Shafik Diwan – General Surgery Elective/Hepatobiliary and Transplant Surgery

Hospital Location: London Health Sciences Center, London Ontario, Canada

Supervisors: Dr. Douglas Quan – Professor of Hepaticobiliary and Transplant Surgery, Dr. William Wall – Director, Transplant Program at LHSC

Contact for Elective:

Christine Ward, Program Administrator

Phone: 519-663-3269

Fax:  519-663-3068

christine.ward@lhsc.on.ca

Main Activities: My time on the general surgery service at UWO was spent primarily between 4 places: the wards, the clinic, the emergency department and, of course, the operating theater. The general surgery teams consisted of 4 individuals which includes the attending physician (consultant), the senior and junior residents and the medical student. Because of this, the medical student was an essential component to the functioning of the team. I was often the first person to attend a consultation or see patients on the wards or in the emergency department. In the operating theater, I was usually the first or second surgical assist, meaning I would be scrubbed in on every surgical case and would be actively involved in the operation. A typical day on the service would usually begin between 5:30 and 6:00 am, and depending on the activities for that day would usually end around 6:00 or 7:00 pm. Our call schedule would follow that of the residents, meaning I would be on call every third day. While on call, medical students would be the first members of the team to attend to a patient in the emergency department, would be expected to develop treatment plans and write orders which would be signed off by the resident.

Advantages: The London Health Science Center at the University of Western Ontario is known to have one of the best general surgery programs in the country. In addition, the transplant program at UWO is one of the largest in the country. Because of this, I was able to see many diverse surgical cases that most physicians may never see in their careers. During my time at UWO, I was a surgical assist for such diverse cases as liver and renal transplants and splenectomies to many common general surgery cases such as cholycystectomies and appendectomies. Furthermore, the teaching ethos at UWO is such that the medical student is thrown into the deep end and expected to perform. Although this method of teaching is daunting, it is highly effective at developing confidence and the skills necessary for surgery. On my last day of my elective, I was given the opportunity to cross clamp the inferior vena cava during a liver transplant; something I will never forget.

Disadvantages: Hours. The working hours on the general surgery service at UWO for residents and medical students are fairly intense. I found this left little time for other activities including study time. Another drawback I found in coming from another school is that the medical students at UWO seemed better prepared to handle ward issues and administrative tasks as well as the practical skills of surgery i.e. scrubbing, suturing, inserting NG tubes, inserting foley catheters, etc.  As UCC students, we are not exposed to surgery to this level and are, in my opinion, less prepared for these expectations. That being said, it did not take much time to become accustomed to these duties. You are given many opportunities to perfect practical skills are therefore you develop them fairly quickly.

Life Outside of Work: London Ontario is a city of approximately 450 thousand and is located in South Western Ontario.  The city offers much in terms of restaurants, bars and clubs and UWO has an active and diverse student body. Grand Bend, located approximately 1 hour from London, has beautiful beaches on the shores of Lake Huron and is a favored weekend or daytime destination by residents of London.

Most Memorable Moment: Holding a 1.5 foot long spleen in my hands following a splenectomy for a patient who had a splenic vein thrombosis. Also, clamping the inferior vena cava while the surgeons performed the anastamosis during a liver transplantation.

Would I recommend this elective: Definitely

How to Organize This Elective: London Health Science Center is affiliated with the University of Western Ontario and is located on the UWO campus. The Visiting Student Elective office (VSE) at UWO organizes student electives and they can be contacted to organize an elective in general surgery. There are no scheduled elective dates and students can request any 4 week period during the summer. Certain electives at UWO are only offered to Canadian residents and one should inquire about this before they apply. I would recommend applying for an elective in general surgery early. I had applied around 9 months prior to the start of the elective; however I would advise applying even earlier. The elective itself costs around 500 dollars Canadian for a 4-week period, and accommodation has to be arranged on your own. I would recommend staying at Elgin Hall, which is an apartment style residence on UWO campus. It is located approximately 10 minute walk from LHSC and costs 500 dollars Canadian for the month. The contact person through the VSE is Sarah Rwankwole, and she is easily accessible via phone or email with any questions you might have. The website for the VSE is the following:

http://www.schulich.uwo.ca/medicine/undergraduate/vse