Let's Talk Surgery: The RCSEd Podcast

Let's Talk Surgery Podcast, Surgical Crossroads: Choosing your specialty - the Rural episode

October 18, 2021 RCSEd Season 8 Episode 11
Let's Talk Surgery: The RCSEd Podcast
Let's Talk Surgery Podcast, Surgical Crossroads: Choosing your specialty - the Rural episode
Show Notes Chapter Markers

This episode we focus on rural surgery and meet  two somewhat unusual surgeons – people who do things a bit differently in a very unique setting.

Gordon McFarlane is a Consultant Surgeon in Lerwick, Shetland Islands.  He graduated from Aberdeen University and continued training in general surgery in Aberdeen and Inverness. He worked for 9 years as a surgeon in Chogoria, Kenya, at a 300-bed rural church hospital. On returning to the UK, he spent 4 years on the West of Scotland Training Rotation in General Surgery, the last year of which was as a Rural Surgical Trainee with the North of Scotland Deanery. He was appointed to Gilbert Bain Hospital, Shetland in 2004. He is a Fellow of the College of Surgeons of East Central and Southern Africa, and a member of the Viking Surgeons Association. He maintains an interest in rural surgical training and surgery in Africa. 

Stuart Fergusson (@sj_fergusson) is a Rural Surgical Fellow at Aberdeen Royal Infirmary. He graduated MBChB from the University of Glasgow in 2006 and subsequently trained in colorectal and general surgery in Scotland and Northern Ireland. Following completion of training, he spent 5 months volunteering in a remote and rural Zambia mission hospital, and will spend August 2021 – August 2023 in a Rural Surgical Fellowship prior to taking up an appointment as a consultant surgeon with NHS Shetland. Stuart describes himself as unusual in that he has always aspired to work in a rural hospital. During his training he enjoyed every specialty he encountered, and is fascinated by the huge range of pathology he has experienced during his clinical work so far in Zambia and Shetland.

Rural surgeons work solely within Scotland in the six rural general hospitals and perform a wide range of surgery – essentially treating anything that comes to their door or stabilising for transfer if necessary. The skill set is clearly huge, and the variety of cases can be intimidating, as well as exciting. As our guests explain, their job is to provide the best solution available in that moment; it’s about being practical rather than a perfectionist, which both find very satisfying. They are also passionate about the unique opportunity to advocate for their local communities – shaping their patients’ journey in a very personal way. And of course, a huge attraction is living in some of the most beautiful parts of the world.

Rural surgery is clearly unconventional in terms of career path, and both Gordon and Stuart describe how they essentially carved out their own training programmes. Those already in the specialty have been working hard to raise its profile among general surgeons and at government level. 

For trainees whose interest has been piqued by today’s episode, our guests' advice is to seek out a broad range of surgical and wider life experience. In particular look into taster weeks and travelling fellowships and explore the opportunities on offer from the Viking Surgeons Association and the Royal College of Surgeons.

If you would like to find out more about remote, rural and humanitarian healthcare then please have a look at RCSEd’s Faculty of Remote, Rural and Humanitarian Healthcare (FRRHH). 

Contact Information
Visit https://www.rcsed.ac.uk/ for further information and details on becoming a member. 

Email: [email protected] for any questions or topic suggestions you may have for future episodes. 

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Introduction to the topic and guests.
[Sadie Khwaja – Gordon McFarlane] What is a rural surgeon? What's the definition of it?
[SK – GM] So what's a typical week for you then, what does it look like?
[SK – GM] So the skill set is huge isn't it; from endoscopy all the way through open surgery? Is that kind of skill set based on the particular things that you would pick?
[SK – GM] And what's on-call like? I mean, I presume you're doing a one in three, is that right?
[SK – GM] Let's just travel a little bit back in time. So how did you end up in Shetland?
[SK – GM] What did you learn from your time abroad?
[SK – GM] How do you keep your skill set going in that kind of environment?
[SK – GM] As consultants, part of us is our clinical work; what's the other side of you?
[SK – GM] When you get a difficult patient, it's nice to have your colleagues that you can transfer the patient to. How do you deal with those challenging patients? Is the community that you work for small enough that you probably know them?
[SK – GM] Looking back now, obviously, you're happy with your career as it is. Any changes you would make to it?
[SK – GM] When you say rural, I mean these days with technology, are you rural?
[SK – GM] With technology, you've got everything; the whole world is accessible, and you’re in a rural world with a lovely landscape and so forth. Do you think you've got the best job going?
[SK – GM] During your time in Africa you must have seen some quite late presenting conditions. Is that the case in the Shetlands?
[SK – GM] Where is rural surgery going in the future? What do you feel you'd like to see?
[Sesi Hotonu – GM] What about the other specialties like ophthalmology, max facs? [Do those patients] get transferred out? Or do you guys do things in those regions as well?
[SH – Stuart Fergusson] I guess you must fall into the bracket of younger trainees who are being encouraged to follow the rural surgery path. Is that right?
[SH – SF] Who is Stuart and why did he want to do rural surgery in the first place?
[SH – SF] And delving a bit deeper into getting to rural surgery, you were training at a time where things were a lot more formalised…, so how did you carve out the training that you needed to do the job that you're doing now?
[SH – SF] On a practical note, how far away is the nearest big, multi-specialty hospital from somewhere like the Shetlands?
[SH – SF] Has there ever been a time where the sheer number of things that walk through the door or the types of things that walked through the door genuinely scared you, or do you just have to act first and be scared later?
[SH – SF] So, let's talk about what training looks like these days. It seems there's still not a formalised training pathway. What does it look like?
[SH – SF] You mentioned that you did other things, research policy, leadership experience. I've just finished a leadership fellowship myself. And I think all these things are useful to a career in rural surgery. Is that right?
[SH – SF] Why Zambia, and how did you organise it? You took your wife with you as well, what was family life like?
[SK – All] You must be very practical. So out of work, do you like building things or doing things with your hands?
[SK – GM] What do you feel about job satisfaction Gordon, and do you get that [from knowing] you've made a difference for these patients?
[SH – GM] What's the most interesting surgical improvisation you've done? And, of course, maintaining confidentiality and anonymity the most interesting or weirdest case you've had to tackle in your career as a surgeon either in Kenya or in the Shetlands?
[SH – SF] Do you have, Stuart, any final words of advice for our listeners out there who might be excited about the prospect of rural surgery? What would you say to them?
[SH – GM] What about you Gordon, any words of wisdom for our listeners?