Reconstructive trauma surgery interface fellowship

Authors: AV Giblin, TC Wright, M Henley, DPS Sandhu, D Evriviades 

Publication date:  09 Nov 2012

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Interface fellowships have been created in areas where surgical specialties overlap to offer doctors the benefits of multidisciplinary teaching and surgical practice. Unbundling specialty territoriality in this way allows the fellows to expand their understanding of surgery and improve their ability to provide the best quality care for their patients.[1]

The United Kingdom has 18 interface fellowships in reconstructive aesthetic surgery, 10 in hand surgery, nine in breast and oncoplastic surgery, seven in head and neck surgery, and six in cleft lip and palate surgery.[2] These fellowships are open to surgical trainees from numerous specialties and have approval from the General Medical Council, the royal colleges, and postgraduate deaneries.

What is it?

The reconstructive trauma surgery interface fellowship at the Queen Elizabeth Hospital, Birmingham, is a new addition to the interface fellowship family and has been running for a year. The posts were initially for three months but have now been increased to four months after feedback from fellows, with start dates in March, July, and November.

The main aims of the fellowship are for doctors to take an active role in all aspects of major soft tissue and skeletal trauma and to work closely with all individuals and teams involved in the acute and later management of patients with all forms of major trauma.

Who is it for?

This course is open to applicants from plastic surgery; trauma and orthopaedics; ear, nose, and throat; and oral-maxillofacial surgery who have passed part 1 of their specialist fellowship examination (full fellowship is desirable). Candidates must be able to complete the fellowship before receiving their certificate of completion of training or must extend their training.

Why do it?

Twenty two regional major trauma centres have recently been created in the UK to improve clinical outcomes for major trauma patients. These centres are open 24 hours a day, seven days a week, and are staffed by consultant led specialist teams that have access to all the required facilities, such as computed tomography scanning, interventional radiology, emergency theatre, and critical care. This development means that all trainees will be exposed to and must appreciate trauma management in the UK.

What does it entail?

The Queen Elizabeth Hospital is an exceptionally busy new hospital and major trauma centre with 30 theatres. It is unique within the UK in receiving patients from military conflicts—mainly Afghanistan—as well as civilians with trauma, patients with burns, and patients who need surgery for cancer.

The fellowship focuses on self directed learning in trauma and reconstruction surgery. If you want to see, plan, and be involved in reconstruction of myriad defects and functional problems, this is the place to do it.

You will be involved in the planning of care and the treatment of patients with trauma, from their arrival in hospital, in case conferences, on ward rounds, and in theatre. All trauma cases are open to each fellow, and involvement in ongoing departmental projects is encouraged.

The workload includes microsurgery, local flaps, and bony fixation work (head, neck, and the rest of the body). Weekly supervisor meetings assess progress, and a logbook and diary are kept throughout.

Your educational supervisor will encourage you to attend theatres, clinics, and courses outside your home specialty, within Queen Elizabeth Hospital and elsewhere, to maximise the benefit from your post. Handover packs will help you identify key people and opportunities, timetables, and the whereabouts of theatres and departments.

How is it assessed?

Assessment throughout this fellowship takes place in an initiative called THREAD (the trainee handover reflective experiential assessment document). THREAD is an innovative, self directed, reflective, two way process between fellow and mentor that is used as a tool for formative assessment and professional development. It is not a prescriptive, modular, tick box process but rather a sophisticated method for analysis and assessment of procedures or circumstances involving yourself or others, with the aim of generating conclusions on views, techniques, surgical choices, and handling difficult situations. This is a much more involved process for the more mature trainee and is therefore more useful than current log and file exercises.

How do you apply?

The national appointment system is run by the Severn Deanery, with annual recruitment through the websites of NHS Jobs, the Severn Deanery, and the Joint Committee on Surgical Training.

How is it funded?

All interface fellowships are funded by the Department of Health. The budget is hosted by the South West Strategic Health Authority, and the Severn Deanery postgraduate dean is the responsible officer. The centralised nature of funding gives the fellow flexibility and innovation, supporting study leave for courses and leadership and management training, with particular reference to the consultant role. The salary is within the specialty registrar salary scale.

Is it worth it?

This is a fellowship for the grown-up, thinking surgeon. It offers the opportunity to see things you have not had the opportunity to be involved in, to fill in weaknesses in your armamentarium, and to understand subjects peripheral to your normal specialty work. Although the supervisors are very supportive, you are neither spoon fed nor hand held and must create your own timetable and plan, which will entail honing your management and diplomacy skills.

THREAD may feel a little uncomfortable and foreign initially, but over time it will without question increase what you gain from your time in Queen Elizabeth Hospital, and perhaps you will take it on as a learning and self appraisal tool in the future.

The fellowship is a fabulous experience in a multidisciplinary setting, offering as much or as little as you choose to take from it. It represents an excellent opportunity for all doctors with an interest in trauma or reconstructive surgery to appreciate and manage major trauma at any level.

Top tips

• The post does not attract any banding, so plan your finances accordingly.

• Interface fellows are invited to attend a number of management and leadership courses, which are paid for. There may be an additional study budget for other trauma related courses.

Competing interests: None declared.

AV Giblin plastic surgery specialist registrar and reconstruction trauma interface fellow 2011  Queen Elizabeth Hospital, Birmingham, UK
TC Wright plastic surgery specialist registrar and reconstruction trauma interface fellow 2011  Queen Elizabeth Hospital, Birmingham, UK
M Henley consultant plastic surgeon and educational adviser to the JCST Interface Groups  Nottingham University Hospitals NHS Trust, UK
DPS Sandhu postgraduate dean and lead dean for interface fellowships  Severn Deanery, UK
D Evriviades consultant plastic and reconstructive surgeon, and educational supervisor for the interface fellowship in reconstructive trauma surgery  Queen Elizabeth Hospital, Birmingham, UK

 drgiblin@yahoo.co.uk