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Plastic Surgery Training Program

Rotation Description Form

I. Rotation Format: Clinical Educational 1 month experience at high volume cleft center in Guwahati India. Operations Smiles’ “Guwahati Comprehensive Cleft Care Center” also known as GC4


International Cleft Rotation

Guwahati India

Rotation Duration:

1 month



Hershey Medical Center

Call responsibility (q):

1 in 7


In House



Responsible faculty member: (CV attached):

Drs, Mackay, Campbell, Sarma, Despansade

Training Level:


II. Goals and Objectives:

Goals: The goal of this rotation is to expose the resident to cleft lip and palate care in a resource poor area of India.

The resident will apply the skills acquired in her/his training to date to the comprehensive care of these patients.

The resident will continue to expand on the medical knowledge and refine his/her skills in evaluating and organizing treatment plans and improving the technical skill and judgment needed to surgically treat these patients.


  • Explain the embryology of the development of the facial structures and the occurrence cleft lip and palate.

  • Discuss the value and importance of the cleft lip and palate team, participate in Team Day evaluations and help plan cleft lip and palate patient treatment

  • Describe what is know of the incidence of cleft lip and palate in India

  • Discuss the etiology, genetics, embryology and anatomy of congenital disorders of the head and neck.

  • Discuss the craniofacial team, the roles of the different specialists and the evaluation of complex craniofacial patients and how can be adapted and modified in resource poor parts of the world

  • Discuss the diagnosis and treatment of the following congenital anomalies that you may encounter in Guwahati including:

    • Craniosynostosis

    • Hemifacial microsomia

    • Craniofacial clefts

    • Orbital hypertelorism

    • Pierre-Robin sequence

    • Craniofacial tumors

    • Coanal atresia

    • Nasal anomalies

    • Ear anomalies (prominent ear, microtia)

    • Vascular anomalies

    • Branchial cleft cysts

    • Thyroglossal duct cysts

    • Lymphatic anomalies

Patient Care

  • Draw the reconstruction of a unilateral and bilateral cleft lip and palate.

  • Diagnose and develop a treatment plan including the surgical markings for patients you see in Guwahati including:

  • Participate in the Cleft Team’s multidisciplinary screening evaluation and treatment planning for the patients you see.

  • Provide perioperative care and participate in surgical treatment of the patients you encounter.

  • Evaluate and treats patients with head and neck tumors of a vascular origin.

Practice Based learning and Improvement

  • Use available information technology to prepare for surgical cases, bringing to the OR the knowledge of current modalities of care and the scientific evidence for that care of cleft lip and palate patients.

  • Analyze the effectiveness of own practice with immediate evaluation and then by analyzing the evaluations and photographs sent to the residents at the 1-month and 6-month follow up on the patients whose care the residents participated in.

  • Improve own practices in the care of cleft patients by integrating appropriately gathered data and feedback.

  • Educate medical students and peers in the lessons learned from the rotation.

Interpersonal and Communication Skills

  • Demonstrate knowledge of the broad scope of cleft lip and palate surgery and demonstrate skills required to communicate with pediatric patients and their families through interpreter at the site in Guwahati

  • Educates patients and families in postoperative and rehabilitative strategies of cleft patients.

  • Demonstrates compassion for patients and families afflicted with clefts.

  • Provides adequate counseling and informed consent to patients using the nurses and child life specialists at the GC4 center in Guwahati.

  • Assimilate data and information provided by other members of the health care team.

  • Chart and record accurate information using the record keeping system at Guwahati.

System Based Practice

  • Participate in and understand the team based care at the GC4 center in Guwahati including:

    • Speech Therapy

    • Pediatricians

    • Nutritionists

    • Outreach teams that identify and follow-up patients treated at the center

    • Anesthesiologists

    • Nursing

    • Surgeons

  • Demonstrates knowledge of cost-effective cleft care in this resource poor area.

  • Works with the GC4 team in the pre- intra and post –operative care of cleft patients.


  • Develop a sensitivity of the unique stresses placed on families of cleft patients in Guwahati.

  • Show an unselfish regard for the welfare of the cleft patients in Guwahati.

  • Demonstrate firm adherence to a code of moral and ethical values.

  • Is respectful to burn patients and their families especially in times of trauma and stress to the family unit.

  • Respect and appropriately integrates other members of the burn surgery team.

  • Provide prompt consultations when requested.

  • Demonstrate sensitivity to the individual patient’s life and cultural background as they apply to these cleft patients in India

  • Is reliable, punctual, and accountable for own actions in the OR and clinic.

  • Understand the concepts of autonomy, beneficence, non-maleficence, justice, and respect for life for cleft patients in Guwahati.

III. Schedule/Format:

  1. Pre and Post-operative ward rounds Daily 7-8 a.m.

  2. Surgery 8 a.m.-5 p.m. Daily.

  3. Post-operative ward rounds 5- 6 p.m. Daily.

  4. Outpatient Pre-operative screening and Long-term follow-up 12-5 p.m. Wednesday and 8 a.m. – 12 Thursday.

  5. M&M Case based Didactic Session 5- 6 p.m. Thursdays

IV. Method of assessment of resident academic performance

  1. Intra –operative skills assessment Daily

  2. Evaluation by senior nurse in ward, OR and PACU – at end of rotation

  3. 3600 evaluation by supervising faculty and at least one other surgeon at the site.

  4. Progress Meeting with supervising faculty mentor at the end of the rotation

V. Information Sources

Losee and Kirchner – Comprehensive Cleft Care

Plastic Surgery PSEN Online

Plastic Surgery Mathes

Plastic and Reconstructive Surgery Journal – individual subscription for all residents in the program

Journals in the Plastic Surgery Library

  • Cleft Craniofacial Journal

  • Journal of Craniofacial surgery

VI. Resident Staff Interaction

Resident will be directly supervised by one of the attendings at all times

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