The Oz experience

SCTS Ionescu Medical Student Travelling Fellowship 2017: The Oz experience

I was awarded the SCTS Ionescu Medical Student Fellowship following the annual meeting in Belfast 2017. This provided me with a unique opportunity to explore Cardiothoracic Surgery, a specialty we are sparsely exposed to within the undergraduate surgical curriculum.

Devan Limbachia, Final Year Medical Student, University of Birmingham

Melbourne is the capital city of was split into a cardiac team and a thoracic the Australian state of Victoria. team, both consisting of multiple consultants, Described as the ‘most liveable registrars, residents and interns. The office city in the world’, I decided to complete my in which the cardiothoracic team were based 4-week medical school elective here in hope of was shared with the respiratory team and experiencing a different healthcare system to therefore, as an added bonus, I was able that of the UK. St Vincent’s Hospital is one of to spend some time with them for the four five large tertiary hospitals in Melbourne with weeks whilst I was there. This was actually particular strengths in Cardiothoracic, Neuro, very beneficial as I was able to appreciate Gastrointestinal, the physiological Micro and Plastic and surgical side of Surgery. As it is thoracics. an established A typical teaching hospital, day would consist of I thought it would a mixture of multibe a fantastic disciplinary team opportunity (MDT) meetings, to increase teaching sessions, wardmy learning based jobs, clinics and opportunities. numerous theatre lists.

During my Days in the placement, I was hospital were very able to work with flexible and I was the cardiothoracic made to feel extremely surgical team welcome. I was able Monday-Friday. to practice my history The department St Vincent’s Hospital, Melbourne taking and clinical skills (venepuncture, cannulation, examinations, etc), run parts of a pre-admission clinic (with supervision) and scrub into theatre. My theatre experience was really interesting and I was able to observe and assist in a number of procedures including: VATS lobectomy and metastasectomy, AVR and CABG. This was invaluable as I was able to practice my surgical skills and develop my confidence in dealing with the wider multidisciplinary surgical team. Fortunately, I was also able to join a number of on-call shifts which encompassed myself and an intern managing acute emergencies for cardiothoracics, respiratory and CCU. This was a thoroughly enjoyable and immersive experience and I learnt a great deal whilst actively getting involved.

During my elective period, I was able to explore the perceptions towards cardiothoracic surgery. Several studies have hypothesised that negative perceptions have led to a reduction in the number of applicants to specialty training in cardiothoracic surgery, using both quantitative and qualitative methods. A relative lack of undergraduate exposure may contribute to this and the use of early intervention, such as medical elective attachments, may

prevent this downward trend. From my own observations, and speaking to medical students and surgeons during my placement, it was apparent that negative perceptions are playing a causative role in the reduction of applicants to cardiothoracic surgery, especially in those without a pre-existing interest in the field. A large array of negative perceptions are generated during the early years of a medic’s career. As such, this has created a discouraging bias towards the specialty.

Working within the cardiothoracic surgical field shows a contrastingly positive environment, although the field still requires improvement to attract more applicants. Early exposure to the specialty may help to remove some of these negative perceptions. Similar opportunities, including work experience, clinical attachments and educational events may be of benefit in providing similar results and should be considered in demonstrating the wonders of cardiothoracic surgery.

Reflection

My elective experience in Melbourne was definitely memorable and I would highly recommend a placement in Cardiothoracic Surgery at St Vincent’s Hospital. The placement reinforced my ambition for a career in the specialty and taught me plenty, from surgical technique to acute management of cardiothoracic emergencies. It was an opportunity to develop both professionally 3. Medical electives are a great tool in providing students with early exposure to the specialty and scholarships such as this will continue to encourage students.

and personally and has given me a base level of understanding, regarding cardiothoracic surgery, which I can develop throughout my career. My hope is to return to Australia in the near future, following my foundation years in Oxford, to gain further hands-on experience!

Take home messages

1. Cardiothoracic surgery is a vast specialty, plentiful in advancing technology - far from a dying specialty! 2. Negative perceptions associated with cardiothoracic surgery are dissonant and active participation and engagement within the field may help to overcome these.

Acknowledgments

I would like to thank everyone who has helped me during my elective period. In particular, I would like to thank my overseas supervisor Mr Gavin Wright and his team, who provided this memorable experience. Finally, I would like to extend my appreciation to Mr and Dr Ionescu and the SCTS for granting me this fellowship, which has allowed me to complete this fantastic opportunity. n

Jerusalem Cardiothoracic Surgery Elective 2017

Eyal Ben-David, 5th year medical student, St George’s

The Ein-Kerem campus of the Hadassah Medical Center is a beautiful hospital that overlooks the gorgeous hills of Jerusalem. One third of the patient population is orthodox Jewish and one third is Palestinian, the hospital truly abides by its mission – “to extend a hand to all, without regard for race, religion or ethnic origin”.

I spent six extremely educational weeks in the cardiothoracic surgery department. Many hours were spent in the operating theatre, assisting in a variety of interesting and complex operations in cardiac, thoracic and paediatric surgery. I developed my surgical skills, learned the principles of cardiopulmonary bypass and myocardial protection and increased my understanding of many different operations. I found paediatric surgery to be particularly fascinating.

Whilst in Jerusalem, I became involved in a clinical research project evaluating the ability of 30-day mortality predictive models (Society of Thoracic Surgeons Predicted Risk of Mortality, Euroscore 2 and the Logistic EuroSCORE 1) to predict long-term survival following cardiac surgery, working with a team of cardiac surgeons and statisticians. This work has been submitted to the American Society of Thoracic Surgeons annual meeting and is being prepared for submission to a high impact-factor journal. The work was also submitted to the 2018 SCTS annual meeting.

Overall, I had an incredible experience and am extremely motivated to become a cardiac surgeon. None of this would have been possible without the fellowship money which went towards my flights. I am extremely grateful to the SCTS. n