As a specialist trainee trying to develop an interest and expertise in Female & Reconstructive Urology, I have had the opportunity to attend a few excellent courses on reconstructive techniques and pelvic anatomy run by our very own Royal College of Surgeons of England.
On one of these courses, I happened to meet Mr Makar, Consultant Urologist at Worcester, who mentioned this extensive week long reconstructive urology course in Mansoura.
And how grateful I am for that conversation! It is my humble opinion that while specialist urology training in the UK has many strengths, hands-on operative training is not one of them (for whatever reasons), and our counterparts at the same stage of training in some other parts of the world are surgically more confident than us. Going to courses and workshops is a good way of learning skills and gaining confidence.
...specialist urology training in the UK has many strengths, hands-on operative training is not one of them...
I was fortunate to be awarded a generous grant from The Urology Foundation for a visit to Mansoura, Egypt in January 2010 to attend the international training course on “Techniques in Reconstructive Urology” followed by an observership in the department for a further week.
The purpose of the trip was to gain additional experience in reconstructive urological surgery and in particular the various techniques of urinary diversion following cystectomy.
Situated 120 kilometres north of Cairo, Mansoura is the third largest city in the country. There is very little to say about this dry and dusty city apart from a very impressive university with a majestic campus. If the Hospital is the crown of the University, the Urology and Nephrology Centre is the jewel in that crown. The Centre was founded in 1983 and owes a lot to the vision and single handed efforts of Professor Mohamed Ghoneim for its existence. As a result, the universal respect and reverence he commands there is unimaginable. There was only one way the local speakers, themselves professors and senior faculty members, ever referred to him in their talks – His Excellency.
There is no reason why each of us cannot aspire to turn our individual departments into little centres of excellence.
When you consider his achievements on the one hand and see his humility on the other, you just bow to the man’s greatness. We have talked a lot lately about clinical leadership in the NHS. The technical benefits from the course apart, the senior trainees and new consultants from the UK would do well to go there just to draw inspiration on leadership. There is no reason why each of us cannot aspire to turn our individual departments into little centres of excellence. A visit to Mansoura at once humbles you and lifts your ambition.
The course was the first international course on Reconstructive Urology and was run over 7 days from Saturday the 23rd to Friday the 29th January and covered all aspects of reconstruction. Because Egypt is a Muslim country, the working week starts on Saturdays and the weekend falls on Fridays (and partly Thursdays). It is, without a shadow of doubt, one of the most useful courses a British trainee could go on.
The contents were very comprehensive and included ureteric reconstruction, ureteric reimplantation techniques, urethroplasty, hypospadias surgery, bladder exstrophy repair, various options of urinary diversion, surgery for PUJ obstruction, bladder augmentation and slings for urinary incontinence.
The days began with ‘State of the Art’ lectures delivered by well-renowned international experts. This was followed by live surgery demonstrated through video link, the technical quality of which was brilliant. This session was very interactive and participants were encouraged to ask questions. Reasonably priced CDs of the procedures performed were made available instantly for the participants to have as an excellent resource for future reference.
The highlight of the programme by far was the afternoon sessions in which the techniques demonstrated in the morning were practised by us in simulated sessions under exact real life theatre conditions. You hear about the techniques first, watch them and finally get to practise them hands on. Can there be a better way of learning skills? The group who were not practising the techniques participated in the case discussions. These once again were very lively and educative.
Overall, it was an excellent course and I have been so overwhelmed with the whole experience that I have decided to try and establish close links with Mansoura for my own benefit and that of my trainees, once I am a consultant.
After the course, I stayed on for a further week to attend their theatres. The volume and variety of work available was amazing. There is at least one cystectomy going on every single day. The trainees perform most of the operation, usually with help from a junior consultant. The senior consultant on the firm is around and has to scrub only occasionally. This trust shown to them turns the trainees into extremely confident surgeons. Of course they do not have the same governance issues as we do in the UK and as a result it is perhaps easier for them to allow more of a free hand to their trainees.
You hear about the techniques first, watch them and finally get to practise them hands on. Can there be a better way of learning skills?
However, it would be a disrespect to think that their surgery is any less safe than ours. The number of operations I was exposed to in a week there could easily match my operative experience of several months here in the UK. I was allowed to scrub and in fact, was the first assistant on a few occasions. It is well known that the best way of learning technical skills is by practising them repeatedly over a short period of time.
Apart from the unmatched urological experience, what struck me was the warmth of the people. You are treated with respect and made to feel welcome. Everyone seemed to enjoy their work and be proud to be part of a distinguished team. Perhaps we could take a little bit more pride in the fact that we work in the greatest healthcare organisation in the world – the NHS.
Through this piece, I express my gratitude to The Urology Foundation for their sponsorship of my visit and more so to the people, who enable The Foundation to support us through their generous donations. I would unreservedly recommend this and courses similar to this to all British trainees.
