Learning Curve

By: Katharine Griffiths
Created on 18th May 2011

Mr John Pereira, consultant plastic and reconstructive surgeon, comments on the changes that have occurred in cosmetic surgical training in the UK in recent years and what impact that will have on the patient

Current holders of the FRCS (plast) examination in Plastic Surgery can be reasonably assured of having had a broad training in cosmetic surgery, but the same cannot be said for future examinees, and whilst the exam will test the theoretical knowledge of cosmetic surgical procedures, it is a trainee surgeon's log book that reveals the amount of exposure that they have to the practical side of the work.

In the past many ‘cosmetic’ procedures were performed in NHS hospitals and, as a trainee, my generation of surgeons were taken through hundreds of cases of rhinoplasty, breast augmentation, reduction, mastopexy, abdominoplasty, lid surgery and even facelifts for conditions such as facial palsy.

Rationing of care and a reduction of the procedures available via the NHS has taken away the opportunity for surgeons in training. Couple this with a reduction in training years and working hours and the problem becomes even more obvious.

So what is the answer? At McIndoe Surgical Centre in East Grinstead, we have established a ‘Cosmetic Fellowship’ sponsored by Nagor – one of the UK’s leading breast implant providers – to provide training for this gap. Trainees are appointed after application and interview for a three month period. This usually constitutes the final job before the end of their training, or it is even undertaken just before a consultant position is taken up.

During this time they have access to around 16 consultant plastic surgeons performing the whole spectrum of cosmetic procedures. Three theatres run most days and the fellow is free to decide upon the gaps in his or her training that need addressing, and attend for teaching appropriately.

Surgical cases are recruited via our helpline, whereby a patient pays a lower fee for the fellow to perform the surgery whilst supervised by a consultant. Fellows have to have reached an appropriate standard before they are allowed to undertake surgery, and, of course, only assist on the consultant’s own patients.

But it’s not just surgery that our fellows learn. Most important is the consultation experience, learning to evaluate patients, select an appropriate procedure and also turn down unsuitable candidates. Time is spent seeing post-operative patients, watching aesthetic procedures such as Botox and filler injections and chemical peels, and also learning how a practice works.

As consultants we also benefit from the continuing academic stimulus that training provides, and it encourages a keen knowledge of up-to-date literature.

The fellowship has been running for seven years now and numerous surgeons are now practising around the country with the experience and confidence gained in the Nagor/McIndoe fellowship. With a reduction in exposure to these procedures in NHS training I can see this sort of fellowship becoming compulsory not only for sitting the specialist examination in plastic surgery, but also for obtaining medical malpractice insurance and admitting rights to private hospitals. This is of course exactly right, so the quality of surgeons in the UK can continue to be of a high standard and patients’ safety and outcomes can be assured.

So, it is increasingly important, as well as checking that your surgeon is on the specialist register of the General Medical Council for plastic, reconstructive and aesthetic surgery, to ask directly what experience they have in the procedure you want. An honest surgeon will be able to tell you about their training and their experience, as well as the risks and complications in their practice – this is why your consultation should always be with your surgeon from the start.

For he’s a jolly good fellow

Keith Allison, MBChB MD FRCS FRCS(Plast) Consultant Plastic, Reconstructive and Cosmetic Surgeon

"I was the first of the aesthetic/cosmetic surgery fellows based at the McIndoe surgical centre in East Grinstead in 2003. This was one of the most instructive periods of my whole plastic surgery training with excellent and supervised support and care of patients undergoing cosmetic procedures. The fellowship gave me increased confidence as to how to set up my practice as a consultant. In particular, how to focus the patient consultation and stress the important differences between cosmetic surgery and other treatments. Crucially important, is the information given to the patients and helping to manage or match their expectations with what is technically possible in the surgeon’s hands. This fellowship has had a major influence on my practice."

Investing in the future

Nagor have two fellowships running in the UK, one in the Midlands and the other at the world renowned McIndoe Surgical Centre. The Nagor training programme is for the cosmetic surgeons of the future – giving them the chance to gain vital further experience following basic training.

UK Sales Manager of Nagor, Douglas Black: “Founded in 1979, Nagor is the only British company dedicated to the specialist design of high quality breast implants. We are proud to be a part of such an innovative and well-recognised training programme. Nagor-sponsored UK fellows have gone on to develop successful careers in plastic surgery, which clearly indicates the value of such a programme.”

The home of cosmetic surgery

Sir Archibald McIndoe is a key figure in the history of plastic surgery. At the outbreak of World War II he was a consultant in plastic surgery to the Royal Air Force at the Queen Victoria Hospital at East Grinstead. The hospital had been rebuilt shortly before the outbreak of war and it possessed ample land for expansion to allow the establishment of a centre for plastic surgery.

The work done by McIndoe in both physically and psychologically rehabilitating badly burned aircrew earned him an international reputation. After the war, McIndoe helped to found the British Association of Plastic Surgeons.

In 1997 a small group of consultant surgeons and anaesthetists came together and purchased the old McIndoe burns unit originally established as a legacy to Sir Archibald McIndoe. They had a vision to create a truly world class private hospital on the well known NHS campus at East Grinstead. After some serious building work was completed and the ward refurbished, the doors opened for business in June 1999.

The philosophy of the McIndoe Surgical Centre Board was to establish a centre of excellence in plastic, reconstructive and aesthetic surgery. The hospital is now home to over 20 plastic surgeons which makes McIndoe Surgical Centre one of the largest specialist private plastic surgery hospitals in the world.

CS&AG