PRS Global Open Article Review: “Plastic Surgery Training Worldwide: Part 1. The United States and Europe”

by Chad M. Teven, MD (@ChadTevenMD)

I read with great interest the article “Plastic Surgery Training Worldwide: Part 1. The United States and Europe” by Kamali et al.1, and applaud their valuable addition to the literature.  As the authors note, the role of plastic surgery in modern medicine continues to rise as developments within our field expand and new discoveries are made.  In this exciting time of growth, it is critical that the care provided by plastic surgeons is delivered safely, compassionately, and completely.   To that end, comprehensive and proper training of novice plastic surgeons is essential.  In an effort to better understand how plastic surgeons are trained, the authors offer a thought-provoking overview of training paradigms in the United States and Europe.  While the results are interesting, there are several important issues that warrant further discussion.

The current study demonstrates significant differences in plastic surgery training between the United States and European countries (e.g., pathways into residency, program duration, graduation and examination requirements, total number of programs/positions/applicants).1  The authors suggest that standardization of curricula would improve the quality of information exchange and future progress.  Although this conclusion is compelling, it deserves further study.  First, the process of standardizing disparate models would pose a significant challenge.  Is there a specific model in practice that is better than others and therefore should serve as a baseline?   Also, it is not clear that one curriculum would best serve the needs of trainees and their patients in different areas of the world.  Race, age, gender, and cultural differences have become increasingly important considerations in plastic surgery.2  These differences should similarly be considered when studying and optimizing plastic surgery training.  Finally, collaboration fuels discovery, growth, creativity, and innovation.3   Rather than standardize curricula, perhaps we should gain a deeper understanding of the relative strengths and weaknesses of various models and apply them to our own training accordingly.

Another key issue is that many integral features of residency training are not discussed.  In the United States, while programs follow a basic curriculum approved by the Accreditation Council for Graduate Medical Education, many offer unique educational experiences to their trainees.  Examples include various recurring conferences (e.g., morbidity and mortality, indications); global health and volunteer opportunities; and unique forms of didactic education such as cadaver courses, microsurgery labs, and injectable workshops.  Understandably, information regarding specific program features is difficult to obtain as it may not be standardized or catalogued in the United States or Europe.  Nevertheless, these adjunct learning opportunities play a critical role in trainee education and it would be helpful to further characterize them.  This information could provide insights into how programs enhance learning as well as spur new ideas.

Finally, although not the intent of the authors, the current article does not compare the quality of training in different countries.  Our field has recently benefited from an increased emphasis on evidence-based medicine.4   Therefore, it might be helpful to compare outcomes of similar procedures performed by plastic surgeons of different training backgrounds.  This could shed light on whether a particular model is associated with improved patient care.   Ultimately, the best measure of effective training is successful patient outcomes.

In conclusion, the Journal has brought to light an important topic and Part 2 of this excellent work will provide additional insight.  Further study of plastic surgery training will hopefully reveal training practices that result in optimal patient care.



  1. Kamali P, Paridon MWV, Ibrahim AMS, et al. Plastic Surgery Training Worldwide: Part 1. The United States and Europe. Plast Reconstr Surg Glob Open. 2016;4:64e.
  1. Price KM, Gupta PK, Woodward JA, Stinnett SS, Murchison AP. Eyebrow and eyelid dimensions: An anthropometric analysis of African Americans and Caucasians. Plast Reconstr Surg. 2009;124:615-623.
  1. Jalali M, Saldanha F. Introducing the Plastic Surgery Research Network: A Comprehensive Online Platform to Facilitate Interdisciplinary Plastic Surgery Research. Plast Reconstr Surg. 2015;135:1083e.
  1. Rohrich RJ. So You Want to Be Better: The Role of Evidence-Based Medicine in Plastic Surgery. Plast Reconstr Surg. 2010;126:1395.

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