Identification of best practices for resident aesthetic clinics in plastic surgery training: The ACAPS National Survey

Introduction: Resident aesthetic clinics (RACs) have demonstrated good outcomes and acceptable patient satisfaction, but few studies have evaluated their educational, financial, or medicolegal components. We sought to determine RAC best practices. Methods: We surveyed American Council of Academic Plastic Surgeon members (n = 399), focusing on operational details, resident supervision, patient safety, medicolegal history, financial viability, and research opportunities. Of the 96 respondents, 63 reported having a RAC, and 56% of plastic surgery residency program directors responded. Results: RACs averaged 243 patient encounters and 53.9 procedures annually, having been in existence for 19.6 years (mean). Full-time faculty (73%) supervised chief residents (84%) in all aspects of care (65%). Of the 63 RACs, 45 were accredited, 40 had licensed procedural suites, 28 had inclusion/exclusion criteria, and 31 used anesthesiologists. Seventeen had overnight capability, and 17 had a Life Safety Plan. No cases of malignant hyperthermia occurred, but 1 facility death was reported. Sixteen RACs had been involved in a lawsuit, and 33 respondents reported financial viability of the RACs. Net revenue was transferred to both the residents' educational fund (41%) and divisional/departmental overhead (37%). Quality measures included case logs (78%), morbidity/mortality conference (62%), resident surveys (52%), and patient satisfaction scores (46%). Of 63 respondents, 14 have presented or published RACspecific research; 80 of 96 of those who were surveyed believed RACs enhanced education. Conclusions: RACs are an important component of plastic surgery education. Most clinics are financially viable but carry high malpractice risk and consume significant resources. Best practices, to maximize patient safety and optimize resident education, include use of accredited procedural rooms and direct faculty supervision of all components of care.