| Section 01: Organization |
1.1 |
The fellowship is at an ABA Verified Burn Center. |
| Section 01: Organization |
1.2 |
A single fellowship program director must be responsible for the training program. |
| Section 01: Organization |
1.3 |
The fellowship program director meets the following qualifications: |
| Section 01: Organization |
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a. 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: Organization |
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b. 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: Organization |
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c. Has ABLS training (or equivalent) and should be an ABLS Instructor. |
| Section 01: Organization |
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d. Has administrative responsibility for the Burn Care Fellowship Program. |
| Section 01: Organization |
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e. Responsible for all fellowship teaching staff of the burn program. |
| Section 01: Organization |
1.4 |
At least one other general or plastic surgeon assists with the fellowship training. |
| Section 01: Organization |
1.5 |
At least one reconstructive surgeon is available for complicated burn reconstruction. |
| Section 01: Organization |
1.6 |
The 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: Organization |
1.7 |
The clinical fellowship faculty demonstrates commitment to two or more of the following, by documented scholarly pursuits: |
| Section 01: Organization |
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a. Burn-related continuing education. |
| Section 01: Organization |
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b. Regional and national burn and scientific societies. |
| Section 01: Organization |
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c. Presentation and publication of burn-related scientific studies. |
| Section 01: Organization |
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d. Research as it pertains to burn care. |
| Section 01: Organization |
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e. Burn quality improvement. |
| Section 02: Duration and Scope of Training |
2.1 |
The training is at least one year in length. |
| Section 02: Duration and Scope of Training |
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Burn 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 Training |
2.2 |
The 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 Training |
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a. Patient care. This includes resuscitation, acute inpatient care including ICU and management of complications, ward and outpatient treatment. |
| Section 02: Duration and Scope of Training |
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b. Teaching |
| Section 02: Duration and Scope of Training |
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c. Patient/family care conferences |
| Section 02: Duration and Scope of Training |
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d. Bedside and operating room procedures |
| Section 02: Duration and Scope of Training |
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e. Quality Improvement conferences |
| Section 02: Duration and Scope of Training |
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f. System improvement |
| Section 02: Duration and Scope of Training |
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g. Clinical documentation |
| Section 02: Duration and Scope of Training |
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h. Innovative knowledge acquisition |
| Section 02: Duration and Scope of Training |
2.3 |
The fellowship includes non-critical care burn patient management including: |
| Section 02: Duration and Scope of Training |
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a. Regular outpatient clinics |
| Section 02: Duration and Scope of Training |
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b. Reconstructive surgical procedures |
| Section 02: Duration and Scope of Training |
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c. Educational programs |
| Section 02: Duration and Scope of Training |
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d. Research opportunities |
| Section 03: The Educational Program |
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Burn Fellows must obtain competence in the six areas listed below to the level expected of a new practitioner. |
| Section 03: The Educational Program |
3.1 |
Patient care that is compassionate, appropriate, and effective. Burn Fellows must: |
| Section 03: The Educational Program |
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a. Demonstrate manual dexterity appropriate for their training level. |
| Section 03: The Educational Program |
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b. Independently develop and execute burn-specific patient care plans. |
| Section 03: The Educational Program |
3.2 |
Medical 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 Program |
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a. Demonstrate application of this knowledge to care of the burn patient. |
| Section 03: The Educational Program |
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b. Critically evaluate and demonstrate knowledge of pertinent scientific information. |
| Section 03: The Educational Program |
3.3 |
Practice-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 Program |
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a. Critique personal practice outcomes. |
| Section 03: The Educational Program |
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b. Demonstrate recognition of the importance of lifelong learning in surgical practice. |
| Section 03: The Educational Program |
3.4 |
Interpersonal 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 Program |
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a. Communicate effectively with other health care professionals. |
| Section 03: The Educational Program |
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b. Counsel and educate patients and families. |
| Section 03: The Educational Program |
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c. Effectively document practice activities. |
| Section 03: The Educational Program |
3.5 |
Professionalism, 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 Program |
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a. Maintain high standards of ethical behavior. |
| Section 03: The Educational Program |
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b. Demonstrate a commitment to continuity of patient care. |
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c. Demonstrate sensitivity to age, gender and culture of patients and other health care professionals. |
| Section 03: The Educational Program |
3.6 |
Systems-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 Program |
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Burn fellows are expected to: |
| Section 03: The Educational Program |
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a. Practice high-quality, cost effective patient care. |
| Section 03: The Educational Program |
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b. Demonstrate knowledge of risk-benefit analysis. |
| Section 03: The Educational Program |
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c. Demonstrate understanding of the role of different specialists and other health care professionals in interdisciplinary patient management. |
| Section 04: Core Curriculum |
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A formal curriculum must be established in the following areas, with documentation by the program director that proficiency has been achieved: |
| Section 04: Core Curriculum |
4.1 |
Pre-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 Curriculum |
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Resuscitation 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 Curriculum |
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Inhalation 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 Curriculum |
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Wound 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 Curriculum |
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Infection. 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 Curriculum |
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Nutrition. 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 Curriculum |
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Pharmacology. Understanding of appropriate choice and dosing of medications, burn hypermetabolism effects, and drug interactions. |
| Section 04: Core Curriculum |
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Psychosocial. 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 Curriculum |
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Ethics 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 Curriculum |
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Rehabilitation. 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 Curriculum |
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Outpatient management. Safe transition to outpatient care, wound care, pain and itch management; hypertrophic scar diagnosis and management and accessing psychosocial resources. |
| Section 04: Core Curriculum |
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Basic 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 Curriculum |
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Administration 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 Curriculum |
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Pediatric 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 Experience |
5.1 |
Fellow attends weekly teaching sessions, morbidity and mortality conference, and regular quality improvement meetings that are burn-specific. |
| Section 05: Didactic Experience |
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The burn fellow is given ample opportunity to lead some of the sessions and meetings. |
| Section 05: Didactic Experience |
5.2 |
ABLS training is highly encouraged. |
| Section 05: Didactic Experience |
5.3 |
Attendance/presentation at regional and/or national ABA conferences is highly encouraged. |
| Section 06: Evaluation |
6.1 |
The trainees must be regularly evaluated by the fellowship faculty and Director with written reports covering the six core competencies. |
| Section 07: Case Requirements |
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Fellow is directly involved in: |
| Section 07: Case Requirements |
7.1 |
Burn 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 Requirements |
7.2 |
Escharotomy (10 Separate incisions) |
| Section 07: Case Requirements |
7.3 |
Resuscitation (10 definitive resuscitations for patients with ³ 20% TBSA burns) |
| Section 07: Case Requirements |
7.4 |
Inhalation injury (10 patients): Diagnosis, active management in the ICU |
| Section 07: Case Requirements |
7.5 |
Non-operative burn management (50 patients): Plan of care, topical therapy, transition to outpatient care |
| Section 07: Case Requirements |
7.6 |
Outpatient visits (200): Includes acute burns, healed burns, reconstruction, and management of late effects |
