- Email: [email protected]
Research options for plastic surgery
Short reports and correspondence presented trismus secondary to the Ramsay Hunt syndrome in the literature.
References 1. Lund TW, Cohen JI. Trismus appliances and indications for use. Quintessence Int 1993;275. 2. Kadyan V, Clairmont AC, Engle M, Colachis SC. Severe trismus as a complication of cerebrovascular accident: a case report. Arch Phys Med Rehabil 2005;594. 3. Sobn AJ, Tranmer PA. Ramsay hunt syndrome in a patient with human immunodeficiency virus infection. J Am Board Fam Pract 2001;392. 4. Syal R, Tyagi I, Goyal A. Bilateral ramsay hunt syndrome in a diabetic patient. BMC Ear Nose Throat Disord 2004;3.
Ali Akyol Nefati Kiylioglu Department of Neurology, Medical Faculty, Adnan Menderes University, 09100 Aydin, Turkey Eray Copcu Plastic and Reconstructive Surgery Department, Adnan Menderes University, 09100 Aydin, Turkey E-mail address: [email protected] q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2005.09.017
Research options for plastic surgery Boyce, Jain and Nanchahal make interesting points,1,2 but I think that what Medicine in the UK needs is a change in the perception of what it is germane and practicable to expect people to cover during Postgraduate Training. This becomes especially relevant in the UK as the Postgraduate Medical Education and Training Board begins to oversee a new system for training newly qualified doctors up to specialist level in only 6 years. Discussion about whether a PhD is better than a MD or MS becomes irrelevant. The fundamental question we need to ask ourselves is what does a specialist trainee need to learn before embarking on independent practice? Few would disagree that prime must be a detailed knowledge of their Specialty—which should be identified and tested during specialist training. But what about those nonclinical, yet fundamental, core skills that are vital to independent specialist practice? Skills that may currently be learned by being tacked on to
207 specialist training variably, as optional short courses dependant on local Deanery priorities and funding. Specialists must be able to interpret published research. They must work within the structure and systems of an organisation and will be subject to management. The same goes for undergraduate, postgraduate and continuing medical education, audit, appraisal and clinical governance—all of which are core skills for the modern specialist. Instead of time in research being used as a hurdle before entering popular specialties, I would like to see a transparent, robust and equitable selection process for entry to specialist training which is based on evidence and recruitment best practice. Thereafter, I would like to see all trainees, in all specialties, embarking together on integrated, modular, postgraduate degrees teaching a nationally agreed and standardised course of fundamental skills (Management; Audit; Ethics; Research Methodology; Study Design and Analysis and Statistics). A pass in these core subjects after 2–3 years part-time study would gain trainees a Masters level degree— representing the required attainment for a Specialist. Thereafter, and only if they wish to, trainees could transfer to a Doctorate, which they would be able to tailor to their interests and the needs of their particular Specialty. They might embark on supervised research or management training or whatever else they wanted. This Doctorate could be finished in a time span that varied, it could be suspended to account for time on Fellowships, or raising children, and it could be made available to established Consultants as part of their continued professional development. Our current system is flawed and so variable as to be unfair. Trainees expend valuable time and resources that could be targeted so much more efficiently and effectively. We could, and should do things better and if we are not willing to change how we allocate such valuable human and financial resources, we inevitably and culpably become part of the problem itself. It behoves us all to improve the lot of future trainees, so although I accept that this idea may not chime with those of some colleagues, I hope it will stimulate further debate within a Specialty that is proud to be rooted in change and innovation.
References 1. Boyce DE. Research options for plastic surgical trainees. Br J Plast Surg 2004;57(5):473. 2. Jain A, Nanchahal J. Research options for plastic surgical trainees. Br J Plast Surg 2002;55(5):427–9.
208
Short reports and correspondence
Adam Greenbaum St. Thomas’ Hospital, Guys and St. Thomas’ NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK E-mail address: [email protected] q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2005.09.004
Extra abdominal desmoid tumour—a long term follow up—further comment Sir, I read with great interest the excellent paper on extra abdominal desmoid tumours and discussion on management.1 Our Unit in Edinburgh reported three such cases which occurred over a 10 year period and also discussed the various treatment options.2 One of these cases which is still alive and well 20 years after initial diagnosis of tumour in her buttock has had a total of nine local surgical procedure on her left lateral thigh and left buttock. She is still fully mobile but she has recently been seen and reports a further area of suspicion in the medial lateral thigh. She has not had radiotherapy or any drug therapy (including tamoxifen) to date. The advice of three ‘World experts’ was sought in her case in 1989 with regard to management.3 All three indicated she would have a variable disease course but concluded
that mutilating surgery including amputation at hind quarter level was unlikely. One suggested radiotherapy for a minor residual tumour mass has been recommended but pointed out prospective studies were lacking. Another of the advisors stated that sarcomatous changes in the absence of previous radiotherapy, does not occur in this condition. Clearly these remain difficult cases to manage and this recent publication emphasises this. The management algorithm suggested seems appropriate.
References 1. Wagstaff MJD, Raurell A, Perks AGB. Multicentre extraabdominal desmoid tumours. Br J Plast Surg 2004;57:362–5. 2. Wilson SW, McGregor JC. Extra-abdominal desmoid tumours— a report of three cases and a review of the literature. Eur J Plast Surg 1995;18:79–81. 3. McGregor JC. Cry for help. Problem case: recurrent desmoid of the extremity. Eur J Plast Surg 1989;12:286–7.
J.C. McGregor Plastic Surgery Department, St John’s Hospital at Howden, Livingston, West Lothian, Edinburgh, Scotland EH54 6PP, UK E-mail address: [email protected] q 2005 Published by Elsevier Ltd on behalf of The British Association of Plastic Surgeons. doi:10.1016/j.bjps.2005.05.012
References 1. Lund TW, Cohen JI. Trismus appliances and indications for use. Quintessence Int 1993;275. 2. Kadyan V, Clairmont AC, Engle M, Colachis SC. Severe trismus as a complication of cerebrovascular accident: a case report. Arch Phys Med Rehabil 2005;594. 3. Sobn AJ, Tranmer PA. Ramsay hunt syndrome in a patient with human immunodeficiency virus infection. J Am Board Fam Pract 2001;392. 4. Syal R, Tyagi I, Goyal A. Bilateral ramsay hunt syndrome in a diabetic patient. BMC Ear Nose Throat Disord 2004;3.
Ali Akyol Nefati Kiylioglu Department of Neurology, Medical Faculty, Adnan Menderes University, 09100 Aydin, Turkey Eray Copcu Plastic and Reconstructive Surgery Department, Adnan Menderes University, 09100 Aydin, Turkey E-mail address: [email protected] q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2005.09.017
Research options for plastic surgery Boyce, Jain and Nanchahal make interesting points,1,2 but I think that what Medicine in the UK needs is a change in the perception of what it is germane and practicable to expect people to cover during Postgraduate Training. This becomes especially relevant in the UK as the Postgraduate Medical Education and Training Board begins to oversee a new system for training newly qualified doctors up to specialist level in only 6 years. Discussion about whether a PhD is better than a MD or MS becomes irrelevant. The fundamental question we need to ask ourselves is what does a specialist trainee need to learn before embarking on independent practice? Few would disagree that prime must be a detailed knowledge of their Specialty—which should be identified and tested during specialist training. But what about those nonclinical, yet fundamental, core skills that are vital to independent specialist practice? Skills that may currently be learned by being tacked on to
207 specialist training variably, as optional short courses dependant on local Deanery priorities and funding. Specialists must be able to interpret published research. They must work within the structure and systems of an organisation and will be subject to management. The same goes for undergraduate, postgraduate and continuing medical education, audit, appraisal and clinical governance—all of which are core skills for the modern specialist. Instead of time in research being used as a hurdle before entering popular specialties, I would like to see a transparent, robust and equitable selection process for entry to specialist training which is based on evidence and recruitment best practice. Thereafter, I would like to see all trainees, in all specialties, embarking together on integrated, modular, postgraduate degrees teaching a nationally agreed and standardised course of fundamental skills (Management; Audit; Ethics; Research Methodology; Study Design and Analysis and Statistics). A pass in these core subjects after 2–3 years part-time study would gain trainees a Masters level degree— representing the required attainment for a Specialist. Thereafter, and only if they wish to, trainees could transfer to a Doctorate, which they would be able to tailor to their interests and the needs of their particular Specialty. They might embark on supervised research or management training or whatever else they wanted. This Doctorate could be finished in a time span that varied, it could be suspended to account for time on Fellowships, or raising children, and it could be made available to established Consultants as part of their continued professional development. Our current system is flawed and so variable as to be unfair. Trainees expend valuable time and resources that could be targeted so much more efficiently and effectively. We could, and should do things better and if we are not willing to change how we allocate such valuable human and financial resources, we inevitably and culpably become part of the problem itself. It behoves us all to improve the lot of future trainees, so although I accept that this idea may not chime with those of some colleagues, I hope it will stimulate further debate within a Specialty that is proud to be rooted in change and innovation.
References 1. Boyce DE. Research options for plastic surgical trainees. Br J Plast Surg 2004;57(5):473. 2. Jain A, Nanchahal J. Research options for plastic surgical trainees. Br J Plast Surg 2002;55(5):427–9.
208
Short reports and correspondence
Adam Greenbaum St. Thomas’ Hospital, Guys and St. Thomas’ NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK E-mail address: [email protected] q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2005.09.004
Extra abdominal desmoid tumour—a long term follow up—further comment Sir, I read with great interest the excellent paper on extra abdominal desmoid tumours and discussion on management.1 Our Unit in Edinburgh reported three such cases which occurred over a 10 year period and also discussed the various treatment options.2 One of these cases which is still alive and well 20 years after initial diagnosis of tumour in her buttock has had a total of nine local surgical procedure on her left lateral thigh and left buttock. She is still fully mobile but she has recently been seen and reports a further area of suspicion in the medial lateral thigh. She has not had radiotherapy or any drug therapy (including tamoxifen) to date. The advice of three ‘World experts’ was sought in her case in 1989 with regard to management.3 All three indicated she would have a variable disease course but concluded
that mutilating surgery including amputation at hind quarter level was unlikely. One suggested radiotherapy for a minor residual tumour mass has been recommended but pointed out prospective studies were lacking. Another of the advisors stated that sarcomatous changes in the absence of previous radiotherapy, does not occur in this condition. Clearly these remain difficult cases to manage and this recent publication emphasises this. The management algorithm suggested seems appropriate.
References 1. Wagstaff MJD, Raurell A, Perks AGB. Multicentre extraabdominal desmoid tumours. Br J Plast Surg 2004;57:362–5. 2. Wilson SW, McGregor JC. Extra-abdominal desmoid tumours— a report of three cases and a review of the literature. Eur J Plast Surg 1995;18:79–81. 3. McGregor JC. Cry for help. Problem case: recurrent desmoid of the extremity. Eur J Plast Surg 1989;12:286–7.
J.C. McGregor Plastic Surgery Department, St John’s Hospital at Howden, Livingston, West Lothian, Edinburgh, Scotland EH54 6PP, UK E-mail address: [email protected] q 2005 Published by Elsevier Ltd on behalf of The British Association of Plastic Surgeons. doi:10.1016/j.bjps.2005.05.012