11. Educational and Financial Lessons from the Two-Phase Restructuring of the Johns Hopkins Resident Aesthetic Clinic

Abstract

Background: Resident aesthetic clinics (RACs) have gained increasing popularity since the ACGME’s increase in minimum aesthetic surgery requirements. While plentiful studies have demonstrated that RAC’s have successful surgical outcomes, limited literature is available guiding the practical aspects of operating a successful RAC such as balancing case type and volume and effective resident education. Here we present valuable lessons learned from the successful two-phase restructuring of one institution’s RAC. Phase 1 effective July 1, 2018, included new faculty leadership, a formal aesthetic education curriculum, and limiting liposuction and abdominoplasty consults. Phase 2 effective January 1, 2021, consisted of obtaining increased block time, adding junior residents to the rotation, and an industry sponsored implant program. Methods: A retrospective chart review was performed on all 336 patients who underwent a total of 676 procedures in our institution’s RAC from Jan 1, 2011, to Sept 1, 2022. Procedure type and volume were compared before and after the two phases of the restructurings on July 1, 2018, and January 1, 2021. The faculty leader spearheading the clinic restructuring was interviewed to discuss the approach to problems encountered in running a RAC. Results: Of the 235 patients who underwent a total of 507 procedures from January 1, 2011, to July 1, 2018, there was a roughly equal distribution of facial and body contouring cases with limited (14%) breast aesthetic exposure. Between phases 1 and 2, 50 patients underwent 98 procedures over 30 months. 1B shows the effect of limiting body contouring consults to increase the share of facial aesthetics cases performed from 44% to 56%. After phase 2 changes, a balance was achieved among facial, body, and breast cases over the following 20 months. The specific educational challenges that motivated each aspect of the restructuring are presented. Conclusion: Through the context of our institutional RAC, we underscore tangible solutions to educational, financial, and logistic challenges RACs may face. We specifically highlight how to provide residents with more equal exposure to different aesthetic procedures and how to effectively maximize clinic infrastructure to reach targets for surgical procedures.