The subject of young plastic surgeons is a very topical one. The specialty of plastic surgery was approved in our country almost five years ago, and in preparation for this event, we initially promoted the Western approach to the vocational training of future colleagues. We felt that there was a need to focus on reconstructive surgery, because there is a societal demand for surgery for congenital diseases, as well as surgery for trauma and burns. At the same time, we have always insisted on complying with all Ministry of Healthcare requirements for surgeon retraining, namely, that the 5-month courses admit only general, orthopedic, maxillofacial, thoracic, and pediatric surgeons, and urologists, rather than members of other specializations, who are not included in Order 415n. These specialists were required to have been already working for at least five years in the field of plastic surgery and to have performed specific operations that relate to their major field of study: for orthopedic surgeons, this meant hand and microsurgery, and for general surgeons, this meant breast augmentation surgery, etc. We also insisted that training occurs only in educational institutions, which have a special license to teach plastic surgery.
I can sadly report that very few universities are keeping to these rules, so that doctors are being admitted for retraining immediately after completing residency in their major field of study, with no experience in plastic surgery. Surgeons are being admitted to plastic surgery residency programs while having no surgical skills, being “straight out of school”. The main focus when learning the theory is cosmetic surgery. We know the names of certain universities that issue certificates, without having a license to teach plastic surgery. But the bodies responsible for supervision and monitoring are not take any measures to stop this wrong direction. As a result, in our country, 200-300 certificates are annually given to doctors, who don’t have the skills to work independently in this field, who have only selective theoretical knowledge, and who begin their practice by actively advertizing themselves, thus seriously affecting the Russian market for cosmetic services. To compare, France trains only 12 plastic surgeons per year, and England has only 150 full-time places throughout the country, and training is provided only if a place is vacated.
I’ll provide a specific example. Two years ago, a scandal was brewing in one of the institutions, where I teach. A doctor filed a complaint with his state-funded organization because he was being trained in plastic surgery on Saturdays, a non-working day. He demanded double pay for his ‘work’. This was sorted out, and he received the specialist certificate after completing the training. He then moved from the state-funded organization to a private one, and these days he introduces himself to all my surgery patients at the nearby regional center, as my ‘student’, and carries out ‘corrections’ and ‘alterations’ without my approval. The above example of a young practicing surgeon indicates the immaturity of our community of specialists as a whole. Even if doctors gain the knowledge and skills of plastic surgery, the superficiality of their education in general, and the lack of necessary ethical input, creates a wishy-washy professional environment, which undermines all the surgeons in this field, and, most importantly, the patients.
I believe that sooner or later, in the interests of patients, as well as the manufacturers of surgical products and the professional community, there will be changes that will focus on the following:
1. Short-term courses to train plastic surgeons will cease, and teaching will be only through full-time residency training, that is, 2 to 5 years of clinical training, the teaching staff being personally responsible for each trainee.
2. The Ministry of Healthcare will publish the actual lists of universities and medical academies, who have the right to train plastic surgeons, and certificates from other institutions will not be recognized.
3. The doctors, who have received certificates of plastic surgery after 1-2 years of practice, will be subject to an independent exam to ensure their professional skills comply with the international requirements for plastic surgery training. They will thus require additional knowledge to what they acquired at universities with certain teaching staff, profile and clinical trends.
We have yet more work to do, but the future always intrigues and inspires new achievements.