Mr Jamie Nicholson: Trauma and Orthopaedic SurgeryThe 2020 Surgical Spotlight Series is a monthly blog article in which Edinburgh-based surgeons shed light on their surgical specialty and daily life. Our aim is to educate students about each of the various specialties and the array of opportunities they bring. In March, we interviewed Mr Jamie Nicholson, a Senior Registrar at the Royal Infirmary of Edinburgh. He was the previous module organiser of the Undergraduate T&O block for Edinburgh University during 2017-2019. Mr Nicholson graduated in 2011 with MBChB Honours from Aberdeen and a first class BScMedSci. He completed his MRCS whilst an FY on the Academic Foundation Programme. In 2013 he took up a run through Orthopaedic ST job in Edinburgh. Mr Nicholson has an interest in trauma, upper limb surgery and teaching. He is the current organiser of the IST Core surgery T&O day in Scotland since 2018. In 2020 he was appointed as a Member of the Faculty of Surgical Trainers of RCSEd for his work on undergraduate and postgraduate education. The interview can be found below:
Could you tell us about your specialty? Trauma and Orthopaedics is a diverse specialty which, along with General surgery, makes up the vast majority of the surgical workforce in the UK. Roughly half our time is spent dealing with trauma but there is a wide range of ‘sub-specialty’ practice including paediatrics, tumour, major trauma reconstruction, shoulder and elbow, hand, foot, knee, hip or spine. We work closely with emergency medicine to look after patients who sustain trauma. This can be anything from a simple fall resulting in an isolated injury up to a high energy trauma resulting in multiple life changing injuries. Occasionally we perform life and limb saving operations when dealing with open fractures, vascular compromised injuries, compartment syndrome, or for severe infections. The registrar programme is 8 years of specialist training following the completion of foundation years. There is opportunity to take time of out training if one wishes to pursue research or teaching. Most trainees also choose to spend a year (or more) as a fellow to gain extra experience in their chosen sub-specialty prior to taking up a consultant post. What led you to choose the specialty? I knew from early on in medical school that I found surgery fascinating. The skill, confidence and responsibility of surgery was something that really resonated with me. I found orthopaedics was unique in that unlike other surgical disciplines, you are carrying out reconstructive surgery to restore normality and relieve pain for patients following an injury or disease process. The operations are diverse requiring a range of techniques from arthroscopy, major open surgery for fractures or joint replacements, minimally invasive fracture fixation, and delicate soft tissue reconstruction. Describe a typical day in your life. I tend to get up early at 05.45 and when feeling up for it get to the gym before work, with a small child it is usually the only time I have to myself! 0715-0730 – arrive to work, look over the operating cases for the day and check the in-patient list for issues on the ward round. 0800- daily meeting where the new patients and post-op radiographs get reviewed. 0830 - ward round with the consultant and junior doctors. 0900 - theatre or clinic for the day. The working day is varied, challenging and extremely enjoyable without being exhausting. Although we spend most of our time in clinic and theatre, we are also always available for medical advice for the foundation year doctors on the ward. How intensive is your work schedule? The working day is 8-5 but most of us would usually come in early and occasionally stay late to ensure the list is finished and the post-op patients are doing well. Our on call in Orthopaedics is generally quite good and I suspect it is slightly easier than the general surgeons. As a senior we are usually on call from home, having spent a normal day at work, that can mean several phone calls over night or coming back into the hospital to review/operate on potential emergencies. Usually one in six weekends are spent and around one in ten week days on call. The working week is usually 2 or 3 days in theatre and 1 or 2 days in clinic. Most portfolio and research activity is done in your own time in the evening or weekend which does require some time planning and sacrifice. Favourite things about your specialty? The work is extremely rewarding and there is a real sense of satisfaction that comes with seeing patients do well after operations that you have done. Injuries that would have resulted in a loss of limb or lifelong disability in the past can often be managed extremely effectively with a range of reconstruction techniques. There is a real spectrum of pathology and some cases are extremely challenging even for veteran consultants. Orthopaedics is rapidly evolving. Even during my registrar training there are new techniques which didn’t exist five years ago, for example fixation of rib fractures for flail chests. An ‘Academic Orthopod’ used to be an oxymoron. Now research in Orthopaedics is thriving and in Edinburgh we are lucky to be a respected academic unit producing work that is influencing international practice. Highlights of your career? Running the Edinburgh University Orthopaedic Undergraduate block was a real joy and it was inspiring to see medical students being enthusiastic towards surgery. The block is now recognised on a national level for the excellent structure and delivery. Alongside my time spent teaching I have undertaken research on clavicle fractures and have published several papers which have been highly influential to guide management of these injuries. Anything you wish you'd known before starting your career journey? Surgical training comes at a personal cost to your time (including your family) and finances. The race is long and, in the end, its only with yourself (bonus marks if you know the song). Make sure surgery is definitely for you as there are easier paths in medicine and the novelty will wear off if your heart is not completely in the job. Although training is competitive and the temptation is to move from one project to another, be careful with your time. Ensure you enjoy your success and build in down time. Surgery is constantly humbling: when complications occur, they can be devastating for patients and when you have performed the surgery you feel entirely responsible for it which can be challenging to deal with. You should be your own biggest critic and reflect on your performance in order to ensure you learn and grow from it. (Essential reading for all future surgeons is Henry Marsh's 'Do No Harm' and Atul Gawande's 'Complications'). What do you like to do outside of work? Spending time with the family, hill walking, reading, acquiring single cask speyside or islay whisky, rioja wine, HBO TV shows, budding amateur chef, fine dining when a babysitter is available. Any advice for medical students? I think you know early on in medical school if you want to be a surgeon. It may take time to find the speciality that is right for you and be careful of being too heavily influenced by the characters you meet during short surgical attachments as they do not necessarily reflect the speciality as a whole. Find a speciality where you enjoy the ‘bread and butter’ work as that is what you spend most of your time doing. We all have exciting emergencies, but in reality, that makes up only a small part of the job. Start early and stay late (when you can), scrub into as many cases as you can, get involved with a project. RCSEd and BOTA have great student events and membership projects. Find a mentor. It doesn’t need to be a consultant and sometimes a registrar in a speciality of your choosing will be just as good. They will be a good source of advice and potential projects. What attributes are best suited to your specialty? The ability to think critically, make decisions, communicate, take responsibility for your actions and learn from feedback are all good attributes of a surgeon. These so called non-technical skills of surgery are becoming increasing recognised in selection of surgeons. Demonstrating ability and knowledge of them is crucial. The cliché that Orthopaedics requires strength for which males are most suited is an outdated stereotype and should be confined to the past. The new intake of specialist trainees this year in Edinburgh is 75% women. Selection is based fairly on individuals which show ability and commitment to the speciality. Who is your biggest inspiration? Professor Jimmy Hutchison in Aberdeen inspired me to do Orthopaedics. He ran the undergraduate block and was a real role model to aspire to. I was fortunate to have a fantastic Intercalated degree supervisor, Mr Alasdair Sutherland. I was considering a career in general surgery at the time and this insight into Orthopaedics gave me a new perspective. I have genuinely never had any doubts about becoming an Orthopaedic surgeon ever since. ESSS would like to thank Mr Nicholson for his co-operation in the production of this article. Mr Nicholson can be contacted at [email protected] (Twitter: @OrthoNicholson)
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