UCSF is the only campus in the University of California system that is solely devoted to health sciences. There are schools of medicine, dentistry, nursing and pharmacy on campus; the medical school is over 135 years old. UCSF has one of the oldest plastic surgery residencies in the country. Established in 1951, the first chief of plastic surgery was Harry Blackfield, followed by William Morris. Steven Miller (presently Chair of the ABMS) headed the program briefly. Luis O. Vasconez took over in 1978; he and Dr. Stephen Mathes were the first full time faculty in plastic surgery at UCSF. Dr. Mathes became Chief of Plastic surgery in 1985 and directed the program until 2005, when he stepped down as chief and was succeeded by Dr. William Hoffman.
Beginning originally as more of a private practice based program, Dr. Vasconez and Dr. Mathes built the program to its present scope, with 8 full time and 15 clinical faculty. The residency expanded from four positions (2 per year) to six in 1994. The first coordinated residency position was offered in 1997; the coordinated program was expanded to three positions a year starting in 2002. A residency review site visit was performed in spring 2005 and the program received full accreditation for another three years; this was shortened from the usual five years because of the change in program directors.
The plastic surgery residency at the University of California, San Francisco is a six-year clinical program consisting of three years of training in general surgery followed by three years of specialty training in plastic surgery. Graduates of the program are eligible to enter the examination process resulting in certification from the American Board of Plastic Surgery. In the first three years the program emphasizes broad and intensive training in all aspects of general surgery. With a few minor variations, the training is identical to the categorical general surgery program; these include additional months of training in Oral Surgery, Hand Surgery, and Orthopedics instead of rotations in GI physiology and endoscopy. A total of six months of the first three years are spent on plastic surgery services at the various hospitals.
The last three years of training in plastic surgery encompasses in-depth training in every aspect of the specialty. We have been approved for a change in program length to three years of clinical training in plastic surgery. This began with the residents starting in 2008. Graduates of the training are comfortable handling the wide range of problems presented to plastic surgeons spanning the tertiary care specialist in an academic practice through the general plastic surgery practitioner in solo private practice. About 40% of our graduates in the past twenty years have gone on to additional fellowship training. Graduates that do pursue fellowships typically have sought training in hand surgery, microsurgery, pediatric/craniofacial surgery or cosmetic surgery at some of the best programs in the country.
Graduates from our training program have entered academic practice at major university hospitals (45%), including chiefs at three existing programs, and solo or group private practice (55%). The faculty members of UCSF are proud not only of the jobs that our graduates have obtained but also that the majority did so without the need for further training. Some of this success is due to the fact that our program does not have specialty fellows; the plastic surgery residents are given primary responsibility to care for the patients during their training without the additional layer of specialty fellows.
Weekly conferences present learning opportunities as well as a regular forum for interchange among the residents and the faculty of the program.
There is a weekly seminar style lecture on Monday evenings. The goal of this is to cover the entire curriculum in plastic surgery in a three year cycle, in lectures given by a single faculty member with both the preliminary and the plastic surgery residents. We have had lectures by the clinical and the full time faculty, local plastic surgeons, and members of other departments. This has been an enormously successful program and we are making every endeavor to have as many residents as possible freed up for a couple of hours to attend these Monday lectures.
There are four Tuesday morning conferences each month: the first Tuesday is a case presentation conference by a single resident each month, the second a "service" conference (morbidity and mortality), the third a hand conference, and the fourth a research presentation. If there is a fifth Tuesday, we generally schedule special topics usually on cosmetic surgery.
Journal club is held once a month, reviewing selected papers from the primary journal of plastic surgery. There is also a quarterly cosmetic lecture series to which we invite the visiting professors from the ASPS and the ASAPS. This is an evening lecture with dinner on a Thursday, with the residents spending most of the following day with the professor as well. In the past years, we have hosted Al Aly, Robert Walton, Joseph McCarthy and Gustavo Colon as visiting professors. Dr. Ronald Iverson, Dr. Fred Menick and Dr. Jack Friedland visited in 2007; and Dr. Kenneth Salyer, Dr. William Swartz and Dr. James Grotting visited in 2008. Thus far in 2009, we have hosted Dr. Glenn Jelks, Dr. Joel Feldman, and Dr. Phillip Blondeel is coming in late October.
All residents are expected to participate in new and ongoing research projects during their time in clinical training. All graduating residents are expected to submit and present an abstract at the Senior Residents Meeting of all graduating plastic surgery residents in the nation. Academic productivity is expected of all residents, at least in clinical projects with the full time and/or clinical faculty.
In general, a research year is required. Residents are encouraged to apply for positions and funding for formal research training between year 3 and 4 of clinical training. Residents should identify their interests in the latter part of their first or early part of their second years so that positions can be allocated in the schedule to accommodate these interests. We have been able to accommodate residents who desire a second research year, but this is based on productivity as well as resident availability.
The Division of Plastic Surgery has an active research group comprised of MDs, PhDs, and fellows in training. The main focuses of research are in wound healing, vascular anomalies, stem cells and craniofacial bone biology. Laboratories are located at UCSF, San Francisco General Hospital and the VA Medical Center.
The primary university hospital, UCSF Medical Center, has over 500 beds, 28 inpatient operating rooms, and 4 outpatient OR's. UCSF has been consistently ranked as one of the top ten hospitals in the nation. UCSF Children's Hospital has been the one of top rated children's hospitals in the state for several years; it represents over 150 of the total beds. It is presently a part of the overall hospital but a separate women's and children's hospital is planned, hopefully to open in 2014.The emphasis in plastic surgery at UCSF hospital is on general reconstruction, including microsurgery and pediatric plastic surgery, including clefts and craniofacial surgery. The team at the Center for Craniofacial Anomalies meets twice a week to evaluate complex pediatric cases and residents are included in this clinic regularly. Cosmetic surgery is done by most of the faculty at the University hospital.
This is a smaller hospital that is part of the university system. The Comprehensive Cancer Center is located at MTZ, which includes the Breast Care Center as well as head, neck and colorectal cancer surgery. Dr. Robert Foster is the chief of plastic surgery at MTZ, where the surgical emphasis is on breast reconstruction and general reconstruction after cancer extirpation. The residents assigned to MTZ are also assigned to the resident cosmetic surgery clinic, supervised by Dr. Gil Gradinger and staffed by rotating clinical faculty. This clinic provides low cost cosmetic surgery with the residents as the primary surgeon and with the clinical faculty supervising directly in the OR. This provides excellent experience in cosmetic surgery for our residents.
San Francisco General Hospital
This is the level I trauma center for the city of San Francisco, and also provides care for indigent patients within the city. The emphasis here is on surgery for hand and maxillofacial trauma, reconstruction after trauma, particularly orthopedic trauma, and general reconstruction as well. The opportunity to work at the SFGH affords the residents the ability to be the primary surgeon for these patients, with close attending supervision in both the clinics and the OR. Dr. Scott Hansen is the chief of plastic surgery at SFGH.
The San Francisco VA Hospital is located at "Lands End", on a promontory overlooking the ocean. The hospital is fairly typical of VA hospitals, with a preponderance of vascular surgery and hand surgery. The chief of Plastic Surgery at the VAH is Dr. Pablo Leon.
Ralph K. Davies/California Pacific Med Center
Each of the first year residents spends two months working at the Buncke Clinic, where the emphasis is on hand and microsurgery, including replantation. The second year residents each spend two months at CPMC (which included three separate hospitals, including Davies) on a rotation that is largely elective and emphasizes working with the private practice faculty, largely on cosmetic surgery.
William Y. Hoffman
Chief, Division of Plastic and Reconstructive Surgery
Dr. Hoffman has been on the plastic surgery faculty at UCSF for 20 years. He assumed responsibility as Chief of the Division and Program Director for the residency program in 2005. His primary clinical areas of expertise are in craniofacial surgery, pediatric plastic surgery, and facial aesthetic surgery. Research interests include fetal cleft surgery, clinical outcomes in craniofacial surgery, and hemangiomas.
Dr. Gregory Buncke: Residency Site-Director, The Buncke Clinic at California-Pacific Medical Center (RK Davies Campus).
Dr. Buncke directs resident training at the microsurgery and hand surgery center at the RK Davies Medical Campus. He is well known for his contributions to microsurgery.
Dr. Robert Foster
Dr. Foster leads the clinical activities at the Cancer Center located at the UCSF-Mt Zion Campus. His primary interest is breast reconstruction. He is active in research involving transplantation and the development of tolerance to transplants.
Dr. Roger Friedenthal: Chief of Plastic Surgery and Residency Site-Director, California-Pacific Medical Center.
Dr. Friedenthal is in private solo practice and is the Chief of Plastic Surgery at CPMC. He organizes the training of residents during their 2nd year rotation at the California-Pacific Medical Center, and also is one of the attendings in the resident cosmetic clinic.
Dr. Gilbert Gradinger: Director Resident Cosmetic Clinic.
Dr. Gradinger is former president of the American Society for Aesthetic Plastic Surgery (ASAPS) and former chair of the American Board of Plastic Surgery. He retired from his private practice several years ago and has dedicated great effort to the organization and maintenance of the Resident Cosmetic Clinic at UCSF. This effort has resulted in a busy cosmetic surgery practice for the senior and chief residents to see their own patients for cosmetic surgery.
Dr. Scott Hansen
Residency Program Director
Dr. Hansen is interested in hand and microsurgery, and is involved in research of Hox genes and angiogenesis. He treats primarily reconstructive patients at San Francisco General Hospital and the UCSF-Parnassus Campus.
Dr. Pablo Leon: Residency Site Director Veterans Administration Medical Center.
Dr. Leon organizes resident training at the VA Medical Center. He has special interest in head and neck reconstruction after cancer extirpation. Research areas are in melanoma.
Dr. Mary H. McGrath
Dr. McGrath has national prominence in academic plastic surgery as a former president of the PSEF and the present chair of the Board of Regents of the American College of Surgeons. She has a reconstructive and cosmetic surgery practice at the UCSF-Parnassus campus. She organizes the monthly Clinical Service teaching conference to review mortality and morbidities.
Dr. David M. Young
Dr. Young has special interest in wound healing and burns. He heads the burn unit at San Francisco General Hospital and has a practice in general reconstructive plastic surgery at the UCSF-Parnassus campus. He has a strong research effort in wound healing and angiogenesis.
The following faculty contribute significantly to residency education through their clinical activities staffing various clinics in the UCSF/CPMC system, participation in teaching conferences, and teaching residents in their own clinical practices. They all hold active clinical appointments at UCSF.
Bernard S. Alpert
K. Ning Chang
John Q. Owsley