In the past two decades, the art of surgery teaching has seen many changes. Gone are the days when surgery teaching emphasized “apprenticeship”; instead, surgery teaching emphasizes competency-based models, evaluation, and teaching best practices that are “evidence-based.” In Canada, surgery teaching in postgraduate surgical training is regulated by the Royal College of Physicians and Surgeons, which introduced “Competence by Design” in the 2010s to replace “time-based” evaluation systems with “milestone-based” evaluation systems—something that has also seen its fair share in plastic surgery teaching, both in academic settings and clinical settings associated with them.
The rise of cosmetic procedures has also impacted training. The rise of cosmetic procedures has contributed to changes in what residents might want to learn. According to the International Society of Aesthetic Plastic Surgery, there were over 30 million aesthetic procedures performed worldwide in 2022. As the number of procedures increases, so does the need for residents to be exposed to both cosmetic procedures and, where appropriate, reconstructive procedures. There is also a growing trend of hospital-based reconstructive surgery, making environments where both worlds intersect even more important.
Urban centers like the prominent cities of Canada, especially Toronto, have become essential for surgical education. Thus, clinics related to academically active surgeons frequently partner with learning hospitals to expand the scope of exposure. This is reminiscent of today’s setting, wherein surgical practitioners frequently work in academic institutions alongside private clinics.
Edelstein Cosmetic Plastic Surgery Clinic was first established in Toronto in 2006 by Jerome Edelstein. From then to the current date, it has conducted its activities as any medical setup while being governed by medical requirements. Although it is a medical clinic, Toronto, as a metropolitan area, is dominated by teaching hospitals and academic departmental affiliations. There are surgeons affiliated with the clinic who also participate in academic and research activities.
Professional mentorship in plastic surgery does not mean being in the operating room only. Professional mentorship involves talking about cases, discussing the results of investigations after surgery, and understanding how to handle patient consultations. In recent times, talking to patients and obtaining ethical consent carries more weight than before. For that reason, clinics that have organized patient consultations and recorded them also offer trainees an overview of how the needs of the patient will be attended to in the future. In plastic surgery, patient desire and outcome can only be considered as closely connected.
The surgeons associated with Edelstein Cosmetic Plastic Surgery, who include Tony Zhong and Jeffrey Fialkov, also have academic positions at the surgery department of a university in Toronto. The work the surgeons do in the areas of reconstructive microsurgery, quality of life, and measuring outcomes creates a pathway from the hospital environment to academia. Academic surgery promotes surgical continuity and demonstrates the application of evidence-based practice standards within the hospital environment and in practice. The trend of academic surgery follows a trend in education within Canada.
Learning does not come from just these residency programs. Continuing medical learning, conferences, and peer-reviewed speaking events are also vital components to skill development. Groups like the Canadian Society of Plastic Surgeons and the International Society of Aesthetic Plastic Surgery offer updated information and new research. Surgeons involved in these platforms actually contribute to the sum of information from the medical community, and clinics associated with these groups can influence medical practices by adopting procedures that conform to updated information.
Mastery of these techniques in reconstructive as well as aesthetic procedures comes only through hands-on experience and guidance. Whether it is breast procedures, body procedures, facial procedures, or microsurgery techniques, each of these is associated with a different skill set. Mentorship programs emphasize anatomy, proportion, and complication management, rather than focusing on a single technique. Trainees learn from practitioners who perform procedures according to guidelines and registry-based reporting. They learn to put these procedures and decisions within the larger framework of evidence-based medicine, which aligns with the national initiative of accountability and outcome measures.
Data from the Canadian Institute for Health Information has documented sustained growth in elective surgical procedures since the mid 2000s, particularly in metropolitan centers. Increased procedural volume expands opportunities for supervised training while also reinforcing the importance of standardized safety measures. Clinics that integrate perioperative documentation, patient-reported outcomes, and structured follow-up create environments where learning occurs within clear professional boundaries. Exposure to these systems informs how future surgeons design their own practices.
Mentorship also includes discussion of professional responsibility. Advertising standards in Ontario restrict promotional claims, and informed consent documentation is legally required. Trainees observing practice in regulated private clinics encounter real-world examples of compliance and ethical communication. This complements teaching that is done within hospitals by working through how such clinical practice guidelines from organizations like the Royal College of Physicians and Surgeons of Canada and Health Canada translate into practice.
As indicated, plastic surgery in Canada by the early 2020s has witnessed an increase in academic involvement to supplement private practice. Edelstein Cosmetic Plastic Surgery, which has been operational since 2006, appears to operate under this platform. At the heart of this professional setup is the academic contribution of Dr Tony Zhong and Dr. Jeffrey Fialkov, among other plastic surgeons, alongside Jerome Edelstein’s leadership framework. This academic setup appears to be a manifestation of a larger shift in plastic surgery education, awaiting the next generation of plastic surgeons.
