GENERAL SURGICAL TRAINING AT CROSSROADS

Being a full-bred General Surgeon from the day I passed out as a Surgeon around 30 years back. I had learned most of my surgeries from the General Surgeons, who could operate head to toe because there was no availability of subspecialties field at that time in most parts of Malaysia.

Thus our seniors and I can be considered as trial and error surgeons because once we are posted to any hospitals at that time. We had to do all types of surgeries even obstetrics/gynecological and orthopedic in certain hospitals.

The hospital which I started my journey as a junior doctor was Kota Bharu Hospital in Kelantan. At that time the General Surgeons had to do orthopedic surgery too, this was in 1990.

As such major and district hospitals that offering surgical services were run by General Surgeons who were well rounded to give the broader required surgical services with their experience.

However with the advancement of refined skill and better outcome from the surgery by subspecialties services. Also, the scope of work skill for General Surgeons to cover became more technological and precise.

As such the birth and requirement of subspecialties increased in Malaysia to give better service to the patients. The availability of these services is mostly at main teaching Universities and only at major hospitals of the states.

However, the number of subspecialties surgeons in each field of surgeries is a bare minimum to maintain the services and perhaps with one or two subspecialties trainees. It is because very few want to sub-specialize after many years of MBBS and Masters training, another 4 years of grueling subspecialties training, very few available training posts, the scope of promotion slim and tempting private practice.

In this complex subspecialties surgical field training.

The current general surgical trainees are absorbed into the universities and main hospitals for their training and qualification as General Surgeons. In the requirement of their general surgical training, they are rotated through various subspecialties in these centers with no actual hands-on work training as general surgeons. Who will be posted to the district hospitals? On top of it, they need to compete at times for hands-on skills with the subspecialties trainees.

As such the newly qualified General Surgeons are posted to district hospitals and major hospitals for their practice of general surgical work.

They unable to perform general surgical work and prefer to refer to subspecialties. As they were rotated in these various subspecialties fields during their training and they are seeing highly refined work and follow-up of patients by the subspecialties team.

Besides most of the trainees never really had a chance to work with general surgeons with pure general surgical work at district-level hospitals. At the same time with increase subspecialties services. There is no place for trial and error at current times. It is important to learn the right method to practice at district hospitals.

I opine it is very important to expose a year or so these general surgical trainees at district hospitals with General Surgeons to do purely general surgical work rather than rotating them in subspecialties at major hospitals and universities most of their training.

So that they get a better grasp of being a General Surgeons when they are posted after completing their training. Along, they understand the intricacies of general surgical work at district hospitals with limited resources and the no availability of high technological investigations.

Even major hospitals find it difficult to retain the subspecialties surgeons in the service due to a high number of them crossing over to private practice. Thus the workload of subspecialties falls back on the General Surgeons.

 Also most of the patients and families will prefer the treatment to be given at the district hospitals rather than referring to a bigger center far away from their home. As such it is important for General Surgeons to be capable of managing the surgical cases with all the limitation at district hospitals which have no subspecialties services most of the time.