17 November 2021 (Last updated: 17 Nov 2021 17:03)
I have had an interest in hand surgery since completing a four-week placement in the speciality in my third year of medical school. However, this was the only exposure I have had to date. Therefore, I saw my elective as the perfect opportunity to explore the speciality further. I undertook my elective at The Robert Jones and Agnes Hunt Orthopaedic Hospital, known for being a leading orthopaedic centre of excellence. My consultant supervisor, Mr Simon Pickard, is a consultant orthopaedic surgeon specialising in hand and upper limb surgery.
My time on my elective was mostly spent either in clinics or in theatre. Most clinics were hand surgery clinics for either new or follow up patients. At first, I would shadow the consultant watching him carry out the history and examination and subsequently coming up with a management plan. After a few clinics I was able to start seeing patients in the clinic before they were seen by the consultant. I found this an excellent opportunity to practice my examination skills which was something I was not confident on previously, having done few orthopaedic examinations during my time in medical school. By the end of my elective I was confident that I could carry out an adequate history and examination of the hand and wrist, as well as get the correct diagnosis for common conditions. I was surprised to find that in the field of hand surgery patients could be of any age from children to the elderly. I suppose this is due to the mix of both trauma and elective surgery as well as the speciality covering a much broader range of conditions than I had assumed. Some of the most interesting clinics I attended whilst on my elective were the specialist clinics. These only run once a month or so, but I was lucky to be able to attend both a spinal injuries clinic as well as a spasticity clinic whilst on my elective. My supervisor also encouraged me to spend time with other healthcare professionals. In particular I spent time with the physiotherapists, occupational therapists and nurses who were also involved in the care of the patients. This gave me a much greater appreciation for their role, particularly in the rehabilitation aspect after surgery.
When I wasn’t in clinic, I spent most of my time in the operating theatres. I was able to see and assist in a wide range of surgeries including neurectomy’s and tendon lengthening, tendon repairs, tendon transfers, carpal tunnel decompressions, fixation of upper limb fracturs and trigger finger releases. This made me realise there’s a lot more to hand surgery than just carpal tunnel releases. One of the most interesting surgeries I was able to observe was an exploration and reconstruction of the brachial plexus in a young man that had been stabbed and subsequently was experiencing weakness of his shoulder. During the surgery it was interesting to see the use of instruments such as an electrical nerve stimulator as well as a microscope. In addition is was a great opportunity to put my anatomy I had learnt in medical school into practice. I was fortunate enough to be able to assist and suture during this surgery. Other procedures I was able to assist in included carpal tunnel releases and trigger finger releases. I have sutured a few times previously, but it was great to put this skill into practice once again and gain further confidence. I also became more familiar with different suturing techniques as well as the different types of sutures. I really enjoyed my time in the operating theatres as I was able to assist and feel a part of the team.
Despite thoroughly enjoying the clinics and theatres I attended, I was also able to get involved in other educational activities. During my elective I had the opportunity to carry out a research project looking at the biomechanical testing of distal radius osteotomy for malunion’s. We have been comparing patient specific plates to standard distal radius plates. Not only was this research project a great academic opportunity, but also an opportunity to get hands on with surgical instruments such as drills and sagittal saws whilst preparing the samples. On Friday afternoons I was able to attend the Registrar’s teaching sessions. They were aimed at preparing the Registrar’s for the exit exams; however, it was useful to see the kind of knowledge they were expected to have at that level. In addition, some interesting topics were covered during these sessions, one of my favourites being the session on amputations. One thing that stood out to me during my elective was that all the staff were keen to teach, which I am very grateful for.
Overall, I have thoroughly enjoyed my time on my elective in hand surgery. It has been an excellent opportunity to put my knowledge I had learned in medical school into practice as well as gain a greater understanding of the speciality. It was extremely valuable to meet people at different stages of their career, from Juniors to Registrars to Consultants, giving me a greater appreciation for the speciality during different stages of the career. These 4 weeks have reiterated to me that hand surgery is definitely a career path I am interested in and would love to pursue in the future. It was a privilege to undertake my elective at The Robert Jones and Agnes Hunt Orthopaedic Hospital and I would highly recommend it to others with an interest in hand surgery.
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