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A CURRENT ASSESSMENT OF CRANIOFACIAL FELLOWSHIP TRAINING
1:30 pm - 1:40 pm
Presenter: Niyant Patel, MD, Akron Children's Hospital

Authors: Niyant Patel (1), Kanlaya Ditthakasem (2), Jeffrey Fearon (3)

Institutions:
(1) Akron Children's Hospital, Akron, OH, (2) Medical City Hospital, Dallas, TX, (3) N/A, Dallas, TX
First Author:
Niyant Patel, MD
Akron Children's Hospital
Background/Purpose:
To evaluate the current status of craniofacial surgery training.
Methods/Description:
An anonymous online survey was emailed to fellows completing a North American or Australian craniofacial fellowship in June of 2013.
Results:
Thirty of 33 craniofacial fellows (91%) completed the survey. All cited previously completing plastic surgery training. Of the respondents, only one U.S. trained plastic surgeon trained internationally, and five international plastic surgeons accepted U.S. fellowships. Only 14% of fellowships (4 of 29) offered the traditional apprenticeship model (single attending). Over half of the programs included some international experience, but only 19% stated this was necessary to address a case-type deficiency. The mean estimated number of cases reported were 380 (307-452, 95% CI). Based on case volume data, four main program types were identified: cleft/orthognathic, intracranial/orbital/midface, general pediatric plastics, and adult/trauma/reconstructive. Seventy-three percent of programs seemed to focus primarily on cleft/orthognathic surgery, 19% seemed focused on adult/trauma/reconstructive, and only 4% seemed to focus on intracranial/orbital/midface. Fellows were more likely to report feeling well prepared if greater than 12 cases in a particular category were performed. Eighty percent felt well prepared for a career in craniofacial surgery, 20% did not. Fifty percent believed craniofacial training could be improved by establishing core areas of exposure and case category minimums. Operative experience, the faculty, clinical diversity, autonomy and mentoring were considered strengths of their fellowship by most and in that order.
Conclusions:
Given that all trainees had initially completed plastic surgery training, it would seem that craniofacial surgery is truly a subspecialty of plastic surgery. Historically, craniofacial fellowships began as apprenticeships but few fellowships today retain this model with most structured in the "residency model" of multiple attendings, higher case volumes, and more generalized clinical experiences. Although, craniofacial surgery has been previously defined as orbital/intracranial surgery, currently there seems to be a broader diversity of clinical exposures offered within fellowships considered "craniofacial." Today, the majority of fellowships focus on cleft/orthognathic and adult/trauma/reconstructive, with only a few focused on orbital/intracranial. Prospective applicants may wish to consider each fellowship's unique clinical offerings to match the specific type of educational experience they are seeking.