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Feature Medical Training

Could a passage to India be the way to get more surgical experience?

BMJ 2012; 345 doi: (Published 10 October 2012) Cite this as: BMJ 2012;345:e6637
  1. Peter Davies, freelance journalist
  1. 1 London, UK
  1. petergdavies{at}

Young doctors from countries such as India have long been coming to the West to gain experience, but is it time the tables were turned? Peter Davies reports

Surgeons have long realised that practice makes perfect; the more operations they perform, the more proficient they become. Now a cardiac surgeon in India is pushing that principle to its limits. At the hospital he founded in Bangalore, Devi Shetty and his colleagues carry out operations in numbers unprecedented in the West while achieving comparable, if not better outcomes.

Meanwhile in the NHS, surgeons in training complain that the junior doctors’ “New Deal” and the European Working Time Directive are restricting opportunities for hands-on experience by limiting their working week to 48 hours. Martin Elliott, co-medical director of Great Ormond Street Hospital, London, says: “It’s really hard for people in smaller specialties to get the level of exposure their seniors had when they were training.” The difference can amount to tens of thousands of hours spent in theatre, he says. “They and we are concerned they won’t end up with that strange three-dimensional knowledge surgeons acquire over time.”

Elliott devised a neat solution: he sent a trainee paediatric cardiac surgeon to work with Shetty at his flagship 1000 bed Narayana Hrudayalaya Hospital. After an intense nine months and hundreds of operations, the trainee has recently returned to a locum consultant post in the NHS. Elliott is keen to send others. He is frank about the cultural and administrative challenges but would like to create formal training partnerships with countries such as India and China, where scope for high volume surgery still exists.

Shetty is scathing about Western restrictions on doctors’ working hours. “By the time you’re an experienced surgeon, it’s time to retire. Any cardiac surgeon of substance has worked long hours. …

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