Pediatric Craniofacial Surgery Fellowship

The Department of Plastic Surgery at UT Southwestern Medical Center offers an ACGME-accredited 12-month Pediatric Craniofacial Surgery Fellowship Program. This fellow is a fully integrated member of a high-volume general pediatric and cleft/craniofacial practice. This position is typically offered to physicians who have successfully completed an accredited plastic surgery residency and are looking for more complete training in pediatric plastic craniofacial surgery.

Goals and Objectives

The goal of the Pediatric Craniofacial Surgery Fellowship Program is to educate and train future academic, clinical, and research leaders in pediatric plastic and craniofacial surgery. Upon completion of the Fellowship Program, the surgeon should have clinical expertise in all aspects of pre-, intra-, and postoperative craniofacial surgical management for infants, children, and young adults. The vast majority of defects and management issues for these patients are outside the scope of adult plastic surgery practice, and are usually only covered for several months in most adult plastic surgery training programs.

Areas of Clinical Training

• In-depth study of pediatric disorders of the soft and osseous craniofacial tissues.
• In-depth and comprehensive "mentorship" experience in the preoperative evaluation, treatment planning, operative treatment, and postoperative management of pediatric patients with congenital and acquired craniofacial and pediatric plastic surgery diagnoses. These diagnoses span the domains of cleft/craniofacial, lesions/vascular anomalies, acquired/traumatic deformity, complex wounds, and aesthetic concerns regarding face and trunk.
• Participation in interdisciplinary pediatric cleft-craniofacial team, and vascular anomalies team, with formal exposure to team members and their respective roles and assumption of a gradual leadership role in these teams.
• Experience in the surgical correction of congenital clefts of the lip and palate both primary and secondary repairs and revisions.
• Formal experience with maxillofacial surgery, focusing on cephalometric analysis, fabrication of dental models and orthagnathic splints, surgical treatment planning, orthognathic surgery.
• Formal experience with pediatric and adult craniomaxillofacial trauma, both for acute and post-traumatic deformity reconstruction.
• Development of facility and expertise in the use of radiologic tools including three-dimensional CT scan and computer surgical planning.
• Participation in clinical research and becoming involved in teaching in both didactic and informal conferences to the residents in plastic surgery and on the clinical services. In addition to the departmental plastic surgery conferences (devoted to pediatric plastic surgery), there is active participation in regularly scheduled clinical pediatric conferences including Grand Rounds, team craniofacial conferences, and at least one regional or national craniofacial conference.
• Weekly outpatient clinic experience in the preoperative evaluation and postoperative management of pediatric plastic surgical patients.

Program Curriculum / Required Scholarly Activities

Clinical Duties and Responsibilities

The fellow will have progressive responsibility based on experience and capability, and will develop as de-facto Chief of Service for all pediatric plastic and craniofacial clinical activity. The fellow will run the Cleft/Craniofacial Team under the aegis of staff physicians. All rotations will be at Children's Health℠. The operative experience will be determined by the fellow's ability and understanding of the complexities of pediatric craniofacial surgery. It will be designed toward gradual, but progressive responsibility commensurate with the fellow's training and surgical expertise, with the goal of being competent to work independently at completion.

Fellows will participate in the operating room on a daily basis. Fellows will assist the attending surgeon or perform major surgery (cleft lip and palate, craniosynostosis surgery, orthognathic surgery, trauma surgery, laser treatments, and other craniofacial and general pediatric plastic surgery procedures) in infants and children. They will be expected to understand fully the anatomy, physiology, and planning of major craniofacial surgery reconstructions as well as the technical performance of these complex procedures. A thorough understanding of the anatomy and physiology will be gained through operative experience, individual study, didactic conferences, and direct communication with the Fellowship Program Director.

Academic / Educational Experiences

Clinical education is primarily derived from lectures and rounds as well as in the course of the pediatric craniofacial surgery fellow's clinical duties, and interacting with the attending staff in plastic surgery. Numerous special conferences are also designed primarily for the instruction of plastic surgery residents and fellows. When not involved in clinical activities, fellows are expected to attend all Pediatric Plastic Craniofacial Surgery Program academic activities throughout the year. Additionally, fellows are required to be involved in the education of the residents and medical students rotating through the service.

Areas of Didactic Training

• Demonstrate knowledge of normal and abnormal embryology and fetal development of the head and neck.
• Demonstrate ability to interpret radiological studies including dental radiographs, cephalometric analysis, CT, and MRI imaging modalities.
• Demonstrate expertise in the construction of pediatric dental study models, orthognathic splints, nasoalveolar molding, and their use in craniofacial and maxillofacial surgery.
• Appreciate the standards of cephalometric normalcy as they relate to the face.
• Demonstrate an understanding of bone healing, including primary healing, malunion, nonunion, osteomyelitis, and the physiology and methods of bone grafting.
• Demonstrate an understanding of the use of alloplastic materials in craniofacial reconstruction.
• Demonstrate knowledge of congenital, developmental, and secondary deformities of the head and face.
• Participation in programmatic conferences including journal club, morbidity, and mortality rounds, and weekly surgical case review.
• Preparation of presentations for national and/or international professional meetings.

Research

Fellows will be expected to initiate and complete at least one research project during their training. These will be facilitated by pediatric plastic surgery faculty members. The opportunity to make presentations at national and international conferences in pediatric plastic craniofacial is offered to fellows who have appropriate material.

Duty Hours

Fellows will take no in-house night call, and no primary call other than occasionally to assist if there is unusual need.  They are expected to share weekend rounding responsibilities with residents and be a resource for them at all times.

Faculty

Listed below are the faculty members involved in the supervision of the pediatric plastic craniofacial fellows at Children's Health. The Fellowship Program has multiple full-time pediatric plastic surgeons who have extensive experience in plastic surgery and pediatric plastic craniofacial surgery, and hold a current Texas Medical License. These members are:

Supervision

Fellows are continuously under close supervision of attending pediatric craniofacial surgeons and plastic surgeons in the performance and interpretation of various pediatric craniofacial procedures. Their performance in the clinical arena and their ability to construct and carry out a management plan is reviewed on a case-by-case basis throughout the day. Fellows are closely supervised and their skills are continuously evaluated.

Evaluation

The fellows will also work side-by-side with residents in the Plastic Surgery Residency Program and other pediatric plastic surgery programs from UT Southwestern Medical School. They will be under the direct supervision of James Seaward, M.D., Pediatric Plastic and Craniofacial Surgery Program Director. Faculty members will also provide feedback to ensure growth by each fellow during the Fellowship Program. Fellows are evaluated by the program director semi-annually. Written evaluations from each faculty member are reviewed with the fellow at that time. Fellows are required to evaluate the faculty, rotations, and fellowship program annually.

Eligibility and Application Process

Applicants must demonstrate that they have completed an appropriate level of training for them to participate in the care of pediatric craniofacial surgery patients. This can be accomplished by the successful completion of three to five years of general surgery training and two to five years of plastic surgery training at UT Southwestern or at another institution. The fellowship is for one year (12 months) in duration. There is no board certification process in pediatric craniofacial surgery, so fellows completing the program at UT Southwestern do not receive additional formal certification.

Each fellow must satisfactorily complete an ACGME-accredited plastic surgery residency program. Applicants from the United States should have completed a prescribed course in plastic surgery at an approved accredited residency and be board-eligible or certified in the specialty of plastic surgery.

Potential applicants should inquire as to the availability of a training position that will begin when the applicant desires. Positions usually begin on July 1, and are 12 months in duration. Interested applicants should contact the program director and submit a personal statement, curriculum vitae, three letters of recommendation from faculty members, and verification of past training and examination scores. Interview dates depend upon the availability of an opening in the fellowship-training program.

The fellowship participates in the Craniofacial Fellow Matching Program which is sponsored by the Association of Academic Chairmen of Plastic Surgery and administered by the Residency Match program in San Francisco, California.

The selection of applicants outside the match is at the discretion of the Program Director, based on whether the candidates satisfy requirements of UT Southwestern Medical School. Decisions are based on demonstrated commitment to the field of pediatric plastic surgery. Applicants who are considered competitive for appointment are normally offered a position with a start date of July 1.

Upon selection into the program, all applicants must meet the requirements established by the Graduate Medical Education Office at Children's Health, as set by the Texas Medical Board, Educational Commission for Foreign Medical Graduates (ECFMG), and the Immigration Services. UT Southwestern and Children's Health require international graduates to meet the terms for an Institutional Permit, as outlined by the Texas Medical Board, and have the documents necessary for a J-1.

This program does not provide the necessary elements to qualify to take the special examination for the certificate of competency. However, the Children's Health Graduate Medical Education Office, in conjunction with the Department of Plastic Surgery at UT Southwestern, does provide a certificate indicating the candidate has satisfactorily completed applicable years of fellowship with the Pediatric Plastic Craniofacial Surgery Fellowship Program.