Integration of plastic surgery into the undergraduate medical curriculum: the Norwich model and experience

Abstract

Plastic surgeons operate throughout the body, treating the widest range of trauma, malignancy, and congenital disease of any specialty. It also deals with a broad spectrum of sensitive emotional and psychological issues such as cancer diagnosis, reconstruction following disfiguring cancer and/or trauma surgery as well as difficult aesthetic issues. Therefore good communication skills and excellent doctor-patient relationships are crucial aspects of the specialty.Plastic surgery is not part of the curriculum in most medical degrees in the United Kingdom. A recent survey of UK medical schools revealed that plastic surgery was part of the curriculum in 12 out of 17 (71%) schools; but a compulsory component in only 2 schools.1 At the University of East Anglia School of Medicine, Health Policy and Practice (UEA) and the Norfolk and Norwich University Hospital (NNUH), the development of an Academic Plastic Surgical Unit has highlighted these issues. The UEA offers a highly innovative, fully integrated 5-year undergraduate MBBS degree programme based on the Problem Based Learning structure. It promotes learning through small group sessions supported by whole class discussions, lectures and seminars as well as self-directed learning. Within each year, clinical experience is provided in both primary care and in hospitals. This unusual modern educational approach emphasises early and frequent patient contact with the application of basic science to clinical problems right from the first year. The stated aims of the course are to produce doctors with sound medical knowledge, exceptional clinical and communication skills - the professionals who are fit for purpose to work in the twenty-first century. The case for plastic and reconstructive surgery Plastic surgery has arguably the highest trauma workload including upper limb and hand injuries, soft tissue injury/loss and reconstructive surgery following trauma. It also deals with a wide range of pathologies; congenital, neoplastic to traumatic. For example, skin cancers, the commonest cancer in the western world has an increasing incidence; at least 100,000 cases are diagnosed each year, compared to 84,500 in 2007.2Thus, the value of teaching plastic surgery in the undergraduate curriculum is indisputable.