Hand surgery in Sydney

For my elective I wanted to experience medicine abroad, spend time in an orthopaedic department, and develop my knowledge and understanding of anatomy.

Experiencing hospital life in a different country and culture was important to me because I felt it would broaden my knowledge and enhance my communication skills. I chose Australia, and more specifically Sydney, because of its multicultural society and the sharp contrast in lifestyle between the suburban and rural areas. I chose orthopaedic surgery as it was an area of medicine I was particularly interested in and I was keen to use my elective to evaluate it as a career option.

Learning the ropes

After I was introduced to the hospital and the team – five consultants, a number of junior medical staff, two nurses and two physiotherapists – my first week was spent shadowing doctors around the department, and attending ward rounds and clinics. The basic routine was that the medical staff rotated between the clinic, attending to patients on wards throughout the hospital, and the operating theatres. The department also ran a meeting each Wednesday morning, teaching on a specific topic followed by history and examination of a patient.

After familiarising myself with the hospital and the department, I started to see patients in the clinic before they were seen by the doctors. At first this was quite daunting as the style of history taken by the Australian doctors differed subtly in structure and content from that with which I had become accustomed during my training at Liverpool.

The examinations also proved demanding. They were carried out differently by the Australian staff to those I was familiar with, and many of the routine examinations were not ones I had done before. However, the staff were extremely helpful and after some teaching and practise I was confident in my ability to gain an adequate history and perform a useful examination of the hand and wrist.
 
During these clinics I came across patients from very varied backgrounds; from the elderly and frail to the very young, from English-speaking Australians to non English-speaking aboriginal people.

I had my first opportunity to conduct a history through an interpreter, a valuable experience enabling me to understand better some of the potential problems that can be encountered by patients with communication difficulties. I also had plenty of opportunities to develop my communication skills, and was able to experience first-hand the different health needs of people from various backgrounds.
 
As part of the morning clinic, minor procedures that did not require anaesthetic were undertaken and I was able to perform a number of these under supervision from the junior doctors. I removed pins that had been in place to fix displaced fractures, removed stitches and dressings and applied new ones, and generally helped the staff with whatever required doing. This was a useful chance to practise some basic clinical skills such as wound cleaning and suturing.

Undertaking a research project

One of the consultants in the hand unit suggested it would be useful to carry out a small research project about a common condition that affects the hand and I decided to look at carpal tunnel syndrome. Briefly, this condition is the most common of the entrapment neuropathies and is caused by compression of the medial nerve as it passes through the carpal tunnel in the wrist.

During my placement I saw several patients with the condition, and my project helped me to understand the mechanism of their symptoms. Towards the end of the attachment, I saw a new patient attending the clinic for the first time and after a thorough history and diagnosis, made a diagnosis of carpal tunnel syndrome that was confirmed by the consultant. To identify the condition myself gave me a lot of confidence and was a very positive experience.

Afternoons in surgery

As the unit was surgical I spent most afternoons in the operating theatres, and as the medical staff of the hand unit also performed surgery for peripheral nerve pathology I was able to see a large and very varied range of operations.

One of the most interesting was an exploration of the brachial plexus in a teenage boy who had been experiencing sensory and motor deficit in his arm after a machete attack. The procedure required the use of an electrical nerve stimulator to identify the different nerves in the plexus. This instrument stimulates the muscle group innervated by the nerve, and therefore moves the relevant part of the body. I assisted during this operation, and operated the stimulator under the supervision of the surgeon. It was interesting and also very useful experience in terms of seeing directly how the nerves function.
 
Other procedures I was involved in included a carpal tunnel release, which was performed on a patient I had seen in clinic a week earlier. My work on this topic made the experience very rewarding and I was again able to assist the surgeon.

I also sutured for the first time, stitching on skin grafts and suturing lacerations on a patient who had fallen. The surgeon guided me through the procedure and although I was quite nervous and shaky at the start, by the end I was much more confident. This was one of the highlights of the elective for me as I felt I was actually being a help to the surgeon rather than being in the way!

From theory to practice

Before the elective I felt I was studying the theory of medicine, and in all my attachments during my first three years of medical school I had not really felt involved in any useful sense with the day-to-day workings of a hospital department. I felt much more a member of the team in Sydney, and that the skills I was learning were immediately useful to me.

Overall, the elective was an exceptionally positive experience that not only improved my knowledge and understanding of medicine and anatomy, but also helped me with my confidence and communication skills in consulting without supervision and in performing practical procedures. It was a valuable experience to work with people from another country and culture. Patients from all walks of life provided constantly changing practice for my communication skills and medical knowledge.
 
Having spent five weeks in an orthopaedic department I am also confident that this is an area of medicine I would enjoy, and I am certainly going to pursue a career in orthopaedic surgery.

This guidance was correct at publication 06/03/2009. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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