Section 01: Organization1.1The fellowship is at an ABA Verified Burn Center.
Section 01: Organization1.2A single fellowship program director must be responsible for the training program.
Section 01: Organization1.3The fellowship program director meets the following qualifications:
Section 01: Organizationa.     Licensed surgeon (MD or DO) with board certification by the American Board of Surgery or the American Board of Plastic Surgery (or equivalent for international burn centers).
Section 01: Organizationb.     Has completed a one-year fellowship in burn care and/or has experience in the care of patients with acute burn injuries for two or more years during the previous 5 years.
Section 01: Organizationc.     Has ABLS training (or equivalent) and should be an ABLS Instructor.
Section 01: Organizationd.     Has administrative responsibility for the Burn Care Fellowship Program.
Section 01: Organizatione.     Responsible for all fellowship teaching staff of the burn program.
Section 01: Organization1.4At least one other general or plastic surgeon assists with the fellowship training.
Section 01: Organization1.5At least one reconstructive surgeon is available for complicated burn reconstruction.
Section 01: Organization1.6The burn fellowship program director and surgical teaching staff have unrestricted privileges regarding the admission, treatment, and discharge of their own patients in the burn center.
Section 01: Organization1.7The clinical fellowship faculty demonstrates commitment to two or more of the following, by documented scholarly pursuits:
Section 01: Organizationa.     Burn-related continuing education.
Section 01: Organizationb.     Regional and national burn and scientific societies.
Section 01: Organizationc.     Presentation and publication of burn-related scientific studies.
Section 01: Organizationd.     Research as it pertains to burn care.
Section 01: Organizatione.     Burn quality improvement.
Section 02: Duration and Scope of Training2.1The training is at least one year in length.
Section 02: Duration and Scope of TrainingBurn specific rotation must be at least six months, if less than 12 months, must demonstrate completion of non-burn specific rotations such as trauma critical care, pulmonary critical care, medical critical care, pediatric critical care, or anesthesia as well as appropriate completion of burn cases.
Section 02: Duration and Scope of Training2.2The burn care fellow’s time is focused on burn care management in and out of the operating room including:
Section 02: Duration and Scope of Traininga.     Patient care. This includes resuscitation, acute inpatient care including ICU and management of complications, ward and outpatient treatment.
Section 02: Duration and Scope of Trainingb.     Teaching
Section 02: Duration and Scope of Trainingc.     Patient/family care conferences
Section 02: Duration and Scope of Trainingd.     Bedside and operating room procedures
Section 02: Duration and Scope of Traininge.     Quality Improvement conferences
Section 02: Duration and Scope of Trainingf.       System improvement
Section 02: Duration and Scope of Trainingg.     Clinical documentation
Section 02: Duration and Scope of Trainingh.     Innovative knowledge acquisition
Section 02: Duration and Scope of Training2.3The fellowship includes non-critical care burn patient management including:
Section 02: Duration and Scope of Traininga.      Regular outpatient clinics
Section 02: Duration and Scope of Trainingb.     Reconstructive surgical procedures
Section 02: Duration and Scope of Trainingc.      Educational programs
Section 02: Duration and Scope of Trainingd.     Research opportunities
Section 03: The Educational ProgramBurn Fellows must obtain competence in the six areas listed below to the level expected of a new practitioner.
Section 03: The Educational Program3.1Patient care that is compassionate, appropriate, and effective. Burn Fellows must:
Section 03: The Educational Programa.      Demonstrate manual dexterity appropriate for their training level.
Section 03: The Educational Programb.     Independently develop and execute burn-specific patient care plans.
Section 03: The Educational Program3.2Medical knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences. Burn fellows are expected to:
Section 03: The Educational Programa.      Demonstrate application of this knowledge to care of the burn patient.
Section 03: The Educational Programb.     Critically evaluate and demonstrate knowledge of pertinent scientific information.
Section 03: The Educational Program3.3Practice-based learning and improvement that involves the investigation and evaluation of care for patients, the appraisal and assimilation of scientific evidence, and improvements in care of burn patients. Burn fellows are expected to:
Section 03: The Educational Programa.      Critique personal practice outcomes.
Section 03: The Educational Programb.     Demonstrate recognition of the importance of lifelong learning in surgical practice.
Section 03: The Educational Program3.4Interpersonal and communication skills leading to the effective exchange of information and collaboration with patients, their families, and other health professionals. Burn fellows are expected to:
Section 03: The Educational Programa.      Communicate effectively with other health care professionals.
Section 03: The Educational Programb.     Counsel and educate patients and families.
Section 03: The Educational Programc.      Effectively document practice activities.
Section 03: The Educational Program3.5Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds. Burn fellows are expected to:
Section 03: The Educational Programa.     Maintain high standards of ethical behavior.
Section 03: The Educational Programb.     Demonstrate a commitment to continuity of patient care.
Section 03: The Educational Programc.     Demonstrate sensitivity to age, gender and culture of patients and other health care professionals.
Section 03: The Educational Program3.6Systems-based practice by demonstrating awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
Section 03: The Educational ProgramBurn fellows are expected to:
Section 03: The Educational Programa.     Practice high-quality, cost effective patient care.
Section 03: The Educational Programb.     Demonstrate knowledge of risk-benefit analysis.
Section 03: The Educational Programc.     Demonstrate understanding of the role of different specialists and other health care professionals in interdisciplinary patient management.
Section 04: Core CurriculumA formal curriculum must be established in the following areas, with documentation by the program director that proficiency has been achieved:
Section 04: Core Curriculum4.1Pre-burn center care. Triage and coordination of transfer of burn injured patients, collaboration with referring providers to develop a plan of care.
Section 04: Core CurriculumResuscitation and cardiovascular physiology. Management of acute burn resuscitation, prevention of, and rescue of burn shock. Diagnosis, monitoring and management of dysrhythmias, and all types of shock. Competency in the management of acute kidney injury, metabolic disturbances, and the use of renal replacement therapies.
Section 04: Core CurriculumInhalation injury and respiratory failure. Diagnosis and management of inhalation injury, carbon monoxide and cyanide poisonings; airway management; interpretation of radiologic and laboratory data; advanced mechanical ventilation strategies; bronchoscopy; and management of complications
Section 04: Core CurriculumWound management. Diagnosis and management of different injury depths and etiologies, performance of escharotomy and fasciotomy, topical wound care and debridement. Develop expertise in surgical wound preparation including specialized areas (face, neck, hands, perineum/genitalia, feet), application of skin substitutes, and skin grafting.
Section 04: Core CurriculumInfection. Diagnosis and management of common ICU and burn-related infections, antibiotic choice and stewardship, development and maintenance of sound infection control practices.
Section 04: Core CurriculumNutrition. Management of nutritional priorities in burn injured patients, assessment of nutritional status, management of enteral and parenteral nutrition, use of metabolic agents to mitigate hypermetabolism.
Section 04: Core CurriculumPharmacology. Understanding of appropriate choice and dosing of medications, burn hypermetabolism effects, and drug interactions.
Section 04: Core CurriculumPsychosocial. Understanding of psychological stressors and common psychiatric diagnoses in the burn-injured patient, understanding the role of psychological colleagues and social services available, diagnosis and referral of cases of suspected abuse and addiction.
Section 04: Core CurriculumEthics and palliative care. Integration of ethical principles and palliation into curative care, promotion of patient- and family-centered care, and management of end-of-life care.
Section 04: Core CurriculumRehabilitation. Collaboration with therapy specialists in formulating a plan of care; understanding principles of positioning, splinting and exercise; understanding of the role of inpatient and outpatient rehabilitation services.
Section 04: Core CurriculumOutpatient management. Safe transition to outpatient care, wound care, pain and itch management; hypertrophic scar diagnosis and management and accessing psychosocial resources.
Section 04: Core CurriculumBasic reconstruction. Understanding factors in scar formation, planning and performance of multiple reconstruction techniques (scar excision, tissue rearrangement, basic skin flaps, and laser/injection therapies).
Section 04: Core CurriculumAdministration and quality improvement. Development and maintenance of clinical protocols, review of quality improvement concerns, monitoring outcomes and reporting of complications, loop closure. Understanding of institutional and burn center specific disaster protocols and strategies.
Section 04: Core CurriculumPediatric care. In programs that care for burn injured children, the fellow must also demonstrate familiarity in pediatric aspects of: airway and ventilator management, burn resuscitation, pain and sedation strategies, pharmacology, nutrition, rehabilitation, and exposure to non-burn skin and soft tissue diseases seen in the burn center.
Section 05: Didactic Experience5.1Fellow attends weekly teaching sessions, morbidity and mortality conference, and regular quality improvement meetings that are burn-specific.
Section 05: Didactic ExperienceThe burn fellow is given ample opportunity to lead some of the sessions and meetings.
Section 05: Didactic Experience5.2ABLS training is highly encouraged.
Section 05: Didactic Experience5.3Attendance/presentation at regional and/or national ABA conferences is highly encouraged.
Section 06: Evaluation6.1The trainees must be regularly evaluated by the fellowship faculty and Director with written reports covering the six core competencies.
Section 07: Case RequirementsFellow is directly involved in:
Section 07: Case Requirements7.1Burn and soft tissue operative cases (125 individual cases, not CPT codes): Includes fasciotomy, surgical debridement, wound bed preparation, application of skin substitutes, skin grafting, amputations, basic reconstruction. Up to 20 laser procedures can count toward this requirement.
Section 07: Case Requirements7.2Escharotomy (10 Separate incisions)
Section 07: Case Requirements7.3Resuscitation (10 definitive resuscitations for patients with ³ 20% TBSA burns)
Section 07: Case Requirements7.4Inhalation injury (10 patients): Diagnosis, active management in the ICU
Section 07: Case Requirements7.5Non-operative burn management (50 patients): Plan of care, topical therapy, transition to outpatient care
Section 07: Case Requirements7.6Outpatient visits (200): Includes acute burns, healed burns, reconstruction, and management of late effects