Marian Ionescu Student Fellowship in Congenital Cardiac Surgery, Leeds Teaching

From the outset, I would like to say that I am incredibly grateful for the generosity and support from Mr Ionescu and the SCTS fellowship which allowed me to undertake a 6-week elective at the Leeds congenital cardiac surgery unit.

I am positive I speak for every medical student when I say that our final year elective is something we all look forward to from the moment we are first exposed to clinical placements. Not only does this part of curriculum offer a break from the responsibilities of medical school, but it also provides an opportunity for exploration of those specialties that we want to see more of, but that the constraints of university don’t allow.

As an aspiring cardiothoracic surgeon still exploring the specialty, I wanted to use my elective as an outlet to discover the breadth of the field. Considering that I had already been involved with the adult subspecialty, this left me with transplant, congenital and minimally invasive. When Ms Van Doorn, a leading surgeon involved in humanitarian work, agreed to mentor me, the budding global surgeon in me could not pass up the chance to learn from a giant such as her. Furthermore, Leeds is home to a rich history in cardiothoracic surgery and home even to the first pericardial valves from Mr Ionescu himself. It would have been sacrilegious of me to turn down an opportunity to learn from such an environment.

During my time there, I learnt that the Leeds Unit operates as a closely integrated multidisciplinary team, while caring for both paediatric and adult congenital cardiac patients. The fellowship exposed me to many aspects of congenital cardiac surgery including daily ward rounds on the paediatric and adult ICU’s and nursing wards, operating sessions, multidisciplinary meetings, surgical and cardiology teaching, outpatient clinics and clinical governance meetings. I also had the opportunity to spend time in the cardiac catheter lab, echocardiography, cardiac MRI and intensive care.

Although COVID has changed the way hospital medicine works, student electives are still very much possible. I want to use this blog to impart some of the valuable lessons I learnt about making the most of the medical student elective and hopefully offer some insight and help others in my place.

I think one of the most important aspects of the elective is ones’ educational mentor and the relationship you build with them. Firstly, you should find a tutor with common interests. This makes collaborative learning easier and contributes to a more personalised and stimulating experience. I found it very useful to build an early rapport with my mentor and compile a list of mutually agreed learning outcomes for the placement. This mitigates any unreasonable expectations of what you can achieve under their supervision while also establishing standards of the teaching they can provide. Next try to create a mutually agreed organisation schedule to navigate your elective. For instance, in my case, Miss Van Doorn and I had a virtual meeting a few weeks before to discuss what the department can offer and subsequently drafted a schedule for each week of the placement. The meeting also helped curb my expectations as it gave me an understanding of the opportunities and limitations that came with undertaking such a specialised elective especially during a global pandemic.

For those students interested specifically in congenital surgery electives, I can recommend the following learning outcome which I have derived from my experience:

1. Aim to participate in the operative procedures at least three times a week. 2. Visit the cardiac catheter lab to watch diagnostic and interventional procedures. 3. Arrange dedicated time with imaging consultants and technicians to gain a basic understanding of Imaging (echocardiography, CT and MRI) in congenital heart disease. 4. Attend daily ward rounds and weekly

MDTs. 5. Shadow the paediatric cardiologists and explore the importance of medical management. 6. Familiarise yourself with the dialogue which must exist between the physician and the patient’s family by attending clinics and consent conversations. 7. Familiarise yourself with the surgical techniques and operations within congenital surgery. 8. Record your surgical experience in a logbook (and continue after your elective). 9. Attend monthly governance meetings. 10. Participate in an audit/QIP with the department or write a case report of an interesting case.

The best advice I can offer to students is to be as present as possible during the elective. The best way to learn in to immerse yourself into the clinical setting and be proactive in looking for learning opportunities. But above all, ask questions! There is nothing worse than watching a 9-hour surgery when you have no idea what the surgeons are doing. Moreover, a more enthusiastic student will receive more attention and better guidance. Aim to go out of your comfort zone and get involved with discussions on patient care, operative decisions and MDT meetings.

My time with Miss Van Doorn and the team at LGI has profoundly impacted my outlook on the specialty. Their shared passion for the work they do made an everlasting impression. I am also beyond grateful to the all the registrars who took me under their wing and went out of their way to make me feel included and ensure that I never felt out of my depth. This placement left with me a profound appreciation for the deeply rooted complexities of such a highly specialised practice. But primarily, this experience strengthened my conviction to pursue a career in congenital cardiac surgery. n