Aussie Med Ed- Australian Medical Education

Journey to Becoming a Surgeon with Dr Fidock

• Dr Gavin Nimon • Season 4 • Episode 61

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What does it take to become a surgeon in Australia? Join us on Aussie Med Ed as we navigate the rigorous and rewarding journey of surgical training with Dr. Blake Fidock, an Orthopaedic registrar. You'll learn the ins and outs of medical school, internships, and the various roles like intern, resident medical officer (RMO), and principal house officer (PHO) that shape a surgical career. Dr. Fidock shares his personal experiences and invaluable insights, making this episode a must-listen for anyone considering a future in surgery or simply curious about the process.

We also shine a spotlight on the key institutions that play a crucial role in Orthopaedic surgical training. Hear about the journey from internship to fellowship. Discover the importance of diverse surgical experiences, research engagement, and recognised courses in shaping a competent and skilled orthopaedic specialist.

Ever wondered what a day in the life of an orthopaedic registrar looks like? Dr. Fidock provides a detailed glimpse into his daily routine, from early morning ward rounds to on-call duties and surgeries. Learn about the evolving nature of on-call work, the significance of continuous learning, and the impact of a supportive team environment. Offering a comprehensive guide to navigating the demanding yet rewarding field of orthopaedic surgery. Listen or watch for an enlightening episode that blends expert insights with relatable anecdotes, offering a clear pathway for aspiring surgeons, medical professionals as well as anyone interested in medicine.

Aussie Med Ed is sponsored by OPC Health, an Australian supplier of prosthetics, orthotics, clinic equipment, compression garments, and more. Rehabilitation devices for doctors, physiotherapists, orthotists, podiatrists, and hand therapists. If you'd like to know what OPC Health offers.

Visit opchealth. com. au and view their range online.

Aussie Med Ed is sponsored by -HealthShare is a digital health company, that provides solutions for patients, General Practitioners and Specialists across Australia.


Aussie Med Ed is sponsored by Avant  Medical Indemnity: They state that they offer holistic support to help the doctor practice safely and believe they have extensive cover that's continually evolving to meet your needs in the ever changing regulatory environment.


Dr Gavin Nimon:

From the first day of medical school to becoming a fully qualified surgeon. The journey is both challenging and rewarding. Just the nomenclature of the different training positions is confusing and, for the uninitiated, quite daunting. Today, we're going to explore the pathways for surgical training in Australia. Joining us today is Dr Blake Fidock, a surgical trainee, who will share his first-hand experiences and valuable insights into the steps involved in this rigorous training process. We'll discuss the different stages of surgical training, including the transition from medical school to internship, the various pathways available and the importance of research and continuous learning.

Dr Gavin Nimon:

Whether you're a medical student considering a career in surgery or a GP interested in understanding the surgical training process better, this episode is packed full of essential information. G'day and welcome to Aussie Med Ed, the Australian medical education podcast, designed with a pragmatic approach to medical conditions by interviewing specialists in the medical field. I'm Gavin Nimon, an orthopaedic surgeon based in Adelaide, and I'm broadcasting from Kaurna land. I'd like to remind you that this podcast is available on all podcast players and is also available as a video version on YouTube. I'd also like to remind you that, if you enjoy this podcast, please subscribe or leave a review or give us a thumbs up, as I really appreciate the support and it helps the channel grow. I'd like to start the podcast by acknowledging the traditional owners of the land on which this podcast is produced, the Kaurna people, and pay my respects to the elders, both past, present and emerging.

Dr Gavin Nimon:

Well, today we're joined by Blake Fidock, currently an a registrar, who stems originally from Newcastle in New South Wales. He's been living and working here in Adelaide as a South Australian orthopaedic trainee since 2020. He's just about to finish his surgical training in August and will be commencing a fellowship in hip and knee arthroplasty in Brisbane, Queensland. Welcome, Blake. Thank you very much for coming on. Aussie Med Ed.

Dr Blake Fidock:

Hi, thanks, Gavin.

Dr Gavin Nimon:

Thanks for having me. It's great to have you on here. First of all, it's really brilliant to have someone who's just gone through the whole process. It's a long route for you and congratulations on finishing your pathway.

Dr Blake Fidock:

Thank you. Thank you. It is a long road, but it's always. It's coming very close to the end now, which is good, so, yeah, very excited.

Dr Gavin Nimon:

Well, it's great to have you here. I thought we'd start off with, first of all, talk about the nomenclature of different areas of medicine. There's obviously RMOs, registrars and other areas are called housemen, particularly overseas. Perhaps we'll start off with what we're called here in South Australia and then talk about different states difference in naming.

Dr Blake Fidock:

So when you finish medical school, the first thing that medical students are employed as are interns in the public hospital, and interns essentially have provisional registration with AHPRA, which means that they are still under supervision of consultants in the hospital and they have various sort of learning objectives they have to tick off throughout the year in order to be deemed safe and suitable for general registration. So everyone sort of starts as an intern and they have 12 months as an intern. They then progress to being a resident medical officer and it varies depending on state to state. So I actually did my medical school and junior years in New South Wales and we were afforded two-year contracts to start with and we were then recognised as junior medical officers or RMOs, as we are down here in South Australia. That position is essentially where you have general medical registration but you're doing some more focused specialty terms. So in South Australia that divides into medical streams or surgical streams, depending on what your interest is. Further down your career path. After you've done one or two years of RMO, then people often progress to being a registrar.

Dr Blake Fidock:

There are various terms for registrars and this is where it can be a little bit confusing. In South Australia the term service registrar is commonly used within the surgical specialties and that is a position where someone is more of a junior registrar and they're not on an accredited training program. So they are providing essentially service to the hospital in a position of a registrar, but they are not formally recognized as part of a training program. Yet In other states this position has slightly different terminology. So in New South Wales it's an unaccredited registrar and in Queensland I think the term is principal house officer or PHO. Nonetheless, the positions are relatively the same. They really denote like a junior registrar position and again, someone who's not on a training program.

Dr Blake Fidock:

Once you've done a few years and it does vary based on the surgical training program you're looking to enter into once you've done a few years as a service or an unaccredited registrar, then you can progress to a training registrar and that requires a formal application to a recognized training program which is generally overseen by the college of surgeons in australia.

Dr Blake Fidock:

So within orthopedics the designated professional body that oversees training is the Australian Orthopaedic Association and they have the right to oversee and facilitate training that's designated to them by the College of Surgeons and your application is both to RACS and to the AOA.

Dr Blake Fidock:

So once you've been successful in that application process, you progress to being a training registrar, which is really much like an advanced training position where you're then under the formal training process and pathway of an accredited training body and that training body is accredited by the Australian Medical Council and there's a variety of criteria that you then have to meet in order to progress through that training pathway.

Dr Blake Fidock:

And then, once you've been a training registrar for a number of years and you've completed all those requirements as now I'm getting to the final stages of doing then you can look to exit your training and you become a fellow of a recognised professional body. So through the College of Surgeons, the Royal Australian College of Surgeons, you can become a fellow of them, which denotes you're a fellow of the Royal Australian College of Surgeons. You can become a fellow of the Australian Orthopedic Association as well, but essentially recognising that you've finished your accredited training pathway and you're now moving to a position of fellow, which most people would then recognise as being a consultant within a public hospital if you're given a public position.

Dr Gavin Nimon:

Wow, for the average person listening to it, let's say, gee, that sounds like a long route. How many years do you think it's taken you to get through to this pathway?

Dr Blake Fidock:

So I mean, I started as an intern in 2013 and it's you know. Now we're midway through 2024. So it's over 10 years and, look, that is fairly standard. There are people that might do it a couple of years faster. There are people that might take a couple of years longer.

Dr Blake Fidock:

Everyone's got various periods during their training where things may either be slightly longer than they wanted, they may happen slightly quicker than they anticipated, but at the end of the day, I would tell anyone that's looking to enter into surgical training today, particularly orthopedics, that you're really looking at 10 years and that's something I think is fairly consistent. One of my mentors when I was a resident back in New South Wales described it to me as essentially the decade of darkness, which is where you sort of enter into this decade of surgical training in order to progress to the other side. I wouldn't say it's as bleak as maybe that term would suggest, but certainly it's around about a 10-year period from completing your medical training to maybe getting to the other side of being a fellow and then starting as a specialist.

Dr Gavin Nimon:

And the question that would obviously come to the layperson's mind is does that mean all that time you're not earning any money?

Dr Blake Fidock:

Fortunately not. So here in Australia, you know, particularly compared to a lot of other countries, we are very fortunate in our position as medical officers through the public hospital system and we are, relative to a lot of other countries, very well compensated. So at the end of the day, you are earning money. You know it is money you're earned for time spent working and there is also a significant additional cost associated with training. So there are fees associated with training, which are direct fees to the colleges, and then there are indirect fees in the form of training courses, conferences that you're attending. So training is not an inexpensive process but fortunately we are well compensated here and well paid for that. So you are working as a doctor throughout that entire period and that includes things like working weekends, working three hours, doing overtime, doing on-call. Fortunately, all of that is well-paid here in Australia and, yes, I wouldn't necessarily worry about that. You are earning an income for that entire period.

Dr Gavin Nimon:

And this is down the pathway for surgery, which is one sort of stream of medicine. There are various other streams. You can go down the pathways, isn't there?

Dr Blake Fidock:

Yeah. So there are a variety of different pathways. So once you've finished your internship and then you're working as a resident, that's when you sort of make that decision about which direction you really want to go. So if you want to stay within the hospital for the vast majority of your training, then you're either looking at a surgery, you're looking at medicine or you're looking at critical care, and they're essentially the three things that happen within the hospital system and they're largely hospital-based training programs.

Dr Blake Fidock:

Medicine specifically looks at basic physician's training and then training to become a physician, so a cardiologist, a respiratory physician, a haematologist. Those training pathways, again facilitated through the public system but very much more medically focused. Then there's critical care, which I suppose you're looking at, intensive care, anaesthetics and emergency, which again is facilitated through the public health system. And then outside of that, I suppose general practice is something where it's not particularly through the hospital system. So they might do one or two years in the hospital but then apply to an accredited general practice training program.

Dr Blake Fidock:

So the Australian RACGP is the Royal College that facilitates training for GPs and the reason I'm familiar with this is my wife is actually in general practice training and they have various accredited sites across the country and then you would essentially apply to one of those training pathways, depending on which state you're in, and then you could train through that pathway in those various states. So, yeah, so if you're not interested in surgery, then there are a variety of training pathways that are available to medical students and junior doctors. It's just really about trying to pick which one you know suits you, suits your life goals, ambitions, your work-life balance, what you want to achieve, and then trying to really funnel your career moves and your rotations into being able to pivot towards those training pathways.

Dr Gavin Nimon:

Yeah, a few other thoughts came to mind as well. I was thinking of the people who went through my medical school many years ago and some have become GPs, physicians, obviously surgeons, anesthetists, obs and gynae, radiologists, ophthalmologists, oncologists.

Dr Gavin Nimon:

Yeah, so I missed a few, so yeah, Paediatricians, pathologists, public health and administration, and someone in my gear has gone into one of those different areas. So it's actually quite exciting that years down the track you actually see these people in different positions. You mentioned the RACs, or Royal Australasian College of Surgeons, and the Australian Orthopaedic Association. They're the different bodies that we're under the auspices of. Can you explain how, say, a general surgical trainee may vary from an orthopaedic trainee in that they actually are purely under the College of Surgeons? Is that right, as opposed to orthopaedics, who are under two different areas?

Dr Blake Fidock:

Yes, the overarching organisation that facilitates medical training or the oversight of medical training in Australia is the Australian Medical Council and then, from a surgical point of view, it's the Royal Australasian College of Surgeons. So the general surgeons are very much under RACS. Racs there's a bit of tradition associated with RACS being predominantly general surgeons, then orthopaedics being a relatively newer specialty compared to general surgery, and then, as things have evolved, the Australian Orthopaedic Association has essentially developed as a separate organisation outside of RACS that essentially represents the interests of and lobbies for the interests of Australian orthopaedic surgeons and then subsequently has then gone into being able to facilitate and develop training for upcoming and future orthopaedic surgeons. And that's been a big focus of the AOA, I think, probably in the last 10 to 20 years is really developing that training pathway. So as an orthopaedic trainee, we are certainly recognised surgical trainees, which is why we are still under the supervision of RACS, but our training is very much facilitated and organised through the Australian Orthopaedic Association.

Dr Blake Fidock:

And our examinations to that extent are done through the College of Surgeons. The College of Surgeons still controls the process by which we are formally examined at the end of our training and then enter to be a recognised fellow or specialist within an area, but the training pathway that you undertake in order to get to that point is essentially developed by the airways. What I would say to anyone that's looking at this process is necessarily to get too worried or try and look too much into there's a larger sort of historical relationship that exists between these very large organisations. It's's just about recognizing that as a surgical trainee, you are certainly a member or an associate or a trainee of both organizations and there are benefits to both. So it's just recognizing that that, yeah, there are two organizations that represent you as a trainee as well in the public hospital and of course there's also other organizations that also we're.

Dr Gavin Nimon:

Then the also itself is actually something like the Australian Health Practitioner Regulatory Authority. Then we've also got other organisations that people become members of, like the Australian Medical Association or in South Australia the South Australian Salaried Medical Officers Association, which are sort of interest groups.

Dr Blake Fidock:

Yes, there's plenty of oversight and supervision that exists when you're working as a doctor in a public hospital and then when you are not, when you're still going through your accredited training process, you know there are plenty of organisations there to represent you and to oversee your development.

Dr Gavin Nimon:

So what do you reckon the routes are? To get into surgical training? Let's focus on orthopaedics. What are the sort of routes to head down this sort of way? I mean, you've mentioned you came straight out of internship heading down this pathway. Does everyone come down that same sort of route or do people go off and try different areas in the first place?

Dr Blake Fidock:

So internship, you will get exposed to a variety of things. You'll do your medical surgical, your emergency terms, which are really important, and I think it's probably important that you then, as an RMO or as a resident, you then explore some of those varying interests that you have as well. I certainly had interests which were heading towards orthopaedics as an intern, but I explored other things whilst I was doing internship and my resident years, including general surgery, vascular surgery. I did rotations in those before I decided to go down the orthopaedic pathway. So that's important. I think exposure is important. Don't try and pigeonhole yourself too much. There are people obviously like that, straight out of med school who know exactly what they want to do and, regardless of what you tell them, they're definitely going to go down that pathway. But it is important to make sure you do get some exposure to what it's like, because what you see as a medical student is very different to what you experience when you come to work. Come to work and it's important that you get to know the team, be part of the team when you're a junior member and then see whether this is the type of environment and these are the type of patients you want to be looking after ultimately when you choose your specialty. But I think so, to start with, from those junior years, exposure is important. Get some exposure, get some experience.

Dr Blake Fidock:

The process to apply to orthopaedics is done through the Australian Orthopaedic Association and the criteria does change every year. So it is important to keep abreast of that as you're getting close to your application. But it does essentially come down to what experience you've had, the referees that you collect along the way, any research you've done as a result of that, and then some recognised courses and publications or presentations that you've done to aid that application process. So in those first couple of years, in those junior years, doing some orthopaedics terms is important. It's important to reaffirm your interest and then guide your career. But it's also important just to develop some basic understanding of orthopaedics, because it's not the easiest thing to sit down and just read in a textbook. It is a very experiential specialty and it is traditionally very much an apprenticeship model-type training and the reason for that, I think, is because it is something that you learn predominantly by doing and you know that's what those junior years are really important for.

Dr Blake Fidock:

But once you decide you want to do that and you're sort of guiding your career towards maybe doing a service or an accredited orthopedic registrar year, then things like engaging in some research so engaging in doing some either literature reviews or joining a research project that's a clinical project or, you know, speaking to your seniors and seeing what's available, trying to jump on board there to at least experience what that's like and then get your name on maybe a presentation or a publication that can come as a result of that work is important, recognizing the courses that you do. And then again, even though the application is through the AOA, racs run a series of those courses. So things like EMST, crisp. There's another one, clear, which is again about evaluating literature and research. So there are a few courses that are important.

Dr Gavin Nimon:

Just outline these abbreviations for us, Blake, if you can.

Dr Blake Fidock:

Yeah, so EMST is the Early Management of Severe Trauma, it's the one that's the old ATLS system, so Advanced Trauma Life Support course, so that one is again a very essential course essentially to do prior to applying to surgical training. Crisp, I think, was the Care of Critically Ill Surgical Patients, and then CLEAR is Critical Literature Evaluation, something, something I can't remember the last two letters for that one, and then ASSET was another one, it something something I can't remember the last two letters for that one, and then asset was another one. It's another surgical skills one that's run through through the College of Surgeons. But essentially, if you go to the application criteria on AOA they'll tell you which courses will grant you points and it's when you come to apply to the AOA you're looking to generate a reasonable number of points in order to meet a threshold, to be a suitable candidate to apply for a training position and subsequently be considered for either interview or collation of your references and compared to other applicants. So doing those courses, doing some research, doing some higher levels of education. So there are points of doing a master's and there are some master's courses that can be done through many universities around Australia and then ultimately you can do a PhD.

Dr Blake Fidock:

But a commitment to a PhD is a big commitment. So I wouldn't necessarily try and do that as a matter of point-tacking for application, because you're looking to commit a lot of time and years in order to do that. I'm not saying you can't do it, but just think about it if you're going to try and get to do a PhD to apply for orthopaedics. So apart from, yeah, research, doing terms and then doing courses, they they're sort of the main things that you're sort of looking to get as part of that are always really in the application process. There might be one or two points here and there that pop up. There is a big sort of push towards rurality recently. So you know recognising people who go to rural terms. So there are a lot of rural hospitals that need service in the form of, you know, junior doctor and then registrar service. So you know, working in rural and remote locations like Alice Springs is looked quite favourably.

Dr Gavin Nimon:

And also give you a lot of experience as well, from different areas.

Dr Blake Fidock:

Yeah, it gives you a lot of experience. Yeah, exactly, I think I worked a total of about 16 months in Alice Springs, so I can certainly be one to say that it is an excellent opportunity to go rural and work in some of those remote communities, particularly when you're looking to apply. I did that pre-training. I certainly think that not only helped my application but just helped me all round when I was ready to apply. So, in essence, there's those things. There's quite a few things to consider, but yeah, they're the broad strokes.

Dr Gavin Nimon:

We talked about applying for advanced orthopaedic training and this pathway. What's the role I mean? Does it still exist, the basic surgical training program that you have to do after an RMO year before you apply for?

Dr Blake Fidock:

advanced orthopaedic? Yeah, no, there was, and I have heard of this and I think it existed just prior to my time. There was basic surgical training, but that doesn't exist anymore. When you're a resident, you can get surgical RMO terms that will allow you to rotate through various surgical specialties, but there is no basic surgical training pathway. That's facilitated through RACs. Essentially, the colleges now really only facilitate accredited training programs and there's no pre-vocational training pathways that I'm aware of.

Dr Gavin Nimon:

And are there any exams you need to do before you apply for the Australian Orthopaedic Association?

Dr Blake Fidock:

Yes, that's probably the one I forgot as part of the AO application. Yes, so there's the GSSE, which is the Generic Surgical Sciences Examination, which is now a prerequisite in order to be able to apply and be eligible for application, which is essentially an examination that's conducted over two days. It's a written exam, it's all multiple choice, but it essentially comes down to anatomy, pathology and physiology and it is a prerequisite in order to apply now and you have to meet the minimum threshold in that examination in order to progress, to be suitable as a candidate. So I think historically it was actually delivered during training, so people had to complete that examination prior to maybe their third year or something. But that has since changed in the last maybe five or so years, where it is now a prerequisite prior to getting onto training.

Dr Blake Fidock:

And I think that's probably a good thing because there are more examinations once you're on training, but it also acts as a really good barrier. You know, the GSSC is a lot of interesting facts about anatomy, pathology and physiology, but it is a barrier to see who is willing to sit down and study some of these random facts that may appear in a multi-choice examination prior to wanting to commence surgical training, which in itself is arduous and long and requires a significant period of commitment. So whether you can sit and do this exam is the good sort of first hurdle to see whether you're a suitable candidate.

Dr Gavin Nimon:

It says hard work and I remember from my days. I still have dreams about doing the exam, so that's many years ago.

Dr Blake Fidock:

I don't think that ever, having just done my fellowship exam in the last well, 12 months ago now, I don't think it will ever leave my brain. Yeah, you still wake up with nightmares sometimes.

Dr Gavin Nimon:

Now people often say look, you know it's very competitive and it's hard to get onto these sort of pathways, but obviously people do. What's your advice? Would you ever try and talk anyone away out of doing orthopaedics? Do you think it's worth a grind?

Dr Blake Fidock:

I wouldn't try and talk anyone out of it. I mean, I think that it's like anything it is competitive, it's hard work, but it is also a highly rewarding career. So you know, if you were to look at other areas outside of medicine and you were saying someone they were going to invest in building a, building a business and trying to have you know professional fulfillment in another area, telling them it's going to take ten years of hard work but you'll get there, most people probably tell record yeah, willing to give that hard work and willing to commit. So I try to tell people that it is not an easy process but it is a rewarding process. It's one that requires a lot of commitment. There's, you know, commitment and there's a bit of luck at the end of the day, like everything in life, particularly during your application process. Sometimes it can be your year, sometimes it can't be your year and it can be the numbers and who's around and you know who you're competing against for that time.

Dr Blake Fidock:

But I think that if you are genuinely interested in orthopaedics as a surgical specialty and you enjoy the work, you enjoy your colleagues, you enjoy treating patients, looking after them and being able to make a difference in their lives, which I think is one of the biggest advantages of orthopaedics, is that you get to actually see that improvement in your patients when you follow them up and that impact that you've made. Then I would say the commitment is worth it. But it's not an easy commitment and it is someone that has a family or also has a partner. It's not an individual commitment either. It's very much a family commitment and that's maybe one of the main bits of advice I give to people now, because if you are at a later stage of life and you're looking to enter into orthopaedics, then by all means go for it if you've got the drive, but make sure you have the conversation with your other half, because it is a whole family commitment, as I'm sure my wife would certainly attest to.

Dr Gavin Nimon:

Look, what about a typical day in orthopaedics? And what does it look like along the pathway? What's it been like along the way?

Dr Blake Fidock:

Yeah, so I mean, it depends on which hospital you're at, and some are certainly busier than others and some rotations are busier than others, but in general you start at around 7 to 7.30 in the morning, somewhere between that time. The first thing we do every day is ward round, and an orthopedic ward round is not like a medical ward round. It is a quick hello and wound check and make sure there's no significant complications or medical adverse events that have happened in the past 24 hours that we need to be aware of, and we're essentially do a quick ward round in the morning. Then, depending on the site you're at, again, you'll generally attend a meeting which will discuss the new admissions plans for the day, including the plans of attack for various operating theatres that you're running, so that we can be appropriately staffed and everyone's on the same page about what we operating theatres that you're running, so that we can be appropriately staffed and everyone's on the same page about what we're doing, and that is particularly the case in larger hospitals. They will have these regular daily meetings to address these and then, depending on where you are sort of in your career, your day could be broken into, I suppose, being on call, which is taking call for any of the new referrals that are coming through the emergency departments. They're going to the ED and assessing patients and then deciding who needs to be admitted and discharged, who can be followed up in the outpatient clinic, going to the outpatient clinic and seeing patients in the outpatients or being in the operating theatre. And in the operating theatre that can be in the emergency or the elective list and those are sort of the main things that you can be doing sort of and that will run essentially we break it into half days generally. So morning session, afternoon session, someone could be there all day. They could be, you know, half day in clinic, half day in theatre, depending on what's running.

Dr Blake Fidock:

Most days generally finish around about five o'clock In the public hospital. You know that's the time that theatres will generally shut. As with all things, sometimes things can run late, sometimes they can finish early. It's more commonly they'll run late than finish early, but generally you can always see hopefully finish around 5 o'clock. If you're on call you may stay later. So if you are holding the phone or on call for that day, those shifts generally can run a little bit later, so maybe 8 or 9 o'clock.

Dr Blake Fidock:

Fortunately there's been a big shift in on-call, particularly in busy hospitals now where orthopaedics are running 24-hour services, so recognising the importance of having day staff and night staff. So you'd be handing over to a night registrar now, as opposed to doing 24 hours of on-call and then expected to front up the next day. That is certainly what used to happen in the old day and I'm sure you would attest to that, Gavin, that that was what you did during your training. But I think I'm fairly fortunate enough to say now that in this generation that we are moving away from that, particularly in busy hospitals where that doesn't happen anymore, and that you know you may be on call for a period of 12 hours, but if you're in a busy quaternary or tertiary level centre, you're probably going to go home and sleep, you know, quite comfortably that night, because you're not going to be woken up overnight and so they're not expected to, you know, to work more than 24 hours in a row. So that's the general sort of overview.

Dr Blake Fidock:

Even if you're not in an accredited training program, we're all training, we're all working towards something. So at the end of the day and throughout the day, there's always reading, there's always things that you want to be doing. There's always that extracurricular stuff that you're trying to build your CV for, You're trying to enhance your knowledge. You've got a list the next day or the day after You're trying to work out. You know, read about some of those cases, do the prep for that to make sure that you're prepared. So that certainly adds up. I'd say there's probably at least an hour of that every day where you're doing something like that. And you know we often do that subconsciously. I think a lot of us. We come home now and we're always looking at, because it's so accessible, we're looking at our phones, we're looking at our Microsoft Teams, we're going through the cases that we have for the next couple of days to make sure everything's all right, that everything's been templated appropriately, all the investigations have been ordered. So that sort of admin time certainly adds up.

Dr Blake Fidock:

And then, if you are in your training years, there's periods of study, there's periods of working on your formalized teaching. So your bone school presentation. So every week the orthopedic trainees have half a day dedicated to teaching. So bone school is our formal, recognized training session. So one training will present that every week so you might have a bone school coming up on cervical spine injuries. So you're sitting there working on your bone school presentation that evening. We've got a journal club coming up the following week. You're working on that journal club presentation. So there's always that sort of stuff outside as well. That's the general day of an orthopaedic registrar, certainly. And then on top of that you try and squeeze in some time to exercise and some time to spend time with family and all that sort of stuff as well.

Dr Gavin Nimon:

I think one of the things you've passed over quickly is actually the enjoyment of being in a hospital scenario too and having lots of different people you meet and being exposed to different people. Have you found that as well? Would that be your experience as well, Blake?

Dr Blake Fidock:

Yeah, I mean 100% working orthopedics. I said to a lot of people orthopedics is a team sport. So you know we work in teams and that is our team. The team that we have when we're working as a unit, that's the. You know the senior registrar, the training registrar, the junior reg, the rmo. You know when you're on orthopedics you're in our team. And then there's also the teams that you work with every day. So you know the theater team you're working with. You know getting to know the theater staff is really important the clinic staff that we.

Dr Blake Fidock:

It's very much a team environment and certainly it's one of the best things about working in the public hospital and during your training years. And you know, even when you have those rotations that are really busy, really hectic rotations that are very full-on, long days, hard work, the thing that makes it worthwhile is if you've got a good team. If you're surrounded by a good team, then that becomes so much easier because every day you're fronting up and you've got your mates there and it's like you're going into bat together. You're all trying to just get through the day together and there's a lot of banter that can be had there as well and that is one of the most enjoyable things.

Dr Blake Fidock:

That's probably one of the main reasons why, ultimately, when I was trying to decide surgical specialty is orthopedics, because when I looked around, you know, at the teams, the guys there would, and guys and girls, the guys, all of them were having fun. You know. They were all enjoying it, despite the fact that it was organized chaos some days and it is organized chaos some days. Everyone was enjoying themselves and there was, you know, good banter and at the end of the day, you know, it was an enjoyable workplace. So, and I think that that has certainly been my experience as well, like my experience overall has been, you know, every rotation I've done and I've worked with, I've found people that I've really gotten along with and you know, we have a good time when we come to work and it's hard work and some days are worse than others, but but overall it's good fun brilliant.

Dr Gavin Nimon:

One of the questions medical students might ask is how do you actually start surgery? You don't come straight out of med school and start opening someone up and doing a procedure. How do you actually become a surgeon? What's your recollection of your first operation and how you're exposed to it?

Dr Blake Fidock:

yeah, I mean I alluded to it slightly earlier that it used to be a bit more of an apprenticeship model, and I think there's some truth in that, in that you are learning a bit of a you know don't tell the anesthetists or the physicians but you're learning a bit of a trade. Really, you're learning how to use your hands and there's a higher degree of dexterity required maybe than some other things, but at the end of the day, you are, you are learning. So we have to go and you have to see, you have to see people do and you have to learn about what they're doing, and then you have to try and replicate what they're doing. And that is essentially the apprenticeship model that we're trying to follow. Now the AOA has very much moved to a competency-based model. Now we're trying to tick off various things that we're good at, but in essence, what we're still doing is, you know, by going with our supervisors and by operating with our consultants, we're watching them do a procedure. They're then watching us do a procedure, and then we're trying to get to that point of learning how to do a procedure independently.

Dr Blake Fidock:

And I think when I was a resident in this was when I was back in Newcastle. I remember I was about second or third year I got rostered to a list with an upper limb surgeon. I'd seen plenty of distal radius fractures and I thought I was getting pretty close to being able to fix a distal radius fracture. And then I sat down at the operating table and I just thought, as I was sitting at that side I was like, what do I do now? What's the first step? And it's like when you take the knife in your hand, you have to. You're then starting. The whole thing changes. So it's not innate Sur. It's not innate. Surgery is not innate. You would never expect someone to be able to enter into a surgical pathway that they know exactly how to operate. And anyone who comes in and says that they can do this and they can do that and is overconfident is often more of a red flag because it is a taught, it is a trained skill. So I would say to anyone that has concerns about how they're going to learn it is.

Dr Blake Fidock:

That's the benefit of doing the junior years and the service of the unaccredited years is that you get exposure, and the more exposure you get, the more you pick up and whether you actually like this process, you like the process of trying to learn how to do something or replicate someone. Do something well, and you enjoy the challenge and then trying to do that yourself, you know, for the betterment of a patient. That's the part that you should really aspire to, and if you don't like that, then you probably shouldn't do it. But that is the model we follow and there's reading behind that, there's understanding, all that knowledge of anatomy and structures at risk and things you don't want to cut. Really, it boils down to what don't you want to cut and how do you want to fix this cut and how do you want to fix this or how do you want to do this. And there are crucial steps that you should always do and there are crucial steps we always should not do.

Dr Blake Fidock:

But being able to recognize that is all part of the training pathway and or I'm still doing that now and towards the end of my training, I certainly still do that now. If anything, I look for it more. Now you learn how to look for those people that you want to watch, you want to emulate and you want to develop skills from, and I think surgeons still do that. You know they go and visit people, go on visitations all the time. So it's very much a lifelong skill. So don't be deterred by the idea of having to learn how to do surgery. That's the job of training is to learn how to do that. And once you learn how, you can constantly sort of be trained in doing that then you're on the right path.

Dr Gavin Nimon:

Yeah, generally it's a group of little steps along the way. You might learn how to sew up the skin or how to do the incision, and eventually they join together. That probably leads me into my sort of segue sort of question, where you say where do you think things are heading for you in the future? I mean, where do you think surgical training is going?

Dr Blake Fidock:

Where do you think you know? What do you think you'll see in the future from what you've already seen so far? I must say I think the model is pretty good at the moment. I like the way that as much as I've again, as I've said, it is an apprenticeship model I like the way that the AOA has certainly formalized the process and they've taken away this time-based, rigid apprenticeship model and turned it into more of a competency-based, flexible model, which I think is certainly in keeping with the demands of modern society and having a more diverse and equitable workforce. So I think that they've got the balance right there.

Dr Blake Fidock:

The biggest challenge that I see, probably with surgical training in the future, is just making sure that, as we increase the number of surgical trainees to service the increasing demand within Australia through an ageing population and this particularly applies to orthopaedics that we still have the capacity for people to train appropriately in the public system. And I don't think you have to be from South Australia to know that the public system is undergoing a lot of challenges at the moment. In every state there are increasing demands across multiple domains in every single state and then, along with the increase in cost of living and the strain that's then put on people that have private health insurance. It's really hard. So we have to try and balance how we can still train the right number of people, how they get adequate exposure for that training in order to service the future, and we can't just increase the numbers without making sure that everyone's still getting the appropriate level of exposure. So that's probably the biggest challenge I would see.

Dr Blake Fidock:

But I think that this challenge is known and it is certainly discussed. They're always addressing that, which is why I think that having the formalized structure of training that we have at the moment, in its capacity to measure the number of cases we're doing, the exposure that we have, the feedback we're constantly getting, is a great way of being able to tick off whether we're competent at something or not, rather than just relying on sending people out there for five years and going okay, you've done your five years, you're good. Now you're good to go. So overall, I think it's good at the moment. I mean, there are going to be challenges.

Dr Gavin Nimon:

It's up to the organisation to sort of adapt to those as they present themselves, and do you think there's any role for technology to help in that sort of process, or do you think some of this new virtual reality and AI sort of information is going to be of any use to us in the future?

Dr Blake Fidock:

Yeah, I mean the augmented reality stuff is interesting. To be honest, I don't have much exposure to it. Again, being in the public system, we're flat out getting a robot for robotic surgery in the public system, so I don't have any exposure to augmented reality. I don't think there's any substitute for actually doing surgery. As much as you can make as many nice 3D, 4d models as you want, until you're there with a blade on skin or a saw in hand cutting bone, I don't think you know how it feels and that's probably the biggest difference. That's probably the biggest challenge that there is. These technologies may help, but I don't know how they're going to replace actually doing.

Dr Gavin Nimon:

Well, look, it's been fantastic spending this evening with you discussing the surgical pathways and how students aspire to be someone like yourself, Blake. I really appreciate your time giving up this evening to discuss it. Thank you very much for coming on. Aussie Med Ed.

Dr Blake Fidock:

No, thank you, Gavin. Thanks, I really appreciate it.

Dr Gavin Nimon:

Yeah, it's been brilliant. Thank you very much.

Dr Gavin Nimon:

I'd like to remind you that all the information presented today is just one opinion and that there are numerous ways of treating all medical conditions. Therefore, you should always seek advice from your health professionals in the area in which you live. Also, if you have any concerns about the information raised today, please speak to your GP or seek assistance from health organisations such as Lifeline in Australia. Thank you very much for listening to our podcast today. I'd like to remind you that the information provided is just general advice and may vary depending on the region in which you are practising or being treated. If you have any concerns or questions about what we've discussed, you should seek advice from your general practitioner. I'd like to thank you very much for listening to our podcast and please subscribe to the podcast for the next episode. Until then, please stay safe.

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Dr Gavin Nimon

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