Abdominal GSW & Peritonitis; Christian/Hindu marriage & gotra/kuli; UK&US medical residencies

[hineas_estel]

I have three completely unrelated questions for fanfiction purposes that I hope someone can give me an answer to :)

Comments

[biascut]

I'm a careers adviser who works with doctors. However, I don't know the American system so it's a bit hard for me to do comparisons.

It depends enormously on what you mean by "completing his surgical training". Postgraduate training to become a surgeon in the UK system is:

5 years' medical degree (most likely undergraduate, although there is now a 4 year postgraduate medicine course for people who've done another degree first)
2 years' Foundation training (you become a fully registered doctor as you move into Year 2. The Foundation programme is 8 x 3 month rotations which will definitely include medical and surgical rotations, and probably GP and/or Psych too. In old money, F1 is Pre-Reg House Officer, and F2 is Senior House Officer or SHO. PRHO and SHO don't formally exist any more. )
2 years' Core Surgical training (4 x 6 month rotations in surgery, definitely including General Surgery. Also referred to casually as SHO.)
5 years' Higher Specialty Training in a specific surgical specialty, such as General Surgery, Vascular Surgery, Otolanryngology etc. (You can see the list of surgical specialties here. CT1 and CT2 are the Core Surgical Training, and ST3 is your first year of Higher Specialty Training. Referred to casually as Registrar, which is what it used to be.)
->> get your Certificate of Completion of Training, or CCT, which qualifies you to apply for Consultant Surgeon roles in your specialty.

So when you say "completed his general surgical training", I am assuming you mean he is a Consultant Surgeon - in which case, it's been a minimum of 7 years since he did anything medical or worked as an A&E doctor. It's quite likely to be longer, since many surgical trainees will take time out of training for research or to get a higher degree.

On the other hand, if you meant "completed Core Surgical Training", then it could be as little as two years since he was working in a medical or A&E rotation in his Foundation programme, which is relatively recent.

I'm also just going to say that it's highly unlikely that someone would complete surgical training and then decide they didn't want to be a surgeon. Surgical training is really, really tough (surgical trainees regularly complain about caps on the number of hours they can work, because they believe they need to work 70-hour weeks to get all the training and experience they need within 7 years.) Completing Core Surgery and getting your Membership of the Royal College of Surgeons and then deciding you don't like surgery and want to do something else is more plausible. On the other hand, it's fanfic, so be as implausible as you want. :)

Happy to answer any questions that I can - although I can't help you on intubations, sorry! One thing you could do is look at the curriculums for Foundation training and A&E training and see whether intubations are on there.

[hineas_estel]

First of all, thank you so much for your comment :)

Second, you're right, I did mean CCT. I should probably have stated that more clearly, sorry. I know switching at that point makes no sense at all, but as you said, it's fanfic. Based on a medical show. And those aren't exactly known for their logical writing or accurate portrayal of just about anything to do with medicine. Which doesn't mean I can't try to make some sense of it.

By my estimation, the character in question would have finished medical school sometime around 1989/99, so he'd go the PRHO/SHO/SpR route. This complicates research somewhat, because, as you said, they don't formally exist anymore. I've gotten my hands on Matthew Stephenson's The Hands-on Guide to Surgical Training (2012), which lists ward rounds, operating, attending clinics, on-call duties, assessment of acute patients, and being the first point of referral for GPs or A&E as registrar duties these days. Do you happen to know if it was the same in the old system?

Also, do you have any insights on what on-call and being first point of referral entails in this case? I'm guessing the later has to do with emergency surgery as opposed to elective one? Would the SpR get called to A&E/Resus/what-have-you and then assess whether a patient would have to be referred or need immediate surgery?

And thanks for tip on looking at the curricula! The Guidelines for the award of a CCT in General Surgery mention ATLS provider/instructor certification and surgical airway management. And the FY guidelines mention airway adjuncts. So that actually answered a few questions :)