Procedure Proficiency Program

1. Introduction

Procedure Proficiency Program (P3) is an educational initiative of the British Association of Body Sculpting (BABS) with the collaboration of the Revision Course Faculty of American Board of Cosmetic Surgery (ABCS) examination.

It is designed to help practicing cosmetic surgeons improve their knowledge and skills to deliver safe, evidence-based care to patients.

Goals of the P3

The Procedure Proficiency Program (P3) of BABS has the following main objectives:

  • To ensure competency to perform a specific cosmetic surgical procedure in a safe and skillful manner
  • To verify that a cosmetic surgeon has the necessary professionalism, ethical conduct and generic competencies to provide a cosmetic surgery to the public
  • To help cosmetic surgeons maintain their proficiency, and to provide the formal framework within which they can revalidate their skills at regular, five-yearly intervals
  • To be an independent, unbiased source of information to inform the public and regulators about which cosmetic surgeons have the necessary credentialing to provide services to their patients

2. P3 Eligibility and Application

The Procedure Proficiency Program is open to practicing cosmetic surgeons who have:

  • Medical degree
  • Full GMC registration with a license to practice, and current appraisals and revalidations
  • Completion of foundation years F1 and F2 for surgical specialties, or at least 2 years experience in a surgical specialty
  • Membership in a Royal College
  • At least 1 year of independent cosmetic practice following the successful completion of a recognised Clinical Fellowship in cosmetic surgery, or 5 years of independent practice for established cosmetic surgeons
  • A procedural logbook of at least 150 procedures performed
  • Full BABS membership
  • BABS submission of audit of clinical outcomes for the year proceeding the application
  • Up to date appraisal and revalidation (preferably through the BABS)

A candidate for P3 must submit the following documents with their application:

  • Documentation of the criteria for eligibility listed above
  • Medical Indemnity Insurance
  • ILS or ALS qualification
  • Satisfactory employment references
  • CRB clearance
  • Paid P3 fees

3. Process of P3

The P3 is designed as a combination of revision exercises and tests.  The program consists of both classroom instruction and simulation labs.  The program has the following components:

  • Revision of foundation knowledge
  • Skills evaluation in a simulated environment
  • Clinical mentorship
  • Skills assessment examination

At the end of the program surgeons must obtain a satisfactory mentorship report, and demonstrate their proficiency in a live surgery with an observing examiner.

Foundation knowledge Review

The review covers all aspects of a particular procedure, including the relevant anatomy and physiology; procedure indications and contraindications; patient selection; patient consultation; patient assessment; patient counseling; and patient consent.  Also required are a firm knowledge of the stages of the surgery; the proper instrumentation and equipment requirements; the mitigation of intraoperative risks; and postoperative care and patient support.  The final exam tests for proficiency in all of these topics.

Skills assessment in simulated environments

The skills assessment takes place in the clinical simulation centers and cadaver laboratories.  This stage tests the complete range of procedural skills required to perform a specific cosmetic surgery.  This includes all be basic essentials, from being able to tie knots, to handling of basic instrumentation, to methods for stopping bleeding, to closing a wound and the use of specific tools.  The assessment includes demonstrations on simulated dummies and cadaver models.  The candidate must demonstrate at least intermediate proficiency at this level before advancing to the mentorship stage.

Clinical Mentorship

Mentorship training is a hands-on process where each candidate applies for private individualized training with a clinical supervisor (a mentor). 

Each candidate will operate under the supervision of their mentor to demonstrate their own surgical skills and technique, as well as to learn from the mentor’s feedback. 

The number of cases required to demonstrate proficiency will vary for each candidate.  The mentor will have the ultimate responsibility of determining when the candidate is capable of proceeding to the final proficiency demonstration exam.  The mentor produces a formal report on both the technical capability of the candidate, as well as on observations of the candidate’s professionalism, ethical behavior and general capabilities.

Skills assessment exam

This final phase requires that the candidate demonstrate the procedure to an examiner.  The mentor cannot be the examiner. 

The candidate must successfully demonstrate each of the core competencies for the procedure. 

The procedure will be video recorded and kept with the candidates’ records for documentation. 

The candidate’s performance will be evaluated against a clear checklist of skills and patient safety behaviors expected by the program. 

4. Outcomes

On completion of the P3, each candidate must possess the following:

  • A passing result on the foundational knowledge theory test
  • A passing result on the demonstration of an intermediate level of competency in practical skill as performed on a dummy or a cadaver
  • A mentorship report containing a confirmation of the technical skills, professionalism, ethical behavior and general professional capabilities of the candidate
  • A passing result on surgical skills as demonstrated during a live surgery.   The procedure is video-recorded, and the resulting evidence of skills is permanently stored.
  • A logbook containing information for each surgery performed, as well as its long-term results and complications

Specific area of competence assessment

P3 will be used as a vehicle to demonstrate knowledge, skills and competency for specific cosmetic surgical procedures (for example, liposuction and body contouring).  A candidate can apply to have P3 training and assessment only for that area of clinical practice of cosmetic surgery.

Competence assessment for General cosmetic surgery proficiency

A candidate can choose to have training and assessment via a P3 modular program to obtain general proficiency verification in cosmetic surgery as a specialty.

P3 can be completed in separate modules covering procedures on various anatomical areas: body, extremities, face, head and neck.   Alternatively all modules can be covered at once (this choice is open to diplomats of ABCS and individuals who have completed Clinical Fellowship training).

Cosmetic Surgery Competence (CSC) certificate

On successful completion of P3 training and assessment the candidate is awarded with the Certificate of Cosmetic Surgery Competence. This can be issued with specification for specific skills and procedures or generally for cosmetic surgery with listed anatomical areas where surgical skills were demonstrated.

Possession of the CSC certificate will verify a cosmetic surgeon’s completion of P3 and it will credential his or her expertise.

Renewal of P3

The CSC will require renewal every five years, and will be based on an adapted version of P3.  The re-certification will consists of a mentorship report and skills assessment based on video recording of his or her operations.