Application for international rotation name and location of the site

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Penn State Hershey Medical Center Plastic Surgery Program: 3624121087


  • Operation Smile – The Guwahati Comprehensive Cleft Care Center, Guwahati, Assam Province, India.


  • Brad Morrow PGY 5


Attachment A


  • Attachment B


  • August 1-30, 2014


The Guwahati Comprehensive Care Cleft Center in Assam Province India is a self-contained unit in a building attached to the Mahendra Mohan Choudhry Hospital (MMC) in Guwahati, India.

See Attachment C1 and C2

  • Type of center

GC4 is a joint venture between the Government of Assam though the MMC hospital and Operation Smile.

See Attachment D

  • Evidence of local authority approval

See Attachment D and A

  • Evidence of ongoing relationship

Four of the staff at GC4 have Clinical Faculty appointments in the Department of Surgery, Division of Plastic Surgery at Penn State’s College of Medicine.

Attachment E

  • Statement of center’s operative volume and type

The surgeons at GC4 perform approximately 2,500 cleft operations a year.

GC4 has four full-time anesthesiologists.

GC4 has a large open plan OR capable of running 6 GA cases at the same time. There is an 8-bed recovery unit, a dental chair, dental x-rays, speech therapists office, pediatrician office, child life area and nutritionists on site.

The main MMH hospital has full laboratory facilities.

A pediatric ICU is available at the Guwahati Medical College for more serious emergencies.

  • Description of the educational resources available including reliable access to web-based educational materials

GC4 has a wireless Internet service.

This rotation will provide the resident with a unique educational experience in a resource poor area that has an overwhelming need to treat children with cleft lip and palate.

The resident will gain experience in all the areas of the competencies as outlined in the table outlining the Goals and Objectives.

  • Attachment F

The site is located in a resource poor area. The resident will work in a high volume cleft lip and palate center. They have a concentrated experience with exposure to a wide variety of clefts that would otherwise take years to see.

They are exposed to cleft children with a spectrum of malnutrition and other co- morbidities. They participate in difficult triage decisions that they do not otherwise encounter.

They learn cultural competence in a setting where the predominant language is Assamese. They have to communicate with patients’ families using interpreters in a unique cultural setting.

They are exposed to a variety of surgeons and techniques that they would otherwise only read about.

They learn first hand about the functioning of a successful non-profit organization.

  • How is continuity of care provided?

The residents participate in pre-operative evaluation and surgical planning on patients who have been screened previously. They write orders for postoperative care and hand the patients off to the PACU. They round on the patients in the ward at the end of the day and again for morning rounds the next day. Most patients are discharged the day after surgery. The residents see all the patients who are inpatients on morning and evening rounds.

  • How are the patients followed long-term?

4 full-time surgeons, 4 full-time anesthesiologists, a pediatrician, dentist, part-time orthodontist and 68 full-time nurses, 2 Child life specialists and administrators staff the center.

  • How does the local staff follow patients and how does the resident receive feedback about individual patient outcomes?

Intermediate and long-term follow-up is carried out at the center.

Residents are provided with post-operative photographs and critical feedback from the full-time staff at the center. This feedback is given 6 to 10 weeks post operatively.

An example is attached.

Attachment G

  • Verification that this is an elective rotation

This is an elective program.

  • Competency based Goals and Objectives of the Rotation

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.


  • 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 (microtia)

    • Vascular anomalies

    • Branchial cleft cysts

    • Lymphatic anomalies

  • Discuss how your workup differed from your experience in at the Hershey Medical Center

Patient Care

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

    • Unilateral and bilateral cleft lips

    • Cleft palates

    • Secondary cleft palate deformities

  • 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.

  • Participate in the follow-up care of the patients who have been treated at the center.

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

  • Participate in educating patients and families in postoperative and rehabilitative plans for the cleft patients you see.

  • Demonstrates compassion for the patients and families you encounter in Guwahati.

  • 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 and on outreach trips.

    • 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.

The resident participates in the screening process of patients presenting to the center. The screenings and post-operative outpatient clinics are scheduled on Wednesday afternoon and Thursday morning each week. The residents, supervised by a surgeon examine and triage the patients. The patients are also assessed a pediatrician, anesthesiologist, and dentist during the screening.

Intermediate and long-term patients are seen every day by the same team.

  • Operative Logs

The resident will enter the operative experience in the ACGME Case Log System.

  • Program’s Accreditation Status

Integrated Plastic Surgery Program Penn State Milton S Hershey Medical Center

Program Number 3624121087

The program is fully accredited. Last Site visit 2008. No citations. Next self–study visit 2015.

  • Supervising faculty ABMS Certification

Dr. Mackay is board certified by the ABPS (First certified 1997, re-certified 2006) and current with ABPS MOC requirements.

Dr Alex Campbell is a USC trained Plastic Surgeon taking the ABPS certifying exam in November 2014.

Drs Hiteswar Sarma and Gaurav Deshpande are both certified specialists in India.

Drs Campbell, Restrepro, Sarma and Deshpande were appointed Clinical Assistant Professors of Surgery in the Division of Plastic Surgery at the PennState Hershey College of Medicine in May 2014.

See Attachment E (appointment letters), Attachment H (CVs ) are not attached

  • Examples of Resident evaluation forms

Attachment I

  • Statement on salary, travel expenses, health insurance, and evacuation insurance.

The sponsoring institution and program will provide the resident’s salary, health insurance and evacuation insurance.

Operation Smile will cover the travel expenses and accommodation expenses in India.

  • Statement addressing physical environmental issues, including housing, communication, safety, and language.

Resident will be accommodated at apartments Lambs Road Accommodations, translators at the center, safety - possibly include photographs of these facilities transport to and from center and to and from airport.

  • State Department Travel Advisory

Guwahati and Assam province in India are not on the US State Department’s Travel Advisory list.

Attachment J Previous RRC and ABPS letters of approval for this rotation.

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