Plastic surgery in the UK and the USA--comparisons and contrasts: some thoughts for the future in the UK

Changing trends in plastic surgery training

BACKGROUND

The currently available training models are being put to scrutiny in India today, both by the residents and the teachers. Plastic surgery specialty was created primarily for reconstructive purposes but the society always perceived it from a cosmetic angle, particularly in the post second world war era. As a result, there is a need to redefine the goals of plastic surgery training in the present times so that the plastic surgeon is "future ready" to meet the needs of society and the market forces.

MATERIALS AND METHODS

The author has reviewed the currently available literature on plastic surgery training from India and the western countries. An attempt has been made to study opinions from the teachers and the trainees. The modules currently available in India and abroad have been analyzed and a suggestion has been made for drafting training programs that would meet the demands of the society as well as prepare the resident both for the aesthetic and reconstructive practice.

CONCLUSIONS

The plastic surgery training needs to be more vibrant and in tune with the changing times. While maintaining its core nature, the current predominantly reconstructive modules need to incorporate the aesthetic content. The evaluation should be both knowledge and competence based. The teachers need to be educated in the various teaching methods that are more applicable to grown up residents. There is a need to find ways to attract talented people in the academic plastic surgery.

The Canadian Plastic Surgery Workforce Survey: Interpretation and Implications

BACKGROUND

Few studies have monitored physician supply in Canada, and no studies have specifically examined the Canadian plastic surgery workforce.

METHODS

In this study, data were gathered by three methods. A survey was distributed to all members of the Canadian Society of Plastic Surgeons in October of 2004. Opinions on the availability of plastic surgery services were solicited. A second survey that focused on demographics and workload was distributed in December of 2004. Finally, the locations of all Canadian trainees graduating between 1995 and 2005 were reviewed.

RESULTS

The response rate to the first survey was 42 percent. Seventy-eight percent of respondents felt that there was a shortage of plastic surgeons in their community. The response rate to the second survey was 40 percent. Twenty-eight percent of respondents were within 5 years of retirement and 3.2 percent stated that they planned to emigrate by 2010. The mean waiting time for an elective consultation was 32 +/- 33 weeks. Review of all 179 plastic surgery graduates over the past 10 years revealed that 23 percent now practice outside of Canada.

CONCLUSIONS

When these results are projected to the total workforce, they indicate that there will be a future shortage of plastic surgeons in Canada. To prevent a further deficit, there is a need to increase the number of plastic surgery trainees in Canada, to offer incentives for graduates to stay in Canada, and to possibly recruit more foreign-trained plastic surgeons to practice within Canada.

Psychological aspects of breast reconstruction: a review of the literature

AIM

This paper critically examines the research literature relating to the psychological aspects of breast reconstruction. Particular attention is given to the role of specialist breast care nurses in supporting women faced with the decision of whether or not to opt for reconstructive surgery.

BACKGROUND

Breast reconstruction is intended to offer psychological benefits (e.g. improvements to quality of life, body image, anxiety and depression) to women treated by mastectomy following diagnosis of breast cancer.

METHODS

A literature search was carried out on the PSYCHINFO, MEDLINE and CINAHL databases using the terms "breast reconstruction", "mastectomy", "reconstructive surgery", "breast surgery", "breast implants", "transverse rectus adominis myocutaneous (TRAM) flap" and "Lat-dorsi". Further relevant articles were identified from the reference lists of papers detected by this literature search. Finally, proceedings of recent psychological and surgical meetings were scrutinized to identify any conference papers on this topic.

FINDINGS

A thorough search of the existing literature revealed a lack of theoretically based studies examining breast reconstruction in terms of relevant psychological constructs, especially in relation to coping and decision-making. This review highlights the methodological flaws with much of the existing research in this area, in particular the reliance upon retrospective designs and the inappropriate use of randomised controlled trials. Suggestions are given for further research in this topical area.

CONCLUSIONS

Existing research into the psychological aspects of breast reconstruction is limited and not sufficiently conclusive to inform changes to policy and the provision of care. More methodologically rigorous research is needed.