Wednesday, 17 October 2012

How the Great British Public Can help to train Surgeons.

I recently blogged about the amazing memorial to all those who have donated their bodies to medical science found at Cardiff Medical School.  I am not sure whether dissection of human cadavers is really necessary for the teaching of undergraduate anatomy.

Don't get me wrong - I think that the teaching of anatomy is of crucial importance in medicine (where are you Vesalius, Harvey and Hunter!)  and I can see from everyday experience that standards are slipping. There are nonetheless very good models, both physical and CGI based , that can be used for teaching anatomy .
One area where the use of human cadavers needs to be expanded in a big way, is surgical training.  I know that the most valuable surgical training courses  I have been on (outside the UK),  have either involved operating on live anaesthetised animals or on human cadavers. A cardiac surgeon colleague in the USA regularly uses donated cadavers to try out new surgical techniques.
Surgical trainees repeatedly tell us that they are not getting the requisite number of hours in the operating theatre and as a consequence do not feel confident of their surgical ability. This is not surprising when one considers the effect of the European Working Time Directive and changes in junior doctors' training in the UK on the number of hours spent in the operating room. Cardiac surgical colleagues from the Brompton Hospital  wrote about this in the BMJ back in 2004. 
In many specialities (mine included) many new techniques that have been demonstrated to be of value to patients are not readily taken up by consultant surgeons.  Increased scrutiny means that they are reluctant to take themselves out of the comfort zone and go through a learning curve - the mere existence of which has become anathema in a patient safety culture.  Noone would argue against safe practice but this reluctance to innovate means new techniques, potentially beneficial and cost effective are denied to patients in this country.
Operating on live animals will never be acceptable to the British public. Surely therefore the use of human cadavers in training of surgical trainees and established consultants must be part of the answer to the shortfall of hours spent in the operating room and to the absolute need to go through a learning curve.  I am confident that the generous spirit of the British people will ensure a sufficient supply of cadavers. The medical director of the NHS, an ex surgeon (cardiac to boot!), and the presidents of the colleges of surgeons in England and Scotland and chairs of the Intercollegiate Board and Academy of Royal colleges should be able to come up with a plan to expand the use of cadavers for training purposes.
The alternative is that Fido gets it!