Evidencing Personal &Professional Development, Perspective of a Surgical Trainee

Introduction: The author strongly believes that there is a continuous need for personal and professional development in order to keep and improve an individual career path way. It is also imperative to provide evidence of these acquired skills and attributes. According to General medical council, it is a responsibility of every doctor to be competent and up to date. This should be achieved by regularly taking part in activities that maintain and further develop competence and performance. This in turn ensures safety and care to patients [1]. Methodology: The author has had excellent opportunities in his career to participate in diverse personal and professional development programmes. It was important to participate in these programmes to achieve career progression. He would like to share three recent activities from his curriculum vitae which resulted in his significant personal and professional development. The author also had his revalidation last year and found to be fit to practice for next 5 years till next revalidation. The author followed an agreed action plan with his supervisor to accomplish this work. Realistic goals and time frame was set with the help of supervisor. Subsequently, the author had a chance to critically analyse below mentioned three different activities, in order to explore all the achieved learning themes behind these events. The author was fortunate enough to be involved into three different personal and professional development programmes. Firstly, he managed a regional colorectal conference and attained an excellent management experience from that conference. He learnt a lot about better time management. He came to know about different management theories and models and is now able to use these theories for his future management responsibilities. Then he had a communication challenge and difficulty in theatre. He was able to resolve that issue with his strong communication skills. He developed his communication skills and assertiveness with the help of this first-hand experience and different communication models. Lastly, the author had a wonderful opportunity to demonstrate and develop his leadership and team working skills in an International Conference. He realized that leader needs to be a role model for his team and should be leaded by his example. He observed and demonstrated different roles of a leader according to needs of his team. He also learnt about different leadership theories and models. He also acquired a good understanding of a team development. Conclusion: It is extremely important for every health care individual to have personal and professional development. The author recommends that lessons learnt from the author’s experience and results can be applied in a broad generalised way to achieve development. It is crucial for us to keep a structured record of this development and provide evidence of the improvement. In short, it was an extremely useful exercise for the author that resulted in significant lifelong development in his management, communication and leadership attributes.

Colonoscopically Assisted Laparoscopic Polypectomy–An Alternative to Right Hemicolectomy for Large Right-Sided Benign Polyps

Introduction: Laparoscopic assisted colonoscopic polypectomies have been well described in the literature and are well established in surgical practice, for removal of large, inaccessible, or flat based polyps. Laparoscope allows the endoscopist a serosal viewpoint and thus clear indication of perforation, in addition to enhancing endoscopic positioning through colonic mobilisation, facilitating polypectomy. We describe a previously rarely published technique, in which the colonoscope directs the surgeon to polyps and laparoscopy enables wedge resection of benign polyps using Endo GIA staplers. Using this method, the colonoscope provides an intra-luminal view ensuring adequate excision with margins whilst the laparoscope provides intra-peritoneal access for the wedge resection. Methods: This is a case series of 12 patients with large tubulovillous adenomas, found and biopsied at colonoscopy. Under a general anaesthetic, an on table colonoscopy was performed to identify and reassess the polyp, whilst a laparoscopy was performed to excise the polyp via wedge resection, using the endoscopic view as guidance. Results: The polyp was identified and completely resected in our 12 patients. All patients were discharged on the first post-operative day. Of the polyps excised, a focus of adenocarcinoma was detected in one and an adjacent endocrine tumour was found in another patient in histology along with tubulovillous adenoma. Rest were all tubulovillous adenomas only. Conclusion: We propose that this technique should be regarded as an alternative to Right hemicolectomies and difficult endoscopic mucosal resections for large adenomas, and be regarded as a definitive and safe procedure in its own right.

Colonoscopy a Real Diagnostic Paragon

Diagnostic colonoscopy acquires the status of gold standard investigation for evaluation of colonic problems. Formally, colonoscopy was first initiated in June 1969 in America. Colonoscopic history can be traced back to 1958. Matsunaga from Japan was the pioneer as he used a gastrocamera which was the start of colonoscopic era. Flexible sigmoidoscopy was later introduced in 1963. Existing colonic perforation and refusal of a fully compos mentis patient, remain absolute contraindications to diagnostic colonoscopy. Bowel Perforation, although less common, is a disastrous complication of colonoscopy. It is a basic right of any patient who has been offered a colonoscopic procedure to have appropriate, clear and concise information about colonoscopy. Consent literally means permission or an agreement which is granted by a patient to a health care individual to receive examination, test, treatment or intervention. Colonoscopic consent process should be valid and has voluntary, fully informed and capacity aspects as its integral components. There were a lot of oppositions against colonoscopy at that time. It was believed to be dangerous and unnecessary exercise by many surgeons. Time has proved that to be a wrong perception. It is now believed to be an extremely useful diagnostic modality. It is safe procedure in experienced hands and provides valuable clinical information. Colonoscopy is not a pleasant investigation as it is usually related with pain and discomfort by patients;fortunately, good analgesia and safe conscious sedation make this hostile but worthwhile procedure tolerable to patients.Today colonoscopy has kept its status of the gold standard investigation in diagnosing bowel cancer and has prime role in the assessment of majority of large bowel symptoms. Colonoscopy also retains the status of being an investigation with highest sensitivity and specificity, out of all available diagnostic modalities, for identifying adenomatous polyps and now it has acquired a unique status of being a diagnostic paragon.