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Advancing as a surgeon
  1. Padraig Egan

Abstract

A year ago, Pádraig Egan enrolled on the European College of Veterinary Surgeons' residency programme, but he admits that it's only now that he realises how much work is involved

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THE end point of this adventure is, hopefully, reaching the point of being eligible to sit the European College diploma exams and gain specialist status in small animal surgery. It's beginning to dawn on me the magnitude of the work that lies ahead. I feel as if I have spent the past 12 months on the back foot. I feel as if I am behind in my reading, behind with my surgical log, behind with my presentations and behind with my referral letters (apologies to any referring vets reading this). Tobias's Small Animal Surgery, all 2332 pages of it, is my usual bedtime reading, much to my partner's dismay as it weighs about 12 kg and I tend to fall asleep while reading, which means it usually ends up strewn across the bed. Despite my fear of never catching up with my work, time was set aside to see the new Star Wars film; I may have shed a tear, that is all I'm going to say.

It is rare for the wider profession to get a glimpse into what a residency programme entails beyond what people remember from their university days. First and foremost, there is the dreaded case log; this document soon becomes the centre of every surgical resident's life. Every case operated on must be diligently recorded and classified according to the type of surgery. We must operate on a specified number of cases within defined subdisciplines of surgery. The first year has so far involved a lot of assisting, but the case numbers are slowly clocking up.

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It would be wrong of me to pretend it's been all fun and games. I am chomping at the bit to start doing more on my own, although I am sure this is a common frustration for anyone in a surgical residency. Life is not all surgery though. Residents are expected to spend time studying diagnostic imaging, internal medicine, anaesthesia and pathology. Two-week placements in each discipline must be completed and for me these are welcome trips up and down the country to observe the work of specialists in these disciplines.

A recent trip to Glasgow vet school to spend time with the internal medicine department taught me one important life lesson – a £19/night hotel in Glasgow is as bad as you might imagine. Oh, and I learnt lots about Addison's disease.

Residents are also expected to complete a scientific study that contributes to the veterinary literature. A minimum of two research papers must be published in peer-review journals over the course of a residency programme. With 12 months down I am still struggling to get past the reviewers. I also have to give five presentations either at major conferences or lecture at CPD events. I have done one so far and, at this point, if I could put emojis in this article I would use the one of a mildly embarrassed face!

I suppose it is all too easy to focus on the frustrating parts of the residency programme, but I am trying also to reflect on more positive aspects. I am learning. I am advancing as a surgeon. My supervisors are starting to extend the leash a little – something I understand must be so hard for them to do. I feel my decision-making, even in complex cases, is becoming clearer as my knowledge of historic and current surgical research expands.

One constant throughout the residency programme is the diplomats who teach and supervise us. I recently read a book that really opened my eyes to what a difficult task supervising a resident can be. The book was called ‘Do No Harm’, written by the eminent neurosurgeon Henry Marsh, and I cannot recommend it highly enough. The book gives a graphic insight into the mind of a surgeon working at the edge of what is surgically possible in humans. Dr Marsh reflects candidly on how he struggles with letting surgical trainees operate with less supervision. After a surgical resident sadly encounters a complication during a simple procedure that leads to life-changing complications for the patient, Dr Marsh speaks frankly about the difficulties of training junior surgeons and the frustration he felt witnessing a surgeon he had trained making a fundamental error. Similar frustrations and fears must also be experienced by those diplomats who train surgical residents across the globe.

However, surgical skills must be passed on from one generation of surgeons to the next, and a residency programme is the safest and most consistent way of ensuring the veterinary profession has a pool of referral surgeons to call on. I will always be grateful for the time diplomats spend teaching and nurturing my surgical skills.

Thankfully, I am yet to make a major surgical error. I know that, given the complexity of some of the surgeries, something will go wrong one day; however, I am hopeful that the guidance of my supervisors – their wise words ringing in my ears – and the challenges of the residency programme will help me do the best for every patient that enters into my care. There is an often quoted saying when it comes to surgery: ‘If the operation is difficult, you aren't doing it right’. The past 12 months have made me reflect on this saying.

The purpose of the programme is to try to make surgery more simple through thorough preparation, guided learning and one-on-one supervision. With two years to go I need to start consolidating things and getting on top of the different parts of the residency, but I am sure things will get easier as I complete the different aspects of the programme and move on to the next challenge.

Padraig is writing a series of articles for Vet Record Careers about his experiences as a resident. See ‘An adventure worth chasing’, VR, August 22/29, 2015, vol 177, pp i-ii, doi:10.1136/vr.h4511

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