of the apprenticeship model. I have also had the opportunity to work with numerous craniofacial, microsurgery, aesthetic, and hand fellows over the years who have appreciated how a dedicated year allowed them to hone a particular skill set.

While the classic definition of an apprentice likely referred to a lengthier one-on-one relationship, there is still a role for an apprenticeship model within modern plastic surgery training. As more integrated programs develop, program directors should strive to incorporate this model into their training program when possible.

REFERENCES
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1. Cable C, Chong T, Pratt DD. Teaching plastic surgery from different perspectives. Plast Reonstr Surg. 2012. 129(6):1428-34.

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