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THIS IS BRUSSELS CALLING

 

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An interview with Bynvant Sandhu, a surgical registrar at Hammersmith Hospital, Imperial College London, on the topic "To specialize or not in transplant medicine or surgery. Should we narrow or widen our education to become either a specialist or an all-rounder in the field?"

The interview was done by Annemarie Weissenbacher, general surgeon at Innsbruck Medical University, clinical research fellow at Nuffield Department of Surgical Sciences, Oxford
.

Specialisation and everyday clinical/surgical life: friend or foes
It's hard to argue that a good breadth of knowledge and technical experience isn't advantageous in surgery. However, I believe that gaining depth of knowledge and skill does require dedicated time. Classical alliances in transplantation such as liver transplantation and hepatobiliary surgery marry well. Disparate fields such as renal and pancreas transplantation alongside occasional colorectal oncological procedures do raise questions in my mind. If the surgeon is performing enough of each procedure and is involved in the care of these patients routinely perhaps this works, but in current practice I imagine this is difficult to achieve. In the relatively young sub-specialties of pancreas, small bowel and composite tissue transplantation where the numbers performed in each unit are often small, I believe that it's particularly important for the surgeon to dedicate their time in order to gain enough operative experience and to amass the knowledge required to expertly manage the care of these patients. In contrast to other fields of surgery, the challenges and complications we see are often non-classical as the specialty evolves with changing trends in the utilisation of extended-criteria organs and emerging therapies requiring adaptations in clinical practice.
What is your advice for becoming a specialist in your specific field?

An understanding of the integral requirements for your development as a clinician and surgeon in terms of knowledge and experience is key. Seeking advice from senior colleagues on these requirements early in your career will allow you to plan your training with this in mind. Of course, not everything goes to plan - I've come to realise that those are often the times when you learn the most. Stoicism and stamina if nothing else! I have been very fortunate throughout my career to have some phenomenal mentors. One thing they all have in common is that they don't always tell me what I want to hear, but instead what I need to hear. Identifying those people and checking in with them regularly can help keep you on track.

Look for additional opportunities to acquire knowledge out-with those routinely available to you. Experience in a number of centres will expose you to alternative approaches to organisational structure and clinical management. In retrospect, I would have gained much more from the educational courses I've attended by preparing well in advance and researching the topic prior to the course! Making time to keep up to date with the latest evidence and research is also vital in transplantation. On a personal level, I believe that passion and commitment are key to achieving your professional aims. I don't need to advise any surgical trainee to spend as much time as possible in the operating theatre - we all get the blues when we feel we're not doing enough!

Where are we in 10 years in transplant surgery? May I ask you to present us your prospects?

From an organisational point of view, I think that transplant surgery will be performed in a smaller number of specialised centres. Clinically, I envisage that the surgical community will continue to push the boundaries in terms of extended criteria donation and high risk transplantation, necessitated by the growing number of patients on their third or fourth transplant. The use of machine preservation for preconditioning organs is likely to be in widespread use and I imagine that robotic transplantation surgery will be on the rise.

I would like to see that we, as a professional community, take on the challenge of meaningful engagement with our patients and the wider public to further both our clinical and scientific aims. I'm always struck that our patients are incredibly knowledgeable and of course passionate about improving outcomes in transplantation and furthering knowledge in the field. There’s a real appetite for knowledge sharing and working in partnership, which we need to begin to fulfil. On a similar note, I think there will be a greater onus on surgeons and surgical researchers to engage with our other key stakeholders, including the media, pharma and politicians in order to ensure adequate organisational and resource allocation to transplantation.
Of course, questions involving predictions of the future are destined to embarrass the respondent?! Either way, I'm optimistic that transplant surgery will continue to present us with exciting challenges in the future.


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