A few years ago at a lecture for a group of surgeons, the moderator introduced me by saying: “The norm is for a specialist to learn everything that needs to be learnt while in government service, then move on to private practice.
“However, our next speaker did most of his progressive work while in private practice.”
His observation was correct.
I left for private practice three years after receiving my membership from the UK Royal College of Obstetricians and Gynaecologists (RCOG), so most of my further specialist learning and training was done after this.
Here are some of the sub-specialist courses and other things I have done to further my skills and career since joining my current private hospital.
- 1994 – Training in laparoscopic surgery at Chang Gung Memorial Hospital in Taiwan.
- 1997 – Training in in vitro fertilisation (IVF) at King’s College London in the United Kingdom, before starting the IVF centre at my private hospital.
- 2003 – Obtained a Masters degree in reproductive medicine from the University of Western Sydney in Australia.
- 2004 – Helped organise the annual congress of the International Society of Gynaecological Endoscopy (ISGE).
- 2006 – Organised a workshop on laparoscopic radical hysterectomy and began offering this surgery along with Dr Vijaendreh Subramaniam.
- 2008 – Started performing laparoscopic Burch colposuspension and laparoscopic sacrocolpopexy with Dr Suresh Nair.
- 2009 – Became president of the Obstetrical and Gynaecological Society of Malaysia.
- 2010 – Started office hysteroscopy.
- 2011 – Organised the first animal workshop in laparoscopic surgery in Malaysia. (This was a real challenge as it had never been done before.)
- 2011-2017 – Organised numerous laparoscopic live surgeries and animal workshops.
- 2012 – Pioneered single incision laparoscopic surgeries in Malaysia.
- 2013 – Obtained a Bachelor degree in laparoscopic surgery from Belgium.
- 2014 – Pioneered 3D laparoscopy in Malaysia.
- 2014 – Organised the annual congress of the Asia Pacific Association of Gynaecological Endoscopy and became its president.
- 2014 – Started a fellowship in laparoscopic surgery and infertility – the first of its kind in a private hospital in Malaysia.
- 2015 – Became an ISGE board member.
- 2016 – Published a book on laparoscopic surgery in gynaecology and common diseases in women.
- 2017 – Became a board member of the Asia Pacific Gynaecology Endoscopy Training group (APGET), which includes helping to organise laparoscopic surgery training workshops every year in the Asia Pacific region.
- 2019 – Attended vNOTES workshop and pioneered vNOTES surgery in Malaysia.
- 2020 – Began giving high-intensity focused ultrasound (HIFU) training, and started a blog and recording teaching videos.
Most specialists in private practice tend to continue in their comfort zone using whatever skills they had acquired while in government service.
This could be out of a sense of complacency or fear of complications from new techniques or technologies.
However, with so much rapid technological advancement nowadays, if one does not progress, one will regress.
Here are some of my tips on how to be progressive in private practice.
1. Keep your own patient records
When I started private practice in 1994, computerisation in medical practice was still in its infancy.
I kept all my patients‘ records in Microsoft Excel and Access.
The data included all the surgeries, deliveries and IVF procedures that I had performed since the first day I joined my first, and only, private hospital.
When I took over ownership of my clinic at the hospital in 1999, I also started keeping outpatient records in a dedicated software programme.
I have complete outpatient records of all the patients in my practice for the last 20 years.
There are many benefits to keeping your own records, including:
- Learning from your patients’ data.
- Conducting research.
- Having the materials to create your own teaching videos.
- Being able to bring all these records with you if you decide to leave your current hospital or clinic.
2. Keep a journal
I have been keeping journals for many years.
I write down what I have learnt the previous day.
These include reflections of surgeries I have performed, as well as any interesting cases I have seen.
This has helped me improve my surgical techniques over time.
3. Keep a record of all the procedures you perform
I keep video recordings of all my surgeries (laparoscopy and laparotomy) and office hysteroscopies (inspection of the uterine cavity through an endoscope inserted through the vagina and cervix).
These videos are edited down to about 10 minutes and kept in my own server at my clinic so that I can access them easily.
I also keep all ultrasound images of my patients in an image processing application.
When patients return for their follow-up appointment, I can easily review their surgeries and ultrasound images, and in this way, I am constantly learning from my patients’ data.
I have designed my own method of archiving and storing all these data.
4. Look for opportunities to learn from others
Early in my career, I realised that the best way to learn surgical skills is to assist experienced surgeons.
The best way to have an opportunity in assisting such surgeons is to invite these experts to perform surgeries at your own medical centre.
That’s when I decided to organise laparoscopic surgery workshops at my hospital and invite experts to operate with me.
In this way, I am always the first assistant and the one who will learn the most.
I have had the privilege of assisting some of the greatest laparoscopic surgeons in the world, such as Dr Lee Chyi Long, Dr Masaaki Ando, Dr Shailesh Puntambekar, Dr Arnaud Wattiez, Dr Joo Hyun Nam, Dr Harry Reich, Dr Bruno Van Herendael and Dr Stefano Bettocchi.
When I am not able to invite an expert to my hospital, I travel to his centre to watch him perform his operations.
Although this is not as good as assisting, much can be learnt while observing and interacting with the experts.
5. Learn from everyone
As we grow older, we shy away from learning from people who are younger than us.
One should be prepared to learn from everyone.
For example, during a recent vNOTES workshop, most of my teachers were decades younger than I was.
I also like to have young Fellows with me because I learn a lot from them.
Swallow your pride and learn from everyone, even younger colleagues.
6. Write down what you have learnt
Whenever I attend a conference, assist in a surgery or watch a webinar, I write down what I have learnt from the session.
I try my very best to implement what I have learnt within two weeks, because after that duration, what is learnt is often forgotten.
This helps me acquire better habits.
7. Keep a notebook with you all the time
When seeing patients, I often write down interesting cases or questions that arise from these cases.
I have tried using a computer, but I found that a notebook is far better as it is easier to review what I have written down.
During my free time, I look for answers to my queries.
An interesting case may be a subject for a video, blog, article or case report.
In this way, I am learning every day and from every interesting patient.
8. Try to learn a new skill every year
At the end of every year, I will write a summary of what I have achieved that year.
After that, I will decide which skill or topic I want to improve the subsequent year.
By focusing on just one topic, I will have a better chance of focused self-improvement.
For example, the new skill I learned last year was how to do HIFU for fibroids and adenomyosis.
I was in China for one week in January 2020 to learn this skill.
Unfortunately due to the Covid-19 pandemic, the HIFU machine could not be installed in my clinic, so I switched to writing blogs and research papers, and creating teaching videos, including learning to speak into a camera.
Editor's note: More tips on how to be progressive in private practice to come next week.
Dr S. Selva is a consultant obstetrician and gynaecologist, and fertility specialist, in private practice in Melaka. This is the 14th article in a weekly series about surviving private practice in Malaysia. For more information, email firstname.lastname@example.org. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.