ASJ Anniversary

13 THE GLEANER | SUNDAY, MARCH 3, 2019 The contribution of the University of West Indies postgraduate training programmes to the Association of Surgeons in Jamaica (ASJ) WHY A DOCTORATE OF MEDICINE (DM)? The establishment of the medical school in 1948 and its first gradu- ating class in 1954 established a steady and dependable stream of adequately trained doctors to meet the needs of Jamaica and Commonwealth Caribbean nations. Once this need was met, the next step was to address the acute short- age of general and specialist-trained surgeons. The opportunity to do so came in 1972 when a DM programme in surgery was established by The University of the West Indies (UWI) with funding from the Government of Jamaica. Critical expertise was provided by the Hope Foundation (Project HOPE). The first graduates were Ronald DuQuesnay in general surgery and, soon after, Charles Lyn and Halda Shaw in otorhinolaryn- gology (ORL). These three pioneers ushered in a new category, the aca- demic surgeon, whose responsibilities included their development as aca- demic teachers at theMona campus. Now in the retirement phase of their careers, theyhavebecomehousehold names in surgical practice in Jamaica through their significant influence on the development of surgery in Jamaica. In general surgery, Ronald DuQuesnay was a master surgeon, a surgeon’s surgeon, especially well known for his no-nonsense opinions in situations where the decision to operate or not was being discussed. He also provided a critical overhaul of the surgical programme when this was needed and for well over a decade, he was in charge of post- graduate surgical training at the UWI, Mona campus. Drs Lyn and Shaw similarly contributed to the development of teaching, to both undergraduates and graduates in their specialty. As the programmes developed, graduates had the opportunity to learn basic man- agement techniques, which were especially useful for those subse- quently appointed senior medical officers in charge of government hospitals. THE EARLY YEARS Once the quality of the DM graduate in general surgery and ORL was confirmed and accepted throughout the region, the period of the 1980s and ’90s saw the es- tablishment of additional training programmes in orthopaedics, urol- ogy, cardiothoracic surgery, neu- rosurgery, and paediatric surgery. More recently, DM programmes in ophthalmology and plastic surgery have been established to provide the necessary trained specialists to meet the needs of the region. Our DM in the various subspecialties of surgery is recognised by the accreditation bodies of the United Kingdom, Canada and Australia, which has allowed our graduates the opportunity to complete fellow- ships in these countries. As a result, there are now super-specialists in laparoscopic surgery, hepatobil- iary surgery and colorectal surgery, among other areas. CONSOLIDATION The DM programmes attract some of the brightest and best of the graduating class and over a pe- riod of at least five years, they are trained in the scientific and clinical methods of surgical diseases, as well as the technical skills required for providing high quality surgical care. Today it is fair to say that the ma- jority of the surgical consultant staff at our hospitals were trained in this programme in Jamaica. Currently, in addition to Jamaica, our graduates are active throughout the region – as far south as Trinidad and Tobago, and north as The Bahamas, and all the islands in between. Additionally, you will find graduates of the DM in surgery in established practice in the USA, Canada, United Kingdom, as well as several currently doing fel- lowship training in Australia. CHALLENGES & CONCLUSION Today, through globalisation and easy access to information through Google, our specialist surgeons aim for, and are held to, the high- est level by a discerning public. The expectations of patients are not surprisingly real and they do not want a ‘trainee doctor’ to do their operation. Whereas with the right supervision and assistance, most residents in the later stages of their training can effectively perform many operations with similar out- comes as the consultant, this fact is sometimes unknown or lost to the public. No surgical procedure is without the possibility that even the appropriate direct actions may be associated with complications, some with harmful consequences. It is often said that a surgeon without complications is not operating often enough. It would be remiss of me to con- clude without some comments about the future of surgical train- ing, given of the significant costs involved and the trend towards subspecialisation. The immediate challenge is to address the cur- rent shortage of specialist-trained surgeons throughout the island. This is despite the fact that in ad- dition to the University Hospital of the West Indies, Kingston Public Hospital and Cornwall Regional Hospital as accredited training in- stitutions, aspects of training are also now provided at Mandeville Regional Hospital and SpanishTown Hospital. We will have to engage international partners, such as the University of Toronto, to facilitate fellowship training for our super subspecialist-trained surgeons, but we must also regionalise care to areas of expertise and develop centres of excellence with restrict- ing and matching surgical proce- dures to institutions and skill sets. Centres of excellence for cancer care and trauma care are areas that come readily to mind. Whether it is minimal invasive surgery, endoscopic surgery or other means of reducing the trauma usually associated with accessing the disease or damaged body part, the majority of surgery per- formed nowadays is dependent on expensive technology which require significant capital expenditure and will need replacement over time. There may be enthusiasm for the latest robotic intervention, but careful cost analysis shows that even in the best hands, the robot may not yet be fully beneficial to the average patient. While there is good evidence of the superiority of laparoscopic surgery in the majority of elective abdominal operations compared to the conventional, open-surgical approaches, there is still a lot to be said for a well-performed open-surgical procedure done in a compassionate and caring environment. For continued success in meet- ing the needs of Jamaica and the region, the Association of Surgeons of Jamaica (ASJ), the UWI and other professional bodies, such as the Caribbean College of Surgeons, must continue to work together, combining resources, forming part- nerships, so that a fully equipped surgical skills laboratory is available for the professional development of the members and residents, offering workshops, short courses and struc- tured training sessions as we strive to provide excellence in surgical care, training and research. Evidenceof partnership is provided by the ‘2018 Guidelines Initiative’ and supported by the Stewart’s Automotive Group, which saw the ASJ and the Department of Surgery, UWI, developing practice guidelines to standardise the quality of surgical carebeingdeliveredacross the island. Such initiatives augur well for the future of surgery in Jamaica. PROFESSOR JOSEPHPLUMMER General andColorectal Surgeon Head of the Department of Surgery, University Hospital of the West Indies Relevance of the doctorate of medicine programme Surgeons Keith Wedderburn, Trevor McCartney and Delroy Fray being honoured by the Medical Association of Jamaica in 2016. ASSOCIATION OF SURGEONS IN JAMAICA 60TH ANNIV SARY FEATURE: THE SUNDAY GLEANER MAGAZINE | MARCH 3, 2019