There are all sorts of great reasons for a medical student to opt for a career in surgery.
Demanding skill and application as much as knowledge and understanding, surgical practice offers the satisfaction of a direct, hands-on approach to treatment. Whether you opt for general surgery or specialise, a surgeon can play a key role in virtually every field of medicine.
Surgery is also a good fit for those who enjoy the challenge of practical problem solving, especially in team environments. Much of the art of surgery lies in the planning, and each procedure can turn into its own project, with a team of professionals working together to plot the best route to the same goal.
But most of all, a career in surgery offers the opportunity of medical practice on the frontline, transforming and saving patient’s lives.
Yet these messages are struggling to get through to today’s medical trainees. For the past decade, concern has been growing that the availability of qualified surgeons is falling badly behind demand for surgical care.
Just this week, The Royal College of Surgeons UK said the shortfall would reach nearly 2,000 consultants by the end of the decade as demand for surgery has outstripped NHS capacity and the number of new recruits has fallen behind.
Elsewhere, from the USA to sub-Saharan Africa, there is the same key problem. There just aren’t enough students choosing core surgical training after their initial medical training is complete.
Some of the figures make for worrying reading. In Sierra Leone, a country of six million people, there were just 10 qualified surgeons at the start of this decade. In the US, meanwhile, one 2009 study predicted that the country would need to train an additional 100,000 surgeons, at a cost of $37 billion, by 2030 to maintain service levels in the face of a growing and ageing population.
Obstructing the surgical pathway
The low numbers of students opting for a career in surgery is a concern for the whole medical community. One study put the figure of those who would even consider surgical training at just 13.2 per cent. A revealing reason given for this low figure was the perception of ‘lifestyle during training’.
It isn’t just a case of surgery training being viewed as hard work. With specialist expertise in short supply, it can often be difficult for students or junior surgeons with an interest in a particular area of surgery to find training opportunities, certainly without travel and considerable upheaval. And even if they are prepared to relocate for a residency under a particular expert, in some cases to another country, the high demand means there is no guarantee of getting a place.
Restricted learning opportunities determined by whatever specialisms local senior surgeons happen to practice can also to poor feedback on surgical courses, which in turn drives numbers down and threatens funding.
In the developing world, these problems are further compounded by low rates of pay and few opportunities for professional development. With countries like Sierra Leone experiencing such acute shortages in qualified surgeons, it is virtually impossible to maintain a meaningful training programme nationwide. The surgeons who do practice quickly become isolated. It is an extremely difficult cycle to break out of – the less trained surgeons there are, the less opportunity there is to train more.
The Proximie solution
The Proximie augmented reality (AR) platform was developed to enable the free flow of surgical expertise so that procedures could be carried out regardless of the leading specialist being available in theatre. By creating a live video link which can be augmented by annotation, by diagrams, by gesture and by superimposing multimedia materials on top of the feed, a surgeon in theatre and a remote mentor can discuss, plan and execute an operation in close collaboration, even if they are tens or thousands of miles apart.
This is great for ensuring surgery can take place as and where it needs to. But it is also an extremely powerful tool for surgical training and skills development.
Through telesurgery, junior doctors are no longer restricted in their learning experiences by the surgery practised in their local hospital. From the comfort of their own iPad or smartphone, they can download the Proximie app and log in to watch live surgical procedures from anywhere in the world.
Proximie also delivers much more than live video. Thanks to the AR component, the Proximie experience is fully interactive. The tutor or mentor, on the one hand, can add to the video by marking up the feed to highlight a particular technique or anatomical detail, or they can post up reference materials for the student to use as they go along. The trainee, on the other hand, can also become directly involved, using diagrams, notes or gesture in the surgical view to illustrate their queries, or practice a technique in shadow for the mentor to check.
And as well as the live experience, Proximie Library provides a resource for storing broadcasts of operations. Over time, this will grow into an enormous learning resource in its own right, where learners can access real demonstrations of chosen procedures complete with added augmentations and illustrations.
The potential for this to reinvigorate surgical training is enormous. By breaking down the barriers which have strangled access to expertise, would-be surgeons now have limitless horizons opened up to them. Any procedure, any specialism, any expert presents a viable learning opportunity, with no need to travel. A single procedure can be accessed by countless trainees, multiplying the development of skills many times over.
Surgery is a wonderfully rewarding, engaging profession which gives those who choose it the ability to transform lives. As we enter a new era of how surgical knowledge and expertise can be communicated and accessed, it also has the power to radically transform healthcare the world over.