My Elective Experience in the UK

Jun Jie Lim

Country of Elective – United Kingdom

City/Hospital of Elective – Newcastle, Royal Victoria Infirmary

Specialty – Plastic surgery

Dates – 23.5.2022- 29.7.2022

Section 1: Introduction

I am a final year medical student from Newcastle University Medicine Malaysia. One of my 4th-year electives was a 9-week placement in the Department of Plastic and Reconstructive Surgery at Royal Victoria Infirmary. I am most passionate about reconstructive and aesthetic surgery because I firmly believe that restoring and refining an individual's appearance significantly improves their quality of life.

Section 2: About the Elective, the hospital, specialty, what you got up to day-to-day, interesting cases

The Royal Victoria Infirmary has a large plastic surgery department with over fifteen plastic surgeons. During my first day of elective, I found it challenging to find my way around as there were no introductions or tours provided, unlike James Cook University Hospital, where I did my elective in Neurology (something to take note of!).

Throughout my electives, I scrubbed in and assisted with skin cancer excisions, craniofacial surgeries, upper and lower limb hand reconstructions, and breast and flap reconstructions, all with supervision and teaching from friendly surgeons. I loved the diversity, inclusivity, and camaraderie among the team. I even went in on weekends to assist with emergency trauma cases and for more time with the most outstanding surgeons and theatre staff I have ever met. I explored an extensive range of subspecialties, including hand, burns, cleft lip and palate, head and neck cancer, skin cancer, breast, and trauma.

Besides shadowing your allocated supervisor, I would suggest finding the opportunity to attend theatres by Mr. Martin Joseph, Mr Kiron Koshy, Mr Aidan Rose, Mr Maniram Ragbir, Mr Dan Saleh, Mr Christopher Lewis and Mr Sanjay Varma as they are excellent surgeons and teachers. I would also like to thank theatre nurses Chris, Elaine, and Carole for being so welcoming and friendly! I am glad to have made friends with elective students from Germany, France and local Newcastle University students who are passionate about plastic surgery.

An interesting case:

"I was involved in an awe-inspiring case of extralevator abdominoperineal resection, total pelvic exenteration, and urinary diversion using an ileal conduit for advanced rectal carcinoma. Three different surgical specialities were involved in this procedure namely colorectal surgery, urology and plastic surgery. Anaesthetics and critical care were also integral for the procedure and perioperative management. This demonstrated the importance of effective team work for the successful outcome of this case. The initial part of the surgery (namely the resection and urinary conduit) was performed by the colorectal surgeon and the urologist. The abdominal part of the procedure was done with the DaVinci Robot and I got the chance to sit in the robotic console and feel the controls. The final part of the procedure was the perineal defect reconstruction using a gluteal turnover flap which was performed by my supervisor (plastic surgeon). I was able to scrub in and assist for this part. Compared to the traditional approach for perineal reconstruction (V-Y inferior gluteal artery perforator flap (IGAP)), the gluteal turnover flap is a relatively new technique that involves less extensive incisions. This, in turn, translates to quicker recovery time, and the patient was able to lie on his back sooner after the surgery. The entire procedure lasted around 10 hours (it was long but exciting to watch!). I find this case exceptionally memorable as it enlightened me on the importance of multidisciplinary teamwork and continually improving your competency and knowledge to deliver the best outcomes for your patient."

Supervisors:

Mr. Martin Joseph was my placement supervisor. Mr. Martin was a very kind surgeon, as he would ensure that medical students like me are involved in the surgery. He would also find opportunities to teach and check in regularly to ask if there was anything I needed or was having difficulties with.

Academic opportunities:

Mr. Martin suggests that I audit the recording of operation dates on operation notes. He noticed that dates of operation notes were not consistently recorded, which could potentially affect treatment planning and follow-up, patient transfer to another health facility, and results in medico-legal consequences. With his guidance, I performed the audit and presented it at the clinical governance meeting. I also presented the project at the NUMed Academic Conference 2022 and won the first prize for the oral presentation. If you are interested, I suggest contacting Dr. David Sainsbury, the department's audit lead, for project opportunities.

Teaching opportunities:

As the most senior medical student on the team, I am glad to be mentoring junior medical students and teaching them about anatomy, principles of reconstructions, theories and concepts of surgical procedures, and suturing skills, which were introduced to me by my supervisor.

Section 3: About the City/Country, travelling and experiences

Newcastle is a beautiful city and the people in Newcastle are friendly. Besides exploring the movie-scene-like Grainger Street, I have visited Tynemouth and Whitby. I would suggest buying a railcard if you travel a lot!

Section 4: How you applied/made contacts and was accepted for the elective plus any tips and tricks

As a Newcastle University Medicine Malaysia student, the elective application process to the Northern deanery is straightforward. I filled up a form sent by the student office and was allocated my first-choice elective in plastic surgery on a first-come-first-serve basis. The choice of hospital and supervisors were allocated randomly.

I have spoken to elective students from other countries, such as Germany and France, regarding their application process. In short, they are required to apply to the Newcastle NHS foundation trust and pay a few hundred pounds.

Section 5: Practicalities such as accommodation and how to prepare for the elective

I stayed at The Chare, under Mr Roddy Yang, for around 85 pounds a week. I recommend the accommodation, as Royal Victoria Infirmary and the city centre are just five minutes away! Other popular accommodations are Garth Heads, Bryson Central, and QuayPoint Unite Students.

Section 6: Tips and Tricks/ Recommendations for students wishing to pursue a similar elective

If you would like to be prepared, I recommend purchasing a suturing kit and practicing basic suturing skills, as they would become handy when the opportunity strikes in the theatre. I would also recommend Oxford Specialist Handbooks: Plastic and Reconstructive Surgery, as it contains answers to most questions asked by my supervisor and other surgeons. Most importantly, I recommend being inquisitive and enthusiastic and demonstrating eagerness to learn.

Section 8: Conclusion

In conclusion, plastic surgery is a good start if you are unsure about a career in surgery, as many minor surgeries last under an hour, which is great for you to dip your toes. I find the elective very inspiring, and I am grateful to meet a brilliant, kind, and supportive surgeon who was passionate about plastic surgery and teaching. I have applied for a specialised foundation programme in Northern, which included a rotation in the same plastic surgery department, as I wish to re-live the magic of plastic surgery!