The Surgeon
Journal of the Royal Colleges
of Surgeons of Edinburgh and
Ireland
Publications Department
Royal College of Surgeons of
Edinburgh
Nicolson Street
Edinburgh EH8 9DW
UK
Telephone: 0131 527 1689
Fax: 0131 527 3406
Email:publications@rcsed.ac.uk
|
|
Sir,
The current surgical trainees are more aware of the importance of research leading to a higher degree than at any time in the past. The aim being to achieve a clear understanding of research methodology and statistical concepts which would lead to critical appraisal of the latest surgical literature and their ultimate approval or disapproval in modern surgical practice. The task of designing and undertaking a specific piece of research can have a large impact on future individual development in terms of competence and confidence.
Most surgeons considering acquiring a higher degree are Senior House Officers (SHOs) at the end of their Basic Surgical Training, or are Specialist Registrars (SpRs) who take time away from clinical responsibilities before completing their training. Different options are available to surgeons in training in the United Kingdom. Working under the supervision of a basic scientist for two years in a laboratory may not seem the most favourable option to most surgical trainees, but in an appropriate environment this may be an invaluable asset to a career and an opportunity that may never arise again.
The move towards integrated teaching methods, with less emphasis on basic science, has made laboratory work further removed from the clinician. Recently, however, there has been an inclination on the part of the trainees towards basic scientific research. This opportunity may arise under the supervision of a professional scientist or a surgeon with particular experience of laboratory work. Before applying to pursue a laboratory oriented research project within a group it needs to be established that the project is relevant to the candidates’ clinical area of interest. A literature search will certainly help to reveal the nature and quality of the work published by the group. Academic and technical capabilities and extraordinary patience are qualities of utmost importance that are required to embark on a laboratory project. It requires a combination of biochemical knowledge and mathematical logic. The researcher needs to have a thorough understanding of the pertinent questions in order to address them successfully. Additionally, interpretation will be very difficult if all the possible compounding factors are not taken into account.
Laboratory research may be clearly relevant in certain specialities, unusual in others, while in surgical specialities it is an option and may revolutionise an individual’s career. It involves a critical review and assessment of the literature, formulating a hypothesis, critical statistical analysis of the data and deriving correct conclusions. Other concepts which the researcher not infrequently comes across are dose-response curves, randomisation, power analysis and controls. These skills are learnt as the research is conducted. Learning and practising experimental techniques teaches technical discipline. Most of the techniques are simple but mistakes are easy to make if one is not careful. Research done in a laboratory also associated with a clinical group facilitates to get access to tissue samples as well. There is a rapid increase in the understanding of the latest basic science published on a topic helps to understand the natural processes of biology and their relation to disease.
Carrying out the experiments on one’s own makes the researcher understand alternative end-points. The shortcomings of such experimental research can thus be appreciated. Eventually, this determines the possibility of applying changes in surgical practice. Working towards a scientific thesis shows a never-ending desire to answer new questions. The period gives an excellent chance to establish relationships with scientists which help future collaborations. Research methodology is learnt from the supervisor and other scientists working in the laboratory. To ensure that the research is productive a great gap in technical and academic knowledge will need to be filled in a short period of time. Again, the supervisor will play the key role in this. This will be supplemented by discussions with PhD students and postdoctoral scientists. Adequate supervision is of paramount importance for steady progress. The beginning of a project can be really testing and there is a steep learning curve with regards to research methodology.
The ideal situation is that the candidate receives a research fellowship. Otherwise, applying for funding can be frustrating and time-consuming. Money is needed for the consumables in the laboratory and for the fellows’ salary. In the increasing competitive field of biomedical research, more and more researchers are competing for an ever-shrinking pot of research funds. Writing grant applications is a skill that researchers must acquire. It takes on an average 4-6 months before one discovers if the funding application has been successful or not. As the competition for funding amongst groups is fierce many rejection letters are not unusual. Evidence of viability of the project and preliminary results may enhance the likelihood of getting a grant.
When considering research, a laboratory-based project is a unique option. Appropriate university departments should be contacted and potential supervisors met whilst in a clinical job to explore prospects. Laboratory work requires a lot of dedication and commitment. It may involve immense work and longer time to produce data but the published material is of a higher standard and the satisfaction achieved after successful completion cannot be matched. This is one opportunity that may never arise again in one’s lifetime.
H.A.Vohra Clinical Research Fellow Surgery University Hospitals Leicester NHS Trust, Glenfield Hospital Leicester, United Kingdom.
Further reading:
Calman KC. Hospital doctors. Training for the future. London: HMSO, 1993. (PL/CMO993)
Evans S, Deeks J. Does research make better doctors? Lancet 1994; 343: 58
Jorm CM, Stamford JA, Strunin L. Doctor in the lab: what is it like for a doctor to work
with scientists? BMJ 313; 867-9
Sir,
Five patients with potentially fatal orofacial infection treated in our unit have been reported recently. We would like to report a sixth case, who was treated after the article was accepted.
A thirty-five year old man was referred to the Ear, Nose and Throat Service by his General Medical Practitioner because of a sore throat and progressive dysphagia. His condition had deteriorated despite taking penicillin for one week, for a presumptive diagnosis of pharyngitis. Right submandibular swelling was believed to be secondary lymphadenopathy.
On examination in hospital it was noted that he had a fluctuant right cervical abscess, and significant trismus with interincisal opening reduced to 1.5cm. His white cell count was 14.5 x 109, but all other tests were within normal limits
He was referred to the maxillofacial team, and the source of the infection was determined as the lower right second and third molar teeth, although the patient reported that he had never had toothache.
He was treated with intravenous fluids and antibiotics for several hours, prior to incision and drainage of the abscess and dental extractions.
An awake fibre-optic intubation was attempted, but the airway became obstructed. The trismus was fixed, the result of chronic infection of the perimandibular tissues, and was not due to spasm of the masticatory muscles. The patient became profoundly cyanosed, and his oxygen saturation dropped to 80%. It was impossible to pass an endotracheal tube, and an emergency tracheostomy was performed.
The abscess was drained via a submandibular incision and appropriate teeth extracted. He made a full recovery.
This case is a further reminder that oro-facial infections can have serious consequences.
N.N.F. Riberio
T. Al-Aredy
G.C.S. Cousin
East Lancashire Maxillofacial Service,
The Royal Infirmary, Blackburn, UK, BB2
3LR
Addendum
J.R.Coll.Surg.Edinb., 2002 47; 6: 772
The following information was omitted from the first letter featured:
Haematuria investigation based on
a standard protocol
Dr A.N. Ghanem Medical Insurance Hospital
PO Box 213 Mansoura 35111
Egypt
Email: an_ghanem@hotmail.com