At ESCP's meeting in Belgrade in September, Sonia Lockwood briefly presented on her fellowship at Århus University Hospital, Denmark, under the direction of Søren Laurberg, between 1 April and 30 June 2013. Sonia is from the Northern General Hospital, Sheffield, UK. Her report, together with a link to a video of her presentation, are given here.
From Northern General Hospital, Sheffield, UK
Visited Aarhus University Hospital, Aarhus, Denmark
The European Society of Coloproctology Surgical Fellowships have an excellent reputation for providing high quality fellowships in the field of colorectal surgery, thereby promoting and supporting postgraduate surgical training opportunities across Europe. I was fortunate enough to receive a 3 month fellowship from the ESCP to take place in Aarhus, Denmark in the spring 2013. The ESCP fellowship in Aarhus sponsored by Covidien is a 3-month comprehensive, ‘hands on’ clinical fellowship program at one of the largest hospitals in Denmark. My aims and expectations were to gain experience and expertise in complex proctology, pelvic floor and functional colorectal surgery in an internationally recognised pelvic floor unit. The fellowship is managed under the auspice of Professor Søren Lauberg, Professor of Colorectal Surgery and the attachment and clinical preceptorship is with Dr Steen Buntzen, Dr Lilli Lundby and Dr Peter Christensen of the anorectal physiology department.
Strengths of program
My fellowship experience can be characterized as a very ‘hands on’ clinical preceptorship. As the colorectal fellow I have spent an active three months whereby I have become fully integrated within the department and the colorectal team as a whole. Despite being a designated ‘pelvic floor fellowship’ I have been extremely fortunate to work very closely with all of the surgeons in the department, gaining experience from each, in their area of colorectal sub-speciality.
An entire spectrum of colorectal surgical procedures is available to the ESCP fellow. Both routine coloproctology and specialized cases; including but not limited to: rectovaginal and complex perineal fistulas, sphincter repairs, prolapse surgery, sacro-neuromodulation and continence procedures are available.
The department has allowed me the opportunity to tailor my experience with relation to my level of experience and expertise and has actively facilitated my attendance and participation in cases or procedures of particular educational benefit or personal interest. In essence I have been able to benefit from the expertise of the entire department across the breadth of colorectal surgery. I have had unlimited exposure to several novel or unfamiliar procedures or techniques. I have observed only a few cases, the department have been keen to ensure that I have received ‘hands on’ practical experience and for the most part I have performed most cases as the primary operator with consultant input and supervision. Although my primary focus has been within the pelvic floor unit focussing on functional disorders I have also had the opportunity to experience robotic surgery, complex IBD, surgery for pseudomyxoma and extensive carcinomatosis and pelvic recurrence.
This is an academically oriented department that is in itself is extremely motivating and inspiring. During the 3 months I have had the opportunity to partake in on-going research projects and have been actively encouraged and supported in doing so. I have submitted an abstract which has achieved a poster presentation at the upcoming 2013 ESCP Congress in Belgrade. My intention is to complete the project, aiming to publish our results in a peer-reviewed journal towards the end of the year.
Operative experience / case mix
The colorectal fellowship in Aarhus has included experiences within a broad mix of both routine and complex colorectal procedures; offering a variety of both open as well as laparoscopic procedures.
During the 3 months I have had the opportunity to experience and participate in various novel procedures including primary fistulectomy with sphincter reconstruction, a laparoscopic Malone procedure, the Altemeier’s procedure, the VAFT procedure, HIPPEC, pouch advancement for fistula disease and an open ventral pouch-pexy for ileo-anal pouch prolapse.
Not only have I had my first opportunity to observe and assist in some of the robotic resections, but in addition I have had the opportunity acquire some new surgical skills through the simulation exercises on the robot. I have used the surgical robotic simulator to practice on the 3-dimensional, virtual-reality visual simulations and skills tasks, receiving feedback on my performances and progress. Skills which I am certain will become common place in colorectal surgery in the forthcoming years.
Clinic and office experience
Whilst I have attended outpatient clinics; consultations take place (understandably) in Danish. Therefore the language barrier has prevented this from being a meaningful educational exercise as I was unable to fully appreciate the nuances of the consultation and the patients’ presenting symptomatology. Despite this, I have had the opportunity to experience the anorectal physiology laboratory, the outpatient clinic environment and appreciate the multidisciplinary working of the department which is fundamental to its success. The nursing staff of the anorectal physiology department has shared their experience and expertise which has given me a valuable insight into enterostomal care, anorectal and colonic physiologic testing, anorectal ultrasound and pelvic floor disorders.
A ‘one stop’ multidisciplinary service clearly is beneficial to the patients and the medical staff, with access to physiology and endoanal ultrasound scanning and one which I would aspire to replicate on returning to the UK.
Opportunity to attend meetings
During my stay I have integrated myself within the department, attending the daily ‘grand round’ and departmental meeting, the daily X-ray conference, colorectal MDT meetings, and the weekly departmental education programme.
I have actively participated and encouraged junior surgeons in the departmental journal club which meets monthly to critically appraise recent peer reviewed articles in colorectal surgery.
I was kindly asked to present at the departmental education meeting, giving a presentation on surgical training in the UK. This was very well received, stimulating active discussion on the different requirements for completion of surgical and colorectal training in the UK compared with the current system in Denmark.
I have introduced the local trainees to the E-Logbook; an electronic operative logbook for use as a record of their case mix and level of participation. This logbook is compulsory in the UK as documented evidence of surgical training.
I have actively involved myself in the training of junior surgeons supervising several juniors during procedures in theatre and providing teaching on a ‘wet lab’ laparoscopic training day for the surgical residents.
In addition I have prepared a ‘Welcome Pack’ for the department, which is designed to form part of an induction package for future fellows and visiting surgeons.
Recreation and leisure
Outside work I have had the opportunity to travel around the region and sample the friendly and relaxed atmosphere that Denmark has to offer. I have taken every opportunity to explore the city and the countryside of Jutland. Aarhus is a vibrant city, which is small enough to get to know yet big enough and lively enough to have plenty to fill the evenings and weekends. Throughout the city I have attended many of the local festivals and cultural events. In addition whilst travelling around the region I have co-incidentally happened upon other small town parades and events giving me a real insight into Danish life and the Danish culture not usually afforded to foreign tourists.
Thanks
I would like to take this opportunity to offer my heartfelt thanks for an inspiring opportunity to work within this department. Please accept my thanks on behalf of the ESCP and Covidien for making this fellowship possible. I give my sincerest thanks to everyone at Department P, Aarhus University Hospital for their hospitality and for sharing with me their experiences and expertise. I would however like to extend individual thanks to Professor Søren Lauberg for the opportunity and to Dr Steen Buntzen, Dr Lilli Lundby and Dr Peter Christensen for their exceptional hospitality, support and expertise. May I also to take this opportunity to extend an invitation to anyone in the unit who wishes to visit the UK (on business or pleasure) to come and stay with me in Yorkshire so that I may return the hospitality and welcome you have afforded me during my stay.
The ESCP Fellowship sponsored by Covidien was very much appreciated and I feel has been an exceptional addition to my surgical training and my future career in colorectal surgery. It has not only introduced me to new procedures and techniques, but also exposure to a different training environment and work culture which I shall take with me into my consultant career. Most of all, I have had the privilege and the pleasure to work with some very gifted surgeons, who are without question extraordinarily welcoming and friendly people with whom I hope to have made both professional and personal relationships which will endure for the remainder of my career. I look forward to meeting again in Belgrade and on many more occasions in the future.
