Surgical trainees should consider taking courses overseas
Authors: Adarsh Nadig
Publication date: 16 Nov 2016
Unable to find a suitable microsurgery course in the UK, Adarsh Nadig undertook a diploma at a prestigious Paris institute
The ultimate aim of higher surgical training is for no trainee to undertake an operation without having performed it as a simulation first. Microsurgical techniques are used in most surgical specialties, but for a trainee in the UK there are only a few courses teaching these skills. 
Microsurgery in Paris
During my training I began investigating microsurgery courses but found that those that were available either offered a very specific curriculum or weren’t long enough to give adequate training opportunities.  Through my research I found a diploma course offered by the Paris 13 University at the Fer à Moulin.
This is a world famous institute offering a year long diploma with a broad curriculum suitable for all surgical trainees. The principles and techniques are learnt and practised over 120 hours of practical hands on training under the supervision of teachers with more than 30 years of experience in the field.
Techniques are practised on sedated rodents and practical sessions are complemented by 30 hours of theory, which is taught in French. Most of the presentation slides are in English, however, and discussion and interaction in English is encouraged. Although I don’t speak French, attendance at the lectures was mandatory.
My lack of French did not deter me as I was passionate about the training opportunity and I believed that language should not be a limiting factor. I have good observational skills and knew I would be able to develop the techniques. I was also well supported by the course organisers and the slides were always in English. It was frustrating when I was unable to participate in discussions but I was able to raise any concerns with friends and staff after the lectures. Although the laboratory chief spoke very little English he could use English technical terms. All the explanations were either diagramatically or videographically demonstrated so it was not difficult to follow.
It was only on the first day of the course that I found out that we would be practising on rodents. As a life long vegetarian I found this very difficult and nearly gave up. But after analysing my concerns, I accepted that the animals’ anatomy was the closest to humans that we could practise on.
The practical sessions were available in pre-recorded videos that described the techniques and procedures. Each trainee was encouraged to do a project related to their specialty. Hence the curriculum could be tailored to individual requirements.
The diploma usually starts in September and finishes in June of the following year, when students sit an exam. Upon successful completion a diploma in microsurgical techniques is awarded.
Application and costs
For participants with no previous experience in working with animals in a laboratory an introduction to microsurgery course is mandatory before the start of a diploma. It costs €290 ($326; £246) and lasts for three days. The overall costs, including travel and accommodation, came in at under €3000 for the six trips that I made to Paris over the year. The courses that are run in the UK are very expensive—a week’s course in the UK cost around half of what I spent for a 12 month diploma.
Is it worth it?
The diploma has been a great experience for me. I now have a much better understanding of both the concept of microsurgery and its application.
The chance to practise regularly over a year made a difference when compared with a week long specialised course. I also have an additional qualification for my CV. The breadth and depth of the teaching and experience I gained from the diploma compares well with any of the short courses offered in the UK.
Surgical trainees, no matter what their sub specialty, should have the opportunity to develop the techniques, skills, and experience over a period of time like I did. It will give them the opportunity to learn and improve and, ultimately, become better surgeons.
I would like to thank Ian Kamaly-Asl, consultant neurosurgeon at Greater Manchester Neurosciences Centre, for advice during the diploma and in the preparation of this article.
Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare that I have no competing interests.
Adarsh Nadig senior clinical fellow in neurosurgery Greater Manchester Neurosciences Centre