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In this climate, then, the AAFPRS proceeded to achieve the first of its two major goals, education. There was a natural give- and-take between organizations, as AAFPRS and AAO-HNS members contended with issues that affected them variously. The road in particular was not always smooth between the AAFPRS and academic programs, which only gradually arrived at their support of training in facial plastic and reconstructive surgery as otolaryngology department chairs searched their own beliefs. But, if relations at times were strained, major objectives nonetheless were achieved before many years passed.
The faculty of Rhinoplasty 1984 illustrates the traditional commitment of AAFPRS leaders to teach the next generation of surgeons. Pictured above are: (first row, from left) Leslie Bernstein, Ted A. Cook, Irvin J. Fine, Richard C. Webster, Robert L. Simons, Trent W. Smith, Richard T. Farrior, and Rudolph Meyer; and (second row, from left) Tony R. Bull, Charles W. Gross, Sidney S. Feuerstein, Jack Anderson, William K. Wright, E. Gaylon McCollough, Howard Diamond, Morey L. Parkes, Walter E. Berman, Charles J. Krause, G. Jan Beekhuis, and H. George Brennan. (Photo courtesy of Robert L. Simons)
Credit certainly is due early leaders, who kept the main goal before them. “We could all see that if we were going to succeed in the long range, we had to have an extremely good educational program,” recalled G. Jan Beekhuis, the AAFPRS’s first education chairman and its 1973 president. Jack Anderson concurred, often saying at AAFPRS board meetings that medical students interested in facial plastic surgery would not pursue otolaryngology without the dual incentive of facial plastic surgery training in residencies and postgraduate work through the AAFPRS.
Progress in postgraduate training came first. The AAFPRS early on began to develop major courses not available elsewhere, and in 1969 offered its first aging face course. The idea of teaching facial plastic surgery procedures not addressed in residency training programs was a radical idea in the mid-sixties, but the plan was to fill the gaps until facial plastic surgery procedures were included in residency curricula. In 1970, the AAFPRS applied to the AMA’s Accreditation Council for Continuing Medical Education for permission to offer its courses for credit. Permission was granted, making the AAFPRS the first organization in otolaryngology to secure such approval for courses conducted in a non-university setting.
At Rhinoplasty 1994, senior surgeons were joined on the faculty by the rising stars of the next generation, many of whom had been students at earlier courses. Pictured (from left) are: J. Regan Thomas, Fred J. Stucker, Wayne F. Larrabee, Calvin M. Johnson Jr., M. Eugene Tardy, H. George Brennan, Dean M. Toriumi, Ferdinand F. Becker, Howard W. Smith, Norman J. Pastorek, Robert L. Simons, Paul H. Toffel, Ira D. Papel, Russell W. H. Kridel, E. Gaylon McCollough, Ted A. Cook, Devinder S. Mangat, Fernando Pedroza, Larry D. Schoenrock, Tony R. Bull, Peter A. Adamson, John L. Frodel Jr., and Claus D. Walter. Not pictured: Leslie Bernstein. (Photo courtesy of Robert L. Simons)
Meanwhile, plans proceeded to redefine the essential training for otolaryngology residencies to include not only aging face, but also all facial plastic and reconstructive surgery procedures. In 1972, William Wright (AAFPRS president in 1970) reported to the AAFPRS board of directors that efforts were proceeding to interest various universities in starting courses in head and neck reconstruction, maxillofacial trauma, and skin surgery. Soon after, Charles J. Krause (AAFPRS president in 1981) reported that the AAFPRS was continuing to work with the training programs, offering every assistance possible to upgrade programs. In the mid- seventies, Charles W. Gross, then AAFPRS education chairman, urged AAFPRS to help residencies to develop soft tissue courses, saying, “You canít do head and neck surgery without doing repair of the surgical defect.” Teaching the first soft tissue course was John T. Dickinson (AAFPRS president in 1965), who deserves credit for starting the AAFPRS audiovisual library. When Ted A. Cook (AAFPRS president in 1989) upgraded and expanded soft tissue courses later on, he looked back to the early seventies and commented of that time, “Most residents became knowledgeable in soft tissue techniques through AAFPRS courses.”
With each refinement to residency training, a step was taken toward universal inclusion of facial plastic surgery in otolaryngology residencies. Finally, in 1975, the ABO, AMA, and the American College of Surgeons approved a revised Essentials in Otolaryngology, which for the first time made mandatory the inclusion of facial plastic surgery training in residency programs and the mastery of this subspecialty for ABO certification. The document was a joint effort of all related groups, although it is generally agreed that the burden of AAFPRS correspondence with the AMA and ABO fell to then AAFPRS Secretary Carl N. Patterson (AAFPRS president in 1975). Patterson, however, fully credits Jerome Hilger (AAFPRS president in 1979; AAOO president in 1970), George A. Sisson (AAFPRS president in 1978; AAO-HNS president in 1983), John Dickinson (AAFPRS president in 1965), and Walter Work (ABO president from 1968 to 1972) and others members of the ABO for their help.
Looking back on this period in the eighties, M. Eugene Tardy, who headed the AAFPRS in 1982, the AAO- HNS in 1986, and the ABO in 1995, observed that: “In the earliest days we sought out university programs with which to co-sponsor courses and AAFPRS programs and educational activities, and it was important for both universities and the Academy to work jointly on these things. That relationship has continued. I think that one of the most important things that has occurred as a result of this cooperation is that today, as opposed to even ten years ago, in almost every major university teaching program in this country there is a person in otolaryngology/head-and-neck surgery who has had a fellowship within the AAFPRS.”
Richard L. Goode’s (left) abiding interest in the AAFPRS Foundation’s fellowship program made him the logical successor in 1984 to AAFPRS President Howard W. Smith, whose lifelong interest in scholarship led him to establish with Robert L. Simons, the Founders Club in 1986. (Photo courtesy of AAFPRS Archives)
The fellowship program alluded to by Tardy had been started by the AAFPRS in 1968, as a natural extension of residency training. However, it was not until 1988 that the fellowships, which until 1988 operated more like preceptorships, matching postgraduates with senior surgeons with whom they wanted to study, were standardized. Standardizing training was necessary preparation to seeking accreditation for the fellowships from the AMA Accreditation Council for Graduate Medical Education, and Peter A. Adamson (AAFPRS president-elect in 1995) volunteered for a lead role in this effort. A standard curriculum was developed, as well as an examination based on the curriculum. The examination was to be administered by a new entity, the American Board of Facial Plastic and Reconstructive Surgery, incorporated in 1986. Leading examination development activities was Donn R. Chatham, whose prodigious efforts earned him the moniker of “father of the ABFPRS examination.” As this paper goes to press, application has been made for accreditation by the ACGME, a process in which many recent AAFPRS presidents have participated, including Richard L. Goode (1984), Fred J. Stucker (1991), J. Regan Thomas (1992), Roger L. Crumley (1994), and Wayne F. Larrabee (1995), as well as G. Richard Holt, whose efforts have been significant for both the AAFPRS and the AAO-HNS (1992 president).