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Fellowships - Report from the First Canadian ASG Fellow
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Report from the First Canadian ASG Fellow
Ross Leighton M.D., FRCSC
2004 Canadian ASG Fellow
Halifax, NS
In 1978, a Travelling Fellowship was jointly established and sponsored by the Austrian, Swiss and German Orthopaedic Societies. Since then, fellows have been visiting centres in Britain, Canada and the USA. The original intention was also for a reciprocal fellowship, and in 1998, two orthopaedic surgeons from the USA visited the German-speaking countries in Europe. This year saw the first fellows from Britain and Canada joining with two others from the USA. I am very grateful to the Canadian Orthopaedic Association for selecting me as this first Canadian representative.
The ASG Fellowship is highly regarded in Europe, and a large alumnus association has developed promoting dialogue and collaboration. Many people worked hard to make our trip a great success, but particular thanks should go to Prof. Hans-Werner Springorum from Bad Mergentheim, and Prof. Jochen Eulert, and Dr Christian Hendrich and Dr Dirk Boehm from Wrzburg, of the ASG Alumnus Association who perfectly coordinated all of the arrangements for our visits and travel.
My companions on the six-week tour of Europe were: Professor Brian Adams from Iowa State University who is a hand and upper limb surgeon, Associate Professor Joe Borrelli from Washington University in St Louis, a trauma surgeon, and Associate Professor Peter Briggs from Newcastle-Upon-Tyne, whose interests are foot and ankle reconstruction. With my own interests in trauma and lower limb reconstruction, we represented a fair spectrum of trauma and orthopaedics between us (excluding spines). Joe Borrelli and I had met previously at the Orthopaedic Trauma Asssociation (OTA) meetings; otherwise, we were all complete strangers at the beginning of our travels. We soon got to know each other and by the end of the tour, we were firm friends.
We arrived in Germany on 12th April and spent the next four weeks visiting university hospitals in Wrzburg, Hannover, Berlin, Munich, Ulm, Heidelberg and Hamburg - spending three or four days in each location. We were formally welcomed to the Fellowship at the Southern German Orthopaedic Association meeting in Baden-Baden, which has been the venue for the annual scientific meeting of the fellows since 1983. We then spent a week in Switzerland visiting Geneva and Zrich. Our tour was completed with a week in Austria visiting Innsbruck, Salzburg and Vienna, returning home on the 22nd of May.
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| Figure 1: Drs. Kristof, Ross Leighton and Prof. Krettick Hanover |
One of the great things about this Fellowship was our ability to have input into the choice of places and people we visited. Most centres made efforts to present clinical and research work that reflected our own particular interests, but there were opportunities to see a wide spectrum of activity. Having been a consultant for over 15 years, it was very useful to see and discuss developments in the broader field of trauma and orthopaedics as well as in my specialist field of hip and knee reconstruction.
On our arrival in each of the cities we visited, we were greeted at the station either by the Chief himself, or by residents who had been detailed to look after us and ensure that all our needs were looked after. Single room accommodation had been provided for us in comfortable and convenient hotels. The most unusual of these was the Schiefes Haus Hotel in Ulm which is the oldest building in the city dating from 1443. With its timber construction and sloping floors and ceilings, it was quite a talking point.
A programme of clinical and research activity had been organized in each place. There was good opportunity to observe and discuss clinical practice. We were also able, on occasions, to assist with surgery and I was delighted to be invited to help with an acetabular osteotomy. Whilst clinical practice was broadly similar to that we are familiar with at home, it was good to be able to hear about and discuss different approaches to those difficult problems and dilemmas we often meet. Ultimately, it is through this sharing of ideas that solutions can be developed and tested. Practice in the Orthopaedic Departments of University Hospitals in Germany and Austria tended to concentrate on joint replacement, spinal surgery, upper limb surgery and paediatrics, with other subspecialties largely being undertaken in the private sector. A broader spectrum of practice in trauma and orthopaedics was seen in Switzerland. There was great interest in recent developments in joint replacement, such as minimally invasive hip replacement and computer-assisted surgery. It was reassuring to see the scientific approach to evaluation of these techniques being used in centres such as Innsbruck and Vienna. Other places were studying techniques such as secondary cementation of the femoral stem in Munich, and re-evaluation of the place of hinge knee arthroplasty at the Endoklinik in Hamburg. Important development work on a new ankle arthroplasty and jigging system has been undertaken by Dr Pascal Rippstein in Zrich, in conjunction with Mr Peter Wood in Wrightington and Dr. Chris Coetzee in the USA.
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| Figure 2: Top of the Olympic Tower, Munich |
The two most obvious differences between the UK and the other European countries we visited are 1) the organization of the clinical team under the direction of a chief or professor, and 2) the separation of the elective orthopaedic and the trauma services. The daily early morning departmental clinical conferences attended by all of the staff were an important means of communication and learning, and the residents clearly regarded this as an important part of their working day. I was able to discuss with trainees their hopes and concerns about training in their respective countries.
The separation of elective orthopaedics and trauma services was striking, and we were able to visit two of the major Trauma Units in Germany: the Medizinische Hochschule in Hannover, and the Charit-Virchow in Berlin. We learned about the local and national organization of trauma, with systems for rapid retrieval and resuscitation. The distinction between trauma and elective orthopaedics is necessarily blurred, and as the numbers of major injuries declines, trauma units are becoming increasingly involved in late post-trauma reconstructive work including joint replacement. Under the direction of Prof. Norbert Haas at the Charit in Berlin, trauma and orthopaedic departments have amalgamated but elsewhere in Germany, more cautious steps are being taken toward greater collaboration and integration.
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| Figure 3: Fellows and Prof. Eulert |
All of the centres visited were involved in basic science research and it was a privilege to be able to see these facilities, to listen to scientific presentations and to contribute our own work. The facilities at the Charit were particularly impressive, but all centres were contributing valuable work in fields such as cartilage and bone culture techniques, articular defect repair, implant coatings, response to wear particles, computers and robotics in surgery and training, and biomechanical studies.
As we were travelling, we often asked ourselves what the real value of the Fellowship was. For me, it has to be meeting many orthopaedic surgeons and making many new friends. A highly enjoyable social programme was organized wherever we went with activities including golf, mountain biking, trout fishing, snow-shoe walking, light aircraft flight over Munich, Nordik walking(!) as well as visits to museums, theatre and sightseeing tours. We were treated to innumerable excellent meals in nice restaurants as well as in our hosts homes. Asparagus was notably in season in Germany! All of this has helped establish those friendships which will be cherished. I see opportunities for collaboration in clinical work and research. I have had many requests for visits to Halifax, Nova Scotia, and conversely there are good training opportunities for our own trainees in Europe. I am infinitely grateful to the COA for awarding me this Fellowship. I returned home tired but exhilarated. The upheaval of organizing absence from family and work has been richly recompensed by the experience.
If you are interested in applying for the 2006 ASG Fellowship tour, contactTrinity Wittman:
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
at the COA Office.
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| Figure 4: Olympic Village, Munich |
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Last Updated on Monday, 11 February 2008 12:50 |
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