Plastic surgery senior house officers in the UK and Ireland: academic background, publication rates and research plans.

Academic achievements by surgical trainees may vary according to the competitiveness of the subspecialty and desirability of the consultant post. Plastic and reconstructive surgery is a competitive specialty. In order to assess the level of achievement of current trainees, we investigated the academic qualifications, publication rates and future research plans of 100 senior house officers in plastic surgery working in units in the United Kingdom and Ireland. Selected results from our survey show that 30% had intercalated degrees, 6% had higher degrees, 58% of trainees had MRCS, 37% had previous plastic surgery experience and 57% had published (range 1-13). We believe this study provides interesting information concerning the current crop of plastic surgery trainees in the United Kingdom and Ireland. This survey may provide a benchmark for consultants to refer to when shortlisting for SHO posts. We also believe it will be of interest to those junior trainees hoping to pursue a career in plastic surgery.     

Hirudo Medicinalis and the plastic surgeon.

Medicinal leech therapy is an ancient craft that dates back to ancient Egypt and the beginnings of civilisation. The popularity of Hirudo Medicinalis has varied throughout history, reaching such a peak in Europe in the early 19th century that supplies were exhausted. During the latter half of the 19th century, their use fell out of favour, as they did not fit in with the emerging concepts of modern medicine. Leeches have enjoyed a renaissance in the world of reconstructive microsurgery during recent years, and their first reported use in alleviating venous engorgement following flap surgery was reported in this journal [M Derganc, F Zdravic, Venous congestion of flaps treated by application of leeches, Br J Plast Surg 13 (1960) 187]. Contemporary plastic and reconstructive surgeons in units throughout the United Kingdom and Ireland continue to use leeches to aid salvage of failing flaps. We carried out a survey of all 62 plastic surgery units in the United Kingdom and the Republic of Ireland to assess the current extent of use, and to investigate current practice. We have shown that the majority of plastic surgery units in the UK and Ireland use leeches post-operatively and that the average number of patients requiring leech therapy was 10 cases per unit per year. Almost all units use antibiotic prophylaxis, but the type of antibiotic and combination used is variable. We outline current practice and suggest a protocol for the use of leeches. Whilst the use of leeches is widespread, the plastic surgery community has progressed little in defining indications for their use or in achieving an accepted protocol for their application in units throughout the UK and Ireland.     

UK paediatric surgical academic output (2005–2020): A cause for concern?

BackgroundThe publication record can be regarded as a key metric of the academic output of a craft surgical speciality with an almost exponential increase in the number of such publications worldwide over the past 20 years (Ashfaq et al. J Surg Res 2018;229:10–11). We aimed to examine and explore if this was the experience within UK paediatric surgery centres.MethodsThe academic search engine Scopus™ (Elsevier) was used to track every paediatric surgeon's (NHS or University) publication history between Jan. 2005 – Dec. 2020. This was validated by an algorithmic search of PubMed™. The h-index (citations/publication), considered a validated metric of career academic output, was also calculated for each individual surgeon. A Field-Weighted Citation Index (Scopus™) (FWCI) was used to assess impact of individual publications. Textbooks, book chapters, abstracts, duplications (“double dipping“) and output attributed to UK BAPS-CASS national studies were excluded. Some output(s), not considered as relevant to “paediatric surgery”, was edited. Data are quoted as median(range).ResultsDuring this 16-year period, there were 3838 publications identified from 26 centres with a “top ten” listing of those paediatric surgical units contributing over half the output (n = 2189, 57%). To look for evidence of trend(s) we analysed the output from these surgical centres in two 5-year periods (2005–9 and 2015–19) and showed an overall fall in output(s) - [730 (53.4%) to 645 (46.4%)] with 6/10 (60%) ‘ top ten ‘ centres here recording a reduction in publications. The median h-index of the 232 contributing paediatric surgical consultants was 12 (range 1–56). The best performing publication from the “top ten” centres had 96.5(51–442) citations with the FWCI being 4.5 (2.2 – 30.2).ConclusionsThis study highlights current paediatric surgery publication output metrics in UK centres. There is evidence of a relative reduction in outputs overall which is a cause for concern for the future, although individual publications from the 10 most active units in the UK remain highly cited. These findings may serve purpose in several ways: (i) UK paediatric surgical centre rankings may be helpful for guiding residency / trainee application; (ii) surgical research funding for the top performing units may be better facilitated and finally (iii) UK centres showing a ‘ fertile ground ‘ for nurturing and training paediatric surgeons with academic aspirations could be useful for future workforce planning.     

BAUS Section of Academic Urology

The BAUS Section of Academic Urology, under the Chairmanship of Professor Kilian Mellon, joined the Society of Academic and Research Surgery for their Annual Meeting on 7 January 2010 at the Royal Free Hospital. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards

BackgroundOpen fractures of the lower limb represent a complex and varied array of injuries. The BOAST 4 document produced by BAPRAS and the BOA provides standards on how to manage these patients, and NICE have recently produced additional guidance. We aimed to assess concordance with these standards in a large cohort representative of UK orthoplastic centres.MethodsPatients admitted to the orthoplastic units at Norfolk and Norwich University Hospital and Royal Stoke University Hospital with open lower limb fractures between 2009 and 2014 were included. Data was gathered from notes and endpoints based on the BOAST 4 document.ResultsIn total, 84 patients were included across the two sites, with 83 having their initial debridement within 24 h (98.8%). Forty-two patients had a documented out-of-hours initial surgery. Of these, 10 (23.8%) had an indication for urgent surgery. This pattern was consistent across both hospitals. A plastic surgeon was present at 33.3% of initial operations. Of 78 patients receiving definitive soft tissue cover, 56.4% had cover within 72 h and 78.2% within 7 days. Main reasons for missing these targets were transfer from other hospitals, plastic surgeons not present at initial operation and intervening critical illness.ConclusionsThis study has identified key areas for improving compliance with the national BOAST 4 and NICE standards. Out-of-hours operating is occurring unnecessarily and time targets are being missed. The development of dedicated referral pathways and a true orthoplastic approach are required to improve the management of this complex set of injuries.     

Incomplete excision of basal cell carcinoma: a prospective multicentre audit.

The audit of incomplete excision of basal cell carcinoma can be used as a parameter for clinical governance in plastic surgery units. However, there are no national standards, and all the previous reports from the UK have been retrospective and from regional units only. This 1 year prospective audit was undertaken simultaneously in the plastic surgery units of three different categories of hospital: a regional plastic surgery unit (University Hospital of South Manchester), a supraregional cancer hospital (Christie Hospital) and a district general hospital (Royal Bolton Hospital). A total of 757 lesions were excised from 600 patients, with 34 lesions (4.5%) being incompletely excised. The incidences of incomplete excision were similar in the regional unit (3.2%) and the district general hospital (3.1%), but higher in the supraregional cancer hospital (7.5%). The commonest site for incomplete excision was the eyebrow, followed by the postauricular area, the nose and the temple. There were no statistically significant differences in the distributions of the age and sex of the patients, the site and size of the lesions or the methods of repair between the three hospitals. However, there were significant differences in the distribution of syndromal, multiple and recurrent lesions, the grade of surgeon, and the clinical and histological subtypes. When the various confounding factors were adjusted by logistic regression, the variables most likely to have affected the incidence of incomplete excision were found to be grade of surgeon, minimal excision margin and histological subtype.     

A national survey (NAP5‐Ireland baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in Ireland

As part of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland concerning accidental awareness during general anaesthesia, we issued a questionnaire to every consultant anaesthetist in each of 46 public hospitals in Ireland, represented by 41 local co‐ordinators. The survey ascertained the number of new cases of accidental awareness becoming known to them for patients under their care or supervision for a calendar year, as well as their career experience. Consultants from all hospitals responded, with an individual response rate of 87% (299 anaesthetists). There were eight new cases of accidental awareness that became known to consultants in 2011; an estimated incidence of 1:23 366. Two out of the eight cases (25%) occurred at or after induction of anaesthesia, but before surgery; four cases (50%) occurred during surgery; and two cases (25%) occurred after surgery was complete, but before full emergence. Four cases were associated with pain or distress (50%), one after an experience at induction and three after experiences during surgery. There were no formal complaints or legal actions that arose in 2011 related to awareness. Depth of anaesthesia monitoring was reported to be available in 33 (80%) departments, and was used by 184 consultants (62%), 18 (6%) routinely. None of the 46 hospitals had a policy to prevent or manage awareness. Similar to the results of a larger survey in the UK, the disparity between the incidence of awareness as known to anaesthetists and that reported in trials warrants explanation. Compared with UK practice, there appears to be greater use of depth of anaesthesia monitoring in Ireland, although this is still infrequent.     

Novel method for assessment and selection of trainees for higher surgical training in general surgery

The aim of the study was to select surgeons for a higher surgical training in general surgery programme at the Royal College of Surgeons in Ireland (RCSI) using an objective, transparent and fair assessment programme. Thirty-two individuals applied for higher surgical training in general surgery in Ireland in 2006. Sixteen applicants were short-listed for interview and further assessment. All applicants were required to report on their education performance at undergraduate level and their postgraduate professional development. Applicants were scored on their training record during basic surgical training, structures references, clinical experience, approved technical skills courses, validated logbook and consolidation sheet. Assessments of their research and academic surgery included, the award of a higher degree by thesis, and other surgically relevant degree's or diplomas that had been obtained through part-time studies and were awarded by educational establishments recognized by RCSI or the Irish Medical Council. Short-listed applicants completed validated objective assessment simulations of surgical skills, an interview and assessment of their suitability for a career in surgery. The nine individuals who were selected for higher surgical training in general surgery consistently scored higher than those candidates who were not, in post-graduate development (P < 0.001), surgical skills (P < 0.002), interview scores (P < 0.007) and suitability for a career in surgery (P < 0.002). All performance assessment elements except undergraduate education showed high internal reliability alpha = 0.89 and good statistical power (range 0.95-0.99). The statistical power of undergraduate education was 0.7. The objective assessment programme introduced by RCSI for selection of candidates for the programme in higher surgical training in general surgery reliably and consistently distinguished between candidates. Candidates selected for further training consistently outperformed those who were not in good concordance between measures. This common selection process for higher surgical training is now being rolled out for selection into higher surgical training across all surgical specialties in Ireland.     

Burns and Plastic Surgery Section

The BBA joined the Society of Academic and Research Surgery for their Annual Meeting on 6 January 2010 at the Royal Free Hospital. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

Exposure to plastic surgery during undergraduate medical training: A single-institution review

BACKGROUND:Applications to surgical residency programs have declined over the past decade. Even highly competitive programs, such as plastic surgery, have begun to witness these effects. Studies have shown that early surgical exposure has a positive influence on career selection.OBJECTIVE:To review plastic surgery application trends across Canada, and to further investigate medical student exposure to plastic surgery.METHODS:To examine plastic surgery application trends, national data from the Canadian Resident Matching Service database were analyzed, comparing 2002 to 2007 with 2008 to 2013. To evaluate plastic surgery exposure, a survey of all undergraduate medical students at the University of Toronto (Toronto, Ontario) during the 2012/2013 academic year was conducted.RESULTS:Comparing 2002 to 2007 and 2008 to 2013, the average number of national plastic surgery training positions nearly doubled, while first-choice applicants decreased by 15.3%. The majority of Canadian academic institutions experienced a decrease in first-choice applicants; 84.7% of survey respondents indicated they had no exposure to plastic surgery during their medical education. Furthermore, 89.7% believed their education had not provided a basic understanding of issues commonly managed by plastic surgeons. The majority of students indicated they receive significantly less plastic surgery teaching than all other surgical subspecialties. More than 44% of students not considering plastic surgery as a career indicated they may be more likely to with increased exposure.CONCLUSION:If there is a desire to grow the specialty through future generations, recruiting tactics to foster greater interest in plastic surgery must be altered. The present study suggests increased and earlier exposure for medical students is a potential solution.     

The effect of the metal-on-metal hip controversy on Internet search activity

The recall of the articular surface replacement (ASR) hip prosthesis in 2010 represents one of the most controversial areas in orthopaedic surgery in recent years. The aim of this study was to compare the impact of the metal-on-metal hip controversy on Internet search activity in four different regions and determine whether the number of related news reports affected Internet search activity. The Google Trends, Keywords and News applications were used to record the number of news articles and Internet search activity for the terms “hip recall”, “metal-on-metal hip” and “ASR hip” from October 2009 to October 2012 in the USA, the UK, Australia and Ireland. There was a large increase in search activity following the official recall in August 2010 in all countries. There was significantly greater search activity after the recall in Ireland compared with the UK for the search term “hip recall” (P = 0.004). For the term “metal-on-metal hip”, the UK had significantly more search activity (P = 0.0009). There was a positive correlation between the number of news stories in UK and Ireland with Internet search activity but not in the USA or Australia. Differences between countries affected by the same recall highlight the complex effects of the media on public awareness. The data demonstrates a window of opportunity prior to the official recall for the development of an awareness campaign to provide patients with accurate information.     

Akademische Gefäßchirurgie in Deutschland: dringender Bedarf für ein strukturiertes Ausbildungsprogramm

During the past two decades, vascular surgery in Germany has been established as an independent subspecialty of surgery. Despite a substantial increase in the total number of vascular surgery departments, only a few independent academic vascular surgery units at university hospitals exist. Commonly, academic vascular surgery units have limited staff who are at the same time responsible for patient care, resident and student teaching, and clinical and experimental research. However, the lack of personnel and resources may limit the promotion and realisation of institutional research projects. In this article we analyse the general conditions for research as well as the scientific publication output at the independent academic vascular surgery units in Germany. Furthermore, we propose an “academic curriculum” that combines both basic laboratory research activities and comprehensive clinical training as the basis of an academic vascular surgery fellowship in Germany. In the long run, this curriculum model may attract medical school graduates interested in an academic career in vascular surgery, and it ultimately may increase the quality of vascular surgery research in Germany.     

Ethnic Minorities Have Equal Access to Bariatric Surgery in the UK and Ireland

Under-representation of ethnic minority groups in bariatric surgery rates has been reported in the USA. Ethnic minorities form 7.9 % of the UK population, but comparable data on provision of bariatric surgery for these groups have not previously been reported in the UK. We calculated an estimate of rates of bariatric surgery amongst ethnic groups in the UK and Ireland using data from the National Bariatric Surgery Registry and census data from the UK and Ireland. The number of procedures recorded per 1,000 morbidly obese patients was 5.2 for Caucasian patients, 5.2 for Asian patients and 5.2 for Black patients. The identical rates across different ethnic groups suggest that bariatric services are provided equitably in the UK, with ethnic minority groups achieving equal access.     

The Effect of <Emphasis Type="Italic">LRP5</Emphasis> Polymorphisms on Bone Mineral Density Is Apparent in Childhood

Paget’s disease of bone (PDB) can adversely affect quality of life, but relatively little is known about the clinical predictors of reduced quality of life in patients with the disease. Here, we studied quality of life and its determinants in a large cohort of PDB patients who had been enrolled into the PRISM study, a randomized comparative trial of intensive versus symptomatic treatment for PDB. Health-related quality of life was assessed using the Short-Form 36 (SF36) questionnaire and other validated assessment instruments in 1,324 subjects with PDB. Clinical predictors of quality of life were identified by multivariate regression analysis. The physical summary (mean ± standard deviation) score of the SF36 was substantially reduced in PDB to 36.3 ± 11.3 compared with the expected population norm of 50 (P < 0.001). The mental summary score was only slightly reduced, to 48.7 ± 11.8, in PDB; but this was statistically significant (P < 0.001). Bone pain due to PDB, previous bisphosphonate therapy, and increasing age were identified as negative predictors of the SF36 physical summary score (P < 0.001); but serum levels of total alkaline phosphatase (ALP) did not predict physical summary score. We conclude that PDB has a substantial negative impact on health-related quality of life, which mainly affects physical functioning. The lack of correlation between ALP and quality of life observed in this study emphasizes the importance of addressing quality-of-life issues when treating PDB and not just focussing on response of ALP levels. The PRISM Trial Group. Writing Group: Marion K. Campbell, William D. Fraser, Anne L. Langston, Graeme MacLennan, Stuart H. Ralston, Peter L. Selby. Independent Trial Steering Committee: Maarten Boers (chair), Juliet Compston (member), Philip Hannaford (observer, host institution representative), Marilyn McCallum (member), Graham Russell (member). Data Monitoring Committee: Ade Adebajo, Nigel Arden, Howard Bird, Margaret Byron, Alison Carr, Ernest Choy (chair 2001–06), Peter Croft, Vern Farewell, Ian Harvey, Sarah Hewlett, Shabbar Jaffar, Martyn Lewis, Gary MacFarlane (chair 2006), Chris Roberts, Lee Shepstone, Deborah Symmons. Trial Office Team: Gary Adams (data manager), Daniel Barnett (trial programmer), Marie Cameron (research assistant), Janice Cruden (data manager), Magnus McGee (trial statistician), Donna Patterson (data manager), Clare Robertson (research assistant), Allan Walker (trial programmer), Euan Wiseman (trial programmer). Local Trial Investigators (the following people were responsible for the local coordination of the study at the collaborating hospital sites, *lead consultant): Aberdeen Royal Infirmary, UK, Vera Herd, Stuart H. Ralston*; University Hospital Aintree, UK, Rose McIver, Mashood Siddiqi*; Royal National Hospital for Rheumatic Disease, Bath, UK, Ashok Bhalla,* Diana Cochran, Sharon Grieve, Sara Mills; Musgrave Park Hospital, Belfast, UK, Katrina Hughes, Richard Wallace*; Queen Elizabeth Hospital, Birmingham, UK, Neil Gittoes,* Liz McGregor; Royal Bolton Hospital, UK, Keatley R. H. Adams,* Mary Adams; Ninewells Hospital, Dundee, UK, Vera Herd, Graham Leese,* Ellen Malcolm; University Hospital of North Durham, UK, Sarah Hailwood*; Medway Maritime Hospital, Gillingham, UK, Paul Ryan,* Gwen Worcester; Western Infirmary, Glasgow, UK, Alastair McLellan,* Debby Nelson; Huddersfield Royal Infirmary, UK, Allan Fairclough, Richard Reece*; Raigmore Hospital, Inverness, UK, Fiona McGhie, Malcolm Steven*; Airedale Hospital, Keighley, UK, Annie Cooper,* Stuart H. Ralston*; Leicester Royal Infirmary and Leicester General Hospital, UK, Margaret Coe, S. Javed Iqbal,* Geraldine McHugh; Royal Liverpool University Hospital, UK, William D. Fraser,* Ya-Wen Jessica Huang, Margaret Little, Vinita Mishra, Nicola Wherly; Llandudno General Hospital, UK, Merle Maddison, Lyn Vaterlaws*; Guy’s Hospital, London, UK, Ignac Fogelman,* Nina Prescod; King’s College Hospital, London, UK, Rama Chandra, Tina Mangion, Caje Moniz*; Manchester Royal Infirmary, UK, Susan Harrison, Peter L. Selby*; James Cook University Hospital, Middlesbrough, UK, John N. Fordham,* Val Lunn, Dawn Youll; Freeman Hospital, Newcastle, UK, Roger Francis*; Norfolk & Norwich University Hospital, UK, Jane Leeder, David G. I. Scott*; City Hospital, Nottingham, UK, David Hosking,* Pat San; Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK, Michael Davie,* Teresa Jones, Dawn Pugh; Nuffield Orthopaedic Centre, Oxford, UK, Matthew Brown, Vicky Toghill, John Wass,* Jo Young; Llandough Hospital, Penarth, UK, Roz Broadbent, Mike Stone,* Jane Turton; Derriford Hospital, Plymouth, UK, Charles Hutton,* Maggie Jolly; Poole Hospital, UK, Julia Taylor, Paul Thompson*; Harold Wood Hospital, Romford, UK, Kuntal Chakravarty*; Oldchurch Hospital, Romford, UK, Christine Heron, Christopher Kelsey*; Hope Hospital, Salford, UK, Sylvia Mercer, Terence W. O’Neill*; Northern General Hospital, Sheffield, UK, Jenny Cliffe, Linda Kersh, Eugene McCloskey*; Southampton General Hospital, UK, Trish Byng, Janet Cushnaghan, Cyrus Cooper,* Nick Harvey, Karen Walker-Bone; Royal National Orthopaedic Hospital, Stanmore, UK, Richard Keen,* Maggie Partridge; Great Western Hospital, Swindon, UK, Lynne Kerton, Elizabeth Price*; Queen Elizabeth II Hospital, Welwyn Garden City, UK, Jill Lomas, Peter Winocour*; Arrowe Park Hospital, Wirral, UK, E. George, T. D. Kennedy,* Anthony Lake; Yeovil District Hospital, UK, Nita Beacham, Clare Buckley, Jenny Knight, Lisa Martin, T. G. Palferman.*     

Maintaining standards of aesthetic practice in trainees subject to NHS restrictions.

The Specialist Advisory Committee (SAC) in plastic surgery within the United Kingdom (UK) recommends a modular training programme to include aesthetic surgery. The intercollegiate board examinations test candidates on all aspects of aesthetic practice yet there is no formal, national aesthetic training in the UK. Closure of National Health Service (NHS) private patient facilities has reduced training opportunity [Nicolle FV. Sir Harold Gillies Memorial Lecture; Aesthetic plastic surgery and the future plastic surgeon. Br J Plast Surg 1998;51:419-24.] Calmanisation [Hospital doctors: training for the future. The Report of the Working Group on Specialist Medical Training (The Calman Report). London: HMSO; 1993.], the European Working Time Directive (EWTD) [; Phillips H, Fleet Z, Bowman K. The European Working time Directive-interim report and guidance from The Royal College of Surgeons of England working party chaired by Mr Hugh Phillips; 2003 []; Chesser S, Bowman K, Phillips H. The European Working Time Directive and the training of surgeons. BMJ Careers Focus 2002;s69-7.], and more importantly the implementation of "local" aesthetic guidelines have placed further pressures on training. Reductions of NHS case mix will ultimately lead to a reduction in trainee experience. With increasing regulatory pressure from the Commission for Healthcare Improvement, standards of aesthetic practice can only be maintained by increasing private/independent sector involvement. At present a disparity exists between the demand and provision of aesthetic surgery training in the UK. Aesthetic surgery forms part of the training curriculum for plastic surgery and as such remains a training issue. A review of aesthetic surgery training is needed in the UK through consultation with trainers and trainee representatives.     

An analysis of the Research Fellowship Scheme of the Royal College of Surgeons of England

BACKGROUND: The Research Fellowship Scheme of the Royal College of Surgeons of England commenced in 1993 with the aim of exposing selected surgical trainees to research techniques and methodology, with the hope of having an impact on surgical research and increasing the cadre of young surgeons who might decide to pursue an academic career in surgery. Over 11 million pounds sterling (approximately US 20 million dollars) has been invested in 264 fellowships. The College wished to evaluate the impact of the Scheme on the careers of research fellows, surgical research, and patient care. As the 10th anniversary of the Scheme approached. STUDY DESIGN: Two-hundred and sixty research fellows whose current addresses were available were sent a questionnaire. Two-hundred and thirty-eight (91.5%) responded. RESULTS: Three-quarters of the research fellows conducted laboratory-based research, with most of the remainder conducting patient-based clinical research. One-third of the fellows who have reached consultant status have an academic component to their post. The total number of publications based on fellowship projects was 531, with a median impact factor of 3.5. Almost all fellows had been awarded a higher degree or were working toward this. Half of the fellows received subsequent funding for research, mostly awarded by national or international funding bodies. CONCLUSIONS: The Research Fellowship Scheme of the Royal College of Surgeons of England has successfully supported many trainee surgeons in the initial phase of their research career. It has helped surgical research by increasing the pool of surgeons willing to embark on an academic career. Indirectly, patient care has benefited by promoting an evidence-based culture among young surgeons. Such schemes are relevant to surgical training programs elsewhere if more young surgeons are to be attracted into academic surgery.     

Initial plastic surgery experience with the first telemedicine links for the British Forces.

In January 1998, the first telemedicine link for the British Defence Medical Services was established between the British military hospital in Sipovo, Bosnia and the Royal Hospital Haslar, the main triservice hospital in the UK. Further links were established later in the year. These simple links use a high-resolution digital camera, the Olympus C1400L and the C1400XL, to capture still images. These are then transmitted without loss of definition as electronic mail attachments to obtain specialist opinions in plastic surgery as well as in radiology, dermatology, orthopaedics, urology, ophthalmology, general medicine, maxillofacial surgery and pathology. Its use is illustrated by representative case reports from the first 11 referrals from Sipovo and elsewhere to the Plastic Surgery Department at Haslar. This system is suitable for use within both a military and a civilian context, anywhere in the world. It can readily be adapted for use by general practitioners and hospital doctors to facilitate referrals to plastic surgery departments.     

Attitudes of Medical Students toward Careers in General Surgery

BACKGROUND: Changes to general surgical undergraduate curricula, alongside changes in work force and postgraduate training, may be associated with a decline in interest in surgical careers. This study examines the attitudes of students toward surgical training and their career intentions. METHODS: A prospective, questionnaire-based survey was submitted to final year students at the end of their general surgery attachment over a single academic year at a UK medical school. Career ambitions and reasoning were assessed. RESULTS: Of 223 eligible students, 193 (87%) completed the questionnaire. There were 118 (61%) females and 75 (39%) males with a median (range) age of 23 (21-41) years. Ninety-eight (51%) respondents undertook their placement at a Teaching Hospital, whereas 93 (41%) were attached to a District General Hospital. One-hundred forty-three (74%) students felt that a four-week attachment had given them a satisfactory exposure to General Surgery, and 36 (19%) disagreed. Sixty-eight (53%) students were unable to select a single specialty that they would most like to pursue as a future career. Of the remainder, 23 (12%) chose general surgery, 24 (12%) chose general medicine, and 22 (11%) chose general practice. Seventy-eight (40%) students would consider a career in general surgery, and 75 (39%) would not; 40 (29%) were undecided. The two most popular attractions to general surgery were challenging postgraduate training and highly regarded career esteem. The two most common disincentives were family considerations and the sacrifice of personal time. CONCLUSIONS: Fewer than half of the final year medical students surveyed were willing to consider general surgery as a future career choice. Potential disincentives should be targeted to promote recruitment into the specialty.     

Head and neck oncology: the UK experience. Who is publishing what?

Using the MEDLINE database (OVID), a retrospective review of the UK literature on head and neck oncology was performed for the period 1994-2000, each publication being categorised by department and first author. Tumours almost exclusively managed by general surgeons, cardiothoracic surgeons and neurosurgeons were excluded. In the years 1994 to 2000, there were a total of 120 UK publications, 72% of which came from non-academic NHS units; 23% of the publications were from ENT units, 23% from oral and maxillofacial (OMF) surgery units and 18% from plastic surgery units. The majority of plastic surgery publications described reconstructive techniques, whereas a wider range of topics was observed in the publications by ENT and OMP surgeons. Several irregularities in the MEDLINE database were discovered and are discussed. The findings of this study may be relevant to the future planning of head and neck oncology services.