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Trainee involvement in Global Reconstructive Surgery

An ever-increasing body of plastic surgery trainees are expressing their desire to be involved in global surgery during their training. Here we explore the possibilities and opportunities – we encourage you to get involved!

 

Why Should Trainees Get Involved in Global Reconstructive Surgery?

Being able to help people in developing world countries may have been one of the reasons you chose a career in plastic surgery in the first place or alternatively your interest in global surgery may have come later. Whatever your personal reasons to want to get involved, there are many reasons why engagement in global surgery as early as possible in you career is a positive venture.

 

Here we outline 3 key reasons:

  1. Satisfaction and reward of using your skills to help populations less fortunate
  2. Trainees have attributes that will benefit the field of global surgery
    • Enthusiasm
    • Energy
    • New ideas, innovation and IT skills
    • Networking
  3. Acquire skills, knowledge and insight to be able to practice effectively as a global reconstructive surgeon when fully qualified

Trainees can indisputably play an important role in global surgery and bring a lot to the table. The question is no longer about whether trainees should be involved but about how to get them involved.

 

Practical aspects of trainee involvement in global reconstructive surgery:

  • What role can trainees play?

  • How do you train to be a global reconstructive surgeon?

Many trainees express a desire to be involved in global reconstructive surgery but are not sure how to go about it during their training. Training, by definition, is to ‘acquire particular skills and behaviours’. But how do you actually go about training to be a global surgeon and be able to demonstrate on your CV that you are adequately qualified for the role?

It is true, that currently within the UK surgical training system there is a lack of a formalised pathway for trainees to follow if they are interested in a career involving global surgery. However, it is also true that there has never been a better time to have an interest in global surgery as a trainee because there has been a rapid expansion of global surgery opportunities for trainees in recent years. Your involvement will depend on what sort of activities you want to be involved with as a global surgeon (see above section).

Here we divide opportunities in global surgery during training

At home in HIC (High Income Countries)

    1. Volunteer with charitable organisations linked with global reconstructive surgery – there are lots if UK based charities in this domain involved with different subspecialties (i.e. cleft, craniofacial, burns etc.) in many countries round the world. UK based activities for these organisations can include raining awareness, strategy development and fund raising.
    2. Join trainee global surgery groups – BFIRST Trainees have been set up to encourage plastic surgery trainee involvement in global surgery and we would love to have you involved. With BFIRST Trainees you can get involved in many ways in the UK including assisting with et overseas fellows when they come to spend time in UK Plastics Units.

There are also lots of other trainee groups and initiative with which we collaborate and with which you can join:

  1. GASOC (Global Anaesthesia, Surgery and Obstetric Collaboration) – A national UK global surgery society for trainees. GASOC run many activities and courses. Of note GASOC run a regular global surgery journal club across three sites (London, Oxford and Glasgow) with live YouTube feeds. Email gasocuk@gmail.com for more information
  2. RGSC (Resident Global Surgery Collaborative) – an online plastic surgery trainee initiative to discuss cases and literature relevant to global reconstructive surgery. You can get involved with the online meetings by emailing Zavira Heinze (zaviraheinze@gmail.com)

 

COURSES – there are a growing number of courses to improve skills in global surgery. An example of some of these:

2018: Global Surgery Course in Oxford – this year inaugural version of this 5-day course in global surgery held in Oxford and run by the Oxford University Global Surgery Group from 10-14th September Visit the website.

2019: RCS England STAE Course (Surgical Training for Austere Environments) – set up by Mr David Nott, this 5 day course has established a reputation for teaching strategies and techniques to surgeons working in austere environments. Visit the website.

CONFERENCES – there are an increasing number of conferences but the most established UK conferences include:

  1. Global Surgical Frontiers organised by RCS England
  2. BSSH / BFIRST Overseas Day – an annual event each Spring focusing on global reconstructive surgery

RESEARCH – it is now possible to have an academic career in global surgery. Some of the options available when gaining experience in this area are:

  1. Diploma in Tropical Medicine – The London School of Hygiene and Tropical Medicine have a good reputation for their diploma programme.
  2. Masters in Public Health (MPH)– this will give you skills in the way healthcare services run, healthcare economics and epidemiology. Lots of universities around the UK are offering this qualification on a part or full-time basis.
  • Program in Global Surgery and Social Change (PGSSC) – run by the Harvard Medical School in USA, trainees can apply for a 2-year program which can include an MPH.
  1. Masters in Global Health with a specialist pathway in Global Surgery – launched in 2012 and run by King’s College in London.
  2. NIHR Global Surgery Research Unit – a collaboration between the Universities of Birmingham, Edinburgh and Warwick, together with the GlobalSurg – developed to support collaborative global surgery research initiatives.

 

Overseas to LMIC (Low and Middle Income Countries)

If you do get the opportunity to go overseas to a LMIC during your training it is worth making sure you make the most of it, you are an asset and your actions are appropriate. A few general principles apply:

  • You should not be doing things abroad that you are not allowed to do at home – the most obvious example of this is surgical operating – UK trainees are supervised in the operating theatre within the training programme structure and the same principles should apply when overseas.
  • HIC Trainees should not usurp training opportunities from LMIC trainees overseas – local trainees should get priority over the training opportunities available

 

The diagram below gives some activities you might be able to get involved in at different stages of your career as a trainee in global surgery.

How do you secure time during training to get involved in global surgery?

Currently there is no consensus regarding trainees taking time during their training towards activities relating to global surgery. For short periods of time, trainees have previously reported taking annual leave or study leave at the discretion of their educational supervisor. Longer periods of time during training (OOPT / OOPE / OOPR / OOPC) will need to be approved at the discretion of your programme director and the SAC.

 

BFIRST Trainees are advocating on behalf of UK plastic surgery trainees for a consensus agreement to support trainees to take time during their training for engagement with global surgery. We will keep you updated on our progress!

 

How do you secure funding during training to get involved in global surgery?

Small scale funding for global surgery projects can be sought from bursary schemes. These include:

  • BSSH Overseas Fellowship – created to facilitate trainee involvement in global hand surgery – allows the trainee to accompany and assist one of the BSSH overseas trips
  • ASiT Global Surgery Award – Annual award of 3x£500 for projects relating to surgical training in a low-resource setting
  • BAPRAS offer a number of bursaries – whilst not directly relating to trainee involvement in global surgery they might link to an aspect of the work

Larger scale funding for significant research project sin global surgery may become more likely following the recent investment by the NIHR into the global surgery research unit.

 

How do I find out more about global reconstructive surgery?

Here are some useful websites and resources for further information in this exciting and worthwhile cause: