title: Analysis of a Resident Aesthetic Clinic: Process for Rhinoplasty, Resident Experience, and Patient Satisfaction.
abstract: Plastic surgery residents often desire additional training in rhinoplasty than what is provided by their residency program. The goal of this study was to define and evaluate a specific process used to structure preoperative, intraoperative, and postoperative protocols for rhinoplasty patients in the resident aesthetic clinic (RAC) to enhance qualitative and quantitative experience. Complication rates and patient/resident satisfaction scores were also examined.
  
  
  METHODS
  Resident clinic rhinoplasty patients underwent a well-defined and established process that included patient education and informed consent, preoperative planning in a conference-based session, specific adherence to established surgical techniques, and structured postoperative management and follow-up. This process also included supervision criteria for residents in the operating room and clinical setting. Patient and resident satisfaction at the RAC was evaluated by a Web-based survey. A database of procedural complications and methods was compiled and evaluated.
  
  
  RESULTS
  Between June 2012 and June 2015, 146 aesthetic resident cases were completed through the University of California, San Diego Residency Aesthetic Surgery Program. Of these cases, 34 (17%) were rhinoplasty procedures. Residents at our institution assisted on an average of 55 rhinoplasty procedures with the faculty and performed an average of 12 rhinoplasty procedures as primary surgeons. The residents surveyed felt that they had a good autonomous experience (P < 0.001), and 90% reported confidence with rhinoplasty. Postoperative complications were recorded and included asymmetry (n = 4, 10.5%), septal perforation (n = 1, 2.6%), and difficulty in breathing (n = 6, 15.8%). There were no patients who experienced infections, and the complication rate requiring revision in the operating room was 0%.
  
  
  CONCLUSIONS
  Optimizing protocols in rhinoplasty in an RAC has allowed for the RAC to flourish in the breadth and complexity of rhinoplasty operations. This has enabled residents to gain a structured and autonomous exposure to rhinoplasty cases. Cases were done with an acceptable complication rate and with good patient and resident satisfaction. This is a unique report in that it provides a structured process for preoperative, intraoperative, and postoperative care in rhinoplasty operations.
authors.affiliation: From the Division of Plastic Surgery, Department of Surgery, UC San Diego Medical Center, San Diego, CA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Brandel
authors.forename: Gehaan F
authors.initials: GF
authors.lastname: DʼSouza
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Marek K
authors.initials: MK
authors.lastname: Dobke
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Gosman
mesh_terms: D004503:Education, Medical, Graduate; D004954:Esthetics; D006801:Humans; D007396:Internship and Residency; D017060:Patient Satisfaction; D011183:Postoperative Complications; D017064:Process Assessment, Health Care; D012225:Rhinoplasty / Q000193:education*; D011795:Surveys and Questionnaires