Global Craniofacial Care

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Paul Tessier provided a major advancement in medicine that led to the creation of a new subspecialty, craniofacial surgery. He presented his first decade of work in 1967 at the 4th annual Congress of the International Confederation of Plastic Surgeons in Rome. He offered a major contribution in the advancement of care for those with grotesque facial and cranial distortions and malformations, and initiated an exciting new era. He captivated and inspired the then-current generation of plastic surgeons, maxillofacial surgeons, and neurosurgeons. That generation was mostly self-taught, but gradually fellowships other than Tessier's began to be created.
In the developed world, well-structured medical and surgical programs and organizations dedicated to improved education and quality of care already existed. For example, certification by subspecialty boards under the American Board of Medical Examiners in the United States provided necessary framework for candidates to be tested by independent of examiners in that specialty. Approval of the educational programs developed by leaders in each recognized medical specialty provided both academic and practical skill-sets for a given graduate medical-education program, together with increasing responsibility and related academic advancement. Most programs began to require years of organized postgraduate education after graduation from medical school and certification by written and oral examinations. The Accreditation Council for Graduate Medical Education is an independent accrediting body in the United States founded in 1981. It is a nonprofit private counsel that evaluates and accredits medical and surgical internship, residency, and fellowship programs in the United States.
In addition, the American Hospital Association oversees and examines the quality of care in hospitals throughout the United States, and thereby raises standards of care. The American College of Surgeons is an organization founded in 1913. It has requirements for membership that create standards for surgical competence and character of the applicants, affirmed by their peers. The organization advances the science of surgery and the competent practice of its art, and eliminates the occasional incompetent operator.
Under the American Board of Plastic Surgery, an ACGME approved craniofacial fellowship was developed. Following board certification in plastic surgery, additional training of a minimum of 1 year in an approved program now leads to the recognition that a young surgeon has spent the appropriate number of years in training and has experience necessary to be labeled a craniofacial surgeon.
The International Society of Craniofacial Surgery was founded in Montreal in June 1983 as a chapter of the International Confederation for Plastic and Reconstructive Surgery. Membership requires completion of an approved fellowship, plus a minimum of 5 years out of fellowship and association with a recognized team. Records of 12 intracranial patients must be submitted and approved for a candidate to be considered for full membership. He or she then must be nominated, seconded, and approved by members in good standing. This standard needs to be continued as a minimum for qualification for membership in the ISCFS.
Most countries in the developing world do not have organized training programs, let alone independent organizations maintaining standards of training and care. If China and other Asian countries are going to compete in the global arena of medicine and dentistry in the coming years, such programs must be insisted upon by leaders in each country if they are to succeed in developing true craniofacial training programs requiring both academic achievement and organized graduate experience in clinical care. These programs must also require formal examinations as well as additional proof of team care, with personal records of intracranial surgery independently performed and submitted for approval.
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