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SICOT e-Newsletter

Issue No. 42 - March 2012

Editorial by Shanmuganathan Rajasekaran - SICOT Treasurer

The SICOT Regional Training Fellowships

We are in an era of knowledge explosion with new ideas and surgical techniques being described every day. Remaining updated with current knowledge and with cutting edge skills is however a major challenge. Gone are the days where knowledge can be acquired from textbooks and journals alone. Surgical training needs mentorship from an expert and actual participation in surgery.

A vast majority of surgeons lack the opportunity to be in an academic environment once they set up their professional practice. Though internet has globalised orthopaedic knowledge, there are many advantages if short-term fellowships can be in the same region. Short-term training abroad may frequently not achieve the desirable end as the spectrum of disease and pathology vary a lot between continents and countries. Degenerative conditions dominate the scenario in the west and the main attention is on biological and regenerative therapies. In contrast, chronic infections, neglected trauma and severe deformities still dominate the treatment list in developing countries which have more than 70% of the population of the world. The affordability of treatment, the cost provider, the type of insurance cover, the nature of social support is so different that the ideal treatment in one country may hardly be suitable for another. A white paper on treatment of many conditions that is universally applicable can hardly be devised.

International fellowships and training have other disadvantages. The cost of international travel and support for stay and boarding is often prohibitively expensive. Language barriers and cultural differences can exert a great strain on learning potential and decrease the value of short-term overseas fellowships. Many countries have now rules that prevent short-term trainees to scrub and participate in surgeries and clinical work. Observing surgeries from a distance is often a poor learning experience in comparison to even well edited videos.

Attempts have been made to overcome these hurdles through short courses, hands-on workshops and cadaver workshops. However, most of them are sponsored and supported by the industry and have a strong industrial bias towards their products. These are more implant oriented than principle oriented and combine business to academics. The focus is more on surgical treatment leading the participants to be more oriented towards surgery.

It appears logical that short-term surgical training and updates must be better done in centres of excellence in one’s own country rather than across continents. This will have the advantage of being trained in a native atmosphere with sophistication and facilities that match those of the trainees’ institution. The nature of pathology and the spectrum of the disease of the two institutions will be the same. Travel and subsidence costs are also a fraction of international fellowships. There are no rules or regulations to prevent the trainees from actively scrubbing and assisting surgeries and the value of such fellowships are immense. Most importantly, these trainees form a very valuable professional relationship with their mentors that allow them to gain on their experience whenever they have a challenging clinical problem.

With the above discussion in mind, the Executive Committee of SICOT has approved the development of such regional short-term surgical training. These training programmes will be in association with selected centres of excellence and mentors who are well known and popular for imparting practical surgical training. SICOT has a huge number of experienced and learned teachers who work in institutions with ample facilities for training. SICOT also has a large number of young and middle-aged surgeons who are looking for opportunities to update their skills. These fellowships will help to bridge the need with the expertise available.

The training will be for short periods and will be individualized to the needs of the trainee. Unlike other fellowships which are age specific and CV-based, these fellowships should be based on the needs of the trainee and will focus on the benefits to the society and the institution of the trainee. SICOT will fund the travel and a small but adequate subsidence fee and the institutions will support to a great extent the accommodation and training facilities. It is obvious that valuable training can be achieved across the globe at a very low cost.

The first of these fellowships is being established in India, at Ganga Hospital, Coimbatore, South India, where short-term fellowships are made available in the fields of trauma, spine surgery and arthroplasty. These fellowships will cater to applicants not only from the country but also from the neighbouring nations.