- Email: [email protected]
Experience of plastic surgery as an undergraduate – vital for the future of the specialty!
Short reports and correspondence
235 Experience of plastic surgery as an undergraduate e vital for the future of the specialty!
Figure 2 X-Ray lateral view showing location of pellet close to second metacarpal.
alternative to the use of an image intensifier. If the right angle of incidence of the probe is applied the anaesthetists are able to identify needles going into vessels or near nerves hence, theoretically, we should be able to see small foreign bodies that depend on the reflectance of the ultrasound waves. As with an ultrasound scan, this is operator dependent. In our opinion this technique is a useful adjunct to aid removal of hard-to-locate foreign bodies, especially within mobile structures such as muscle.
References 1. Cakir B, Akan M, Yildirim S, et al. Localization and removal of ferromagnetic foreign bodies by magnet. Ann Plast Surg 2002;49:541e4. 2. Font VE, Gill CC, Lammermeier DE. Echocardiographically guided removal of an intracardiac foreign body. Cleve Clin J Med 1994;61:228. 3. Sciliano CJ, Lefkowitz H. Removal of intraosseous foreign body in the calcaneus utilizing a fluoroscopically guided bone trephine. J Foot Ankle Surg 1994;33:83. 4. Shiels WE, Babcock DS, Wilson JL, et al. Localization and guided removal of soft tissue foreign bodies with sonography. AJR Am J Roentgenol 1990;155:1277e81. 5. Crawford R, Matheson AB. Clinical value of ultrasonography in the detection and removal of radiolucent foreign bodies. Injury 1989;20:341e3.
Vikranth Visvanathan David McGill Shivram Singh E.J. DaSilva Department of Plastic, Reconstructive and Hand Surgery, University Hospital Birmingham NHS Trust, Birmingham B29 6JD, West Midlands, UK E-mail address: [email protected]
We read the correspondence from Al-Nuaimi et al. with interest.1 They have highlighted the importance of undergraduate teaching of plastic surgery for its educational benefits and now, with the introduction of Modernising Medical Careers (MMC), for the student to be able to make an informed future career choice. Another issue that has arisen is this: with no undergraduate exposure to the specialty there will be certain parts of the medical fraternity that progress through their career with no true understanding of what the regional plastic surgery unit actually does. The perception of the specialty has previously been studied but was brought to the fore by a recent online debate on the BMJ website.2,3 In Aberdeen we are privileged to be on the curriculum of Aberdeen University Medical School, and all students have a period of designated plastic surgery teaching, albeit only two lectures in their 2nd year and a 2-week clinical attachment in their 4th year. The aims of the lectures are to provide an overview of the specialty. This gives the students a basic understanding of the specialty before they attend for their clinical attachment later in their course. The students are timetabled to attend a variety of commitments from outpatient and dressing clinics to outpatient local anaesthetic lists or main theatre, as well as being given specifically prepared tutorials, aimed at the undergraduate level. In addition to the clinical attachments, students also complete the plastic surgery computer-assisted learning (CAL) packages run by the university but designed by our team. These consist of online tutorials that the students go through and include burns management, skin malignancies, general plastic surgery and the reconstructive ladder, and we are currently preparing a package on hand injuries. We are currently auditing our undergraduate teaching methods and feedback has been extremely positive. Students are asked to fill out assessment forms with a modified Likert scale for the CAL and how it related to the clinical attachment. Our pilot has given us 47 responses. All the students agreed that the CAL package aided understanding of the role of plastic surgery (Fig. 1). When asked if the CAL package made their clinical attachment more relevant overall 93.5% agreed (Fig. 2). We find that with the interest stimulated, even during their short attachment, we often have students coming The CAL has aided my understanding of the role of plastic surgery 70.0% 57.4%
60.0% 50.0%
42.6%
40.0% 30.0% 20.0%
ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.08.016
10.0% 0.0% Strongly disagree
disagree
neither
Figure 1
agree
strongly agree
236
Short reports and correspondence The CAL has aided in the relevence of my plastic surgery attachment
70.0% 58.7%
60.0% 50.0% 34.8%
40.0% 30.0% 20.0% 10.0%
2.2%
4.3%
disagree
neither
Figure 1 Image reproduction describing the bridging technique in KCI’s 2005 guidelines.
0.0% Strongly disagree
agree
strongly agree
Figure 2
back looking for information about electives or audit projects and we are confident that whether the students chose to undertake surgical training or another specialty, they will have an understanding of the service that a plastic surgery department provides. We currently have six students undertaking final year electives out of a class of 200, all of whom are serious about pursuing a career in plastic surgery. We believe that the key is ongoing exposure to our department as undergraduates with a variety of teaching methods available. The combination of the students’ clinical attachment and the CAL package has been extremely beneficial for the undergraduates and, at a time when the future of medical training is uncertain, it is vital that our specialty continues to attract suitable candidates.
References
in noncontiguous wounds’ by Culliford et al.1 Subatmospheric suction has become an intrinsic part of the plastic surgeon’s repertoire in managing the difficult wound. Employing a ‘bridge’ of sponge to connect disparate wounds and eliminate the need for multiple suction pumps is an excellent idea both physically and financially. However, regular vacuum-assisted closure (VAC) users should be familiar with this method illustrated (Fig. 1) in both the latest revised Clinical Guidelines published by Kinetic Concepts, Inc. (KCI) in November 20052 and their earlier 2001 version.3 Review of the literature reveals what appears to be the first documentation of the bridging technique, in a paper from 1999, studying disparate wounds of the lower extremities.4 Whilst we welcome this most useful technique being brought to wider attention, we respectfully suggest it not to be as novel as claimed.1
References
1. Al-Nuaimi Y, McGrouther G, Bayat A. Modernizing medical careers in the UK and plastic surgery as a possible career choice: undergraduate opinions. J Plast Reconstr Aesthet Surg 2006; 59:1472e3. 2. Dunkin CSJ, Pleat JM, Jones SA, et al. Perception and reality e a study of public and professional perceptions of plastic surgery. Br J Plast Surg 2003;56:437e43. 3. Zaman MJS. We don’t need another 400 plastic surgeons. BMJ 2007;334:44.
Neil Bremner Michaela Davies Stuart Waterston Aberdeen Royal Infirmary, Aberdeen, UK E-mail address: [email protected] ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.10.005
Re: ‘A novel technique for vacuum assisted closure device application in noncontiguous wounds’ We read with interest the paper entitled ‘A novel technique for vacuum assisted closure device application
1. Culliford IV AT, Spector JA, Levine JP. A novel technique for vacuum assisted closure device application in noncontiguous wounds. J Plast Reconstr Aesthet Surg 2007;60:99e102. 2. KCI.V.A.C. Therapy Clinical Guidelines: A Reference Source for Clinicians. Revised edition. November 2005; London: ISBN 90-78026-01-4. 3. KCI. V.A.C. Recommended Guidelines for Use: Physician & Caregiver Reference Manual. May 2001. 4. Greer SE, Duthie E, Cartolano B, et al. Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy. J Wound Ostomy Continence Nurs 1999;26: 250e3.
Karen Woo Department of Cardiothoracic Surgery, St Mary’s Hospital, Paddington, London, UK E-mail address: [email protected] M.G. Berry Department of Plastic & Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.10.027
235 Experience of plastic surgery as an undergraduate e vital for the future of the specialty!
Figure 2 X-Ray lateral view showing location of pellet close to second metacarpal.
alternative to the use of an image intensifier. If the right angle of incidence of the probe is applied the anaesthetists are able to identify needles going into vessels or near nerves hence, theoretically, we should be able to see small foreign bodies that depend on the reflectance of the ultrasound waves. As with an ultrasound scan, this is operator dependent. In our opinion this technique is a useful adjunct to aid removal of hard-to-locate foreign bodies, especially within mobile structures such as muscle.
References 1. Cakir B, Akan M, Yildirim S, et al. Localization and removal of ferromagnetic foreign bodies by magnet. Ann Plast Surg 2002;49:541e4. 2. Font VE, Gill CC, Lammermeier DE. Echocardiographically guided removal of an intracardiac foreign body. Cleve Clin J Med 1994;61:228. 3. Sciliano CJ, Lefkowitz H. Removal of intraosseous foreign body in the calcaneus utilizing a fluoroscopically guided bone trephine. J Foot Ankle Surg 1994;33:83. 4. Shiels WE, Babcock DS, Wilson JL, et al. Localization and guided removal of soft tissue foreign bodies with sonography. AJR Am J Roentgenol 1990;155:1277e81. 5. Crawford R, Matheson AB. Clinical value of ultrasonography in the detection and removal of radiolucent foreign bodies. Injury 1989;20:341e3.
Vikranth Visvanathan David McGill Shivram Singh E.J. DaSilva Department of Plastic, Reconstructive and Hand Surgery, University Hospital Birmingham NHS Trust, Birmingham B29 6JD, West Midlands, UK E-mail address: [email protected]
We read the correspondence from Al-Nuaimi et al. with interest.1 They have highlighted the importance of undergraduate teaching of plastic surgery for its educational benefits and now, with the introduction of Modernising Medical Careers (MMC), for the student to be able to make an informed future career choice. Another issue that has arisen is this: with no undergraduate exposure to the specialty there will be certain parts of the medical fraternity that progress through their career with no true understanding of what the regional plastic surgery unit actually does. The perception of the specialty has previously been studied but was brought to the fore by a recent online debate on the BMJ website.2,3 In Aberdeen we are privileged to be on the curriculum of Aberdeen University Medical School, and all students have a period of designated plastic surgery teaching, albeit only two lectures in their 2nd year and a 2-week clinical attachment in their 4th year. The aims of the lectures are to provide an overview of the specialty. This gives the students a basic understanding of the specialty before they attend for their clinical attachment later in their course. The students are timetabled to attend a variety of commitments from outpatient and dressing clinics to outpatient local anaesthetic lists or main theatre, as well as being given specifically prepared tutorials, aimed at the undergraduate level. In addition to the clinical attachments, students also complete the plastic surgery computer-assisted learning (CAL) packages run by the university but designed by our team. These consist of online tutorials that the students go through and include burns management, skin malignancies, general plastic surgery and the reconstructive ladder, and we are currently preparing a package on hand injuries. We are currently auditing our undergraduate teaching methods and feedback has been extremely positive. Students are asked to fill out assessment forms with a modified Likert scale for the CAL and how it related to the clinical attachment. Our pilot has given us 47 responses. All the students agreed that the CAL package aided understanding of the role of plastic surgery (Fig. 1). When asked if the CAL package made their clinical attachment more relevant overall 93.5% agreed (Fig. 2). We find that with the interest stimulated, even during their short attachment, we often have students coming The CAL has aided my understanding of the role of plastic surgery 70.0% 57.4%
60.0% 50.0%
42.6%
40.0% 30.0% 20.0%
ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.08.016
10.0% 0.0% Strongly disagree
disagree
neither
Figure 1
agree
strongly agree
236
Short reports and correspondence The CAL has aided in the relevence of my plastic surgery attachment
70.0% 58.7%
60.0% 50.0% 34.8%
40.0% 30.0% 20.0% 10.0%
2.2%
4.3%
disagree
neither
Figure 1 Image reproduction describing the bridging technique in KCI’s 2005 guidelines.
0.0% Strongly disagree
agree
strongly agree
Figure 2
back looking for information about electives or audit projects and we are confident that whether the students chose to undertake surgical training or another specialty, they will have an understanding of the service that a plastic surgery department provides. We currently have six students undertaking final year electives out of a class of 200, all of whom are serious about pursuing a career in plastic surgery. We believe that the key is ongoing exposure to our department as undergraduates with a variety of teaching methods available. The combination of the students’ clinical attachment and the CAL package has been extremely beneficial for the undergraduates and, at a time when the future of medical training is uncertain, it is vital that our specialty continues to attract suitable candidates.
References
in noncontiguous wounds’ by Culliford et al.1 Subatmospheric suction has become an intrinsic part of the plastic surgeon’s repertoire in managing the difficult wound. Employing a ‘bridge’ of sponge to connect disparate wounds and eliminate the need for multiple suction pumps is an excellent idea both physically and financially. However, regular vacuum-assisted closure (VAC) users should be familiar with this method illustrated (Fig. 1) in both the latest revised Clinical Guidelines published by Kinetic Concepts, Inc. (KCI) in November 20052 and their earlier 2001 version.3 Review of the literature reveals what appears to be the first documentation of the bridging technique, in a paper from 1999, studying disparate wounds of the lower extremities.4 Whilst we welcome this most useful technique being brought to wider attention, we respectfully suggest it not to be as novel as claimed.1
References
1. Al-Nuaimi Y, McGrouther G, Bayat A. Modernizing medical careers in the UK and plastic surgery as a possible career choice: undergraduate opinions. J Plast Reconstr Aesthet Surg 2006; 59:1472e3. 2. Dunkin CSJ, Pleat JM, Jones SA, et al. Perception and reality e a study of public and professional perceptions of plastic surgery. Br J Plast Surg 2003;56:437e43. 3. Zaman MJS. We don’t need another 400 plastic surgeons. BMJ 2007;334:44.
Neil Bremner Michaela Davies Stuart Waterston Aberdeen Royal Infirmary, Aberdeen, UK E-mail address: [email protected] ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.10.005
Re: ‘A novel technique for vacuum assisted closure device application in noncontiguous wounds’ We read with interest the paper entitled ‘A novel technique for vacuum assisted closure device application
1. Culliford IV AT, Spector JA, Levine JP. A novel technique for vacuum assisted closure device application in noncontiguous wounds. J Plast Reconstr Aesthet Surg 2007;60:99e102. 2. KCI.V.A.C. Therapy Clinical Guidelines: A Reference Source for Clinicians. Revised edition. November 2005; London: ISBN 90-78026-01-4. 3. KCI. V.A.C. Recommended Guidelines for Use: Physician & Caregiver Reference Manual. May 2001. 4. Greer SE, Duthie E, Cartolano B, et al. Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy. J Wound Ostomy Continence Nurs 1999;26: 250e3.
Karen Woo Department of Cardiothoracic Surgery, St Mary’s Hospital, Paddington, London, UK E-mail address: [email protected] M.G. Berry Department of Plastic & Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.10.027