One week traveling fellowship in England
March 11-18th 2012
It was an honor and a great pleasure to join the colorectal advanced study week in London and in Basingstoke, on March 2012. I joined the colorectal unit in St. Thomas' hospital for the first two days, and then participated in the colorectal M25 course in the pelican centre in Basingstoke.
The visit to St Thomas' hospital was a unique opportunity to get acquainted with the British surgical setting, so distinct from the Israeli, the Spanish and the French ones I knew before and yet so similar.
The visit was short but intense. It started in London, as we arrived at the St. Giles hotel, which is situated in the heart of London, within walking distance from most of London's touristic attractions. I found it close enough to St Thomas' hospital, and actually walked to and from the hospital, passing Trafalgar square, Downing street 10, Westminster abbey and the parliament, crossing the river Thames and enjoying the unexpected warm weather.
Our visit to St Thomas' was meticulously planned. The consultant in charge was Mr. Andrew Williams, and we were cordially directed and escorted by Mr. Jonathan van Dellen, a research fellow. Our hosts actually thought about all our needs during our stay. Our daily schedule and detailed instructions of how to get to the hospital, and how to find our way in it, were sent to us in advance, so we felt confident and warmly welcomed.
On our first day in St Thomas', our group of four fellows divided. I joined Mr. Carapeti in OR for an examination under anesthesia of a complicated fistulae patient. Mr. Carapeti discussed the options with us and eventually only took a skin biopsy from a perianal lesion. Later I joined Mr. Schizas at the One Stop Pelvic Floor Clinic. I had the opportunity to follow the patients around the clinic. First, their examination at the consultation room. Then, anal manometry and Transanal US if necessary. The technician demonstrated the three dimensional US and various pathologies of the anal sphincter and of the anorectal physiology. I was very impressed by the efficient service of this clinic, so different from what I am used to in my own practice, and this is one of my most practical lessons from the fellowship. I will actually try to adopt this service and am already in touch with a colleague pelvic floor expert, in order to further develop a similar one.
In the afternoon, I joined Mr. Carapeti and Mr. Andrews in OR, for an anterior resection for diverticular colovesical fistulae. It was a teaching session with one of the younger members of their team, thus an interesting exposure to their teaching approach.
That same afternoon I joined Mr. Andrews to an emergency total colectomy for a very interesting case of a septic patient with colitis. Her operation was an example of the team's excellent medical judgment, surgical skills and great teaching for a younger member of the team.
In the evening of March 12th, our group was honored by the Jewish Medical Association UK, and we participated in a reception arranged by Prof. Irving Taylor and Dr. David Katz. I enjoyed the lovely reception, where I had the chance to meet some members of the Jewish Medical Society UK. Professor Taylor's and Dr Deutsch's most fascinating lectures were the highlight of the evening, followed by an interesting discussion with the audience. The following lecture by one of the students that was sent for a month in Vanuatu was really delightful and most amusing.
The next day we joined Mr. Andrews on his weekly ward round, with all the consultants. The 'Grand Round' included all the consultants, nurses and other staff members. Apart from the interesting variety of cases, I was deeply impressed by the excellent bedside manners of Mr. Andrews and of each of the consultants.
After the round, I joined Mr. Datta for a repair of en enterocutaneous high output fistulae, and we shared our views about different surgical approaches in treating this complicated condition.
That afternoon we headed for Basingstoke, for the M25 colorectal course.
The course was held in the Pelican centre, and was perfectly organized. It was very intense, and the lectures covered practically every aspect of colorectal surgery and proctology: Anorectal conditions, colonic polyps, CRC, IBD, colorectal emergencies, functional bowel disorders etc. Though intense, a very tight schedule was kept by the conveners, Mr. Muti Abulafi and Mr. Stebbing. I felt that the best lecturers were summoned, and were all happy to share their personal experience with us. All 'Every day' proctology clinic dilemmas were dealt, as were the emergencies in colorectal surgery, the diagnostic tools of choice and the oncological treatment for malignant disease.
The role of MRI in colon and rectal cancer was discussed in great detail providing further information on a topic that is now a matter of some debate in Israel. It was a great honor to attend the legendary Mr. Bill Heald's lecture, which was most enjoyable. Miss Vaizey's lectures, both on sacral nerve stimulation and on the treatment of intestinal failure had a very pragmatic value for my future practice. Miss Senapati's lecture about operative treatment of pilonidal sinus was very interesting, and since we practice a different approach, certainly enriched my surgical armamentarium in treating this common condition.
Lucy Dingwall, the course administrator, took care of all our material needs while staying in Basingstoke, in a highly professional and welcoming manner.
On the 16th March cold afternoon we returned to enjoy another pleasant day in London, which I spent in the guided 'Alternative London Walk' exploring the street art wonders and history of east London, and in a theatre Matinee.
I would like to express my deepest gratitude to the David Yanir foundation for its generous funding, which allowed me with this amazing professional and cultural experience. It was a brief exposure to British colorectal surgery, combined with a thorough course that conferred all aspects of colorectal diseases, and all aspects of its diagnosis and treatment. This combination certainly enriched my professional knowledge and will surely affect my practice in future years.
I would also like to thank Dr. Alex Deutsch arranging it all from the start. My fellowship actually started yet in Israel, when Dr. Deutsch summoned us strangers to his home, and with his and his wife's warm welcome, turned us into a united Israeli group.
I feel very lucky to have had the opportunity to take part in this fellowship. I am sure that in the following years this experience will affect the practice of all fellows in our group, and therefore the wellbeing of our colorectal patients. Thank you