An Orthopedic

Rotation –

Kiwi Style

By Greg Hildebrand

Auckland, New Zealand

• Auckland population: 1.614

million (2016)

• Total NZ population: 4.794

million (2017)

Auckland City Hospital

– New Zealand’s largest public hospital and clinical research facility

– Largest tertiary referral center in New Zealand and smaller surrounding Polynesian islands

– Outpatient clinics held at Greenlane Clinical Centre

– Clinical teaching site for the University of Auckland

Orthopedic Surgery

– My international elective was in orthopedic surgery

– Majority of my time on site was spent at Auckland City Hospital in the orthopedic theatres (OR)

– Pictured to the left is Mr. Twaddle, one of the consultant orthopedic surgeons I had the pleasure of working with

– Long story short, he had worked with my dad (also an orthopedic surgeon) in the states around 30 years ago

Topic of Interest – Medical

Training in NZ

– This became my topic of interest because during the first two weeks of my rotation, I was not allowed to scrub in

– This confused me due to the fact medical students back in the states scrubbed in everyday

– I then realized that medical students, house officers, and even some junior registrars did not routinely scrub in

– Due to this, I became intrigued about medical training in NZ and I wanted to learn more

A Comparison – US vs NZ

USA Medical Training

– Medical student – 4 years

– Resident – 3 to 7 years

– Fellow (if applicable) – 1 to 3 years

– Attending

New Zealand Medical Training

– Medical student – 6 years

– House officer – 2 years

– Junior registrar – as many years as it takes to make senior registrar (usually around 3 years)

– Senior registrar – 3 to 5 years

– Fellow (if applicable) – 1 to 3 years

– General physician or Specialist

Stages of Training in NZ

– Medical student

– Undergraduate degree NOT required

– Total of 6 years with 3 being academic and 3 being clinical

– House Officer

– After graduation, students can apply to become a house officer and will be placed at hospitals throughout New Zealand

– Total of 2 years with 3 month rotations of different specialties (8 rotations total)

– Have NOT declared for a specific specialty at this time

– Main responsibility of doing the grunt work for the registrars

– Rounding, writing notes, taking admissions, etc.

– Not allowed to scrub in for surgery (when on surgical rotation)

Stages of Training in NZ (cont.)

– Junior registrar

– Applicants are eligible to apply 2 years post-graduation, essentially after completing 2 years of being a house officer

– At this point, you HAVE declared and applied to a specialty

– Role in orthopedics: oversee the house officers, scrub into limited surgeries

– This is the catch: you can be a junior registrar forever

– E.g. one junior registrar on the orthopedic service had been there for 14 years

– Senior registrar

– To become a senior registrar, you have to be in the top 15% of your junior registrar class

– Total of 3 to 5 years depending on the specialty

– Role in orthopedics: scrub into all surgeries, teach the junior registrars

– As attending surgeons rarely scrub in, senior registrars perform the majority of cases unaided

In Conclusion

– Pros of medical training in NZ:

– A broad spectrum of training longer into their careers

– More autonomy in the operating room as a senior registrar

– Cons of medical training in NZ:

– Duration of training including medical school: average of 7-11 years in the US with the average being 12-14 years in NZ

– Lack of any specialty experience earlier in their training

– Biased conclusion of a US trained medical student:

– Training in the US is superior to that in NZ because of the medical school structure and more specialized training earlier in the career

– In my own biased opinion, as a 4th year medical student I feel comparable to a house officer in the NZ medical training scheme

Most profound clinical

experience

– I was lucky enough to be a part of a case where biomedical engineers constructed a 3D image of a patient’s ilium

– This allowed them to construct a hip arthroplasty that fit his ilium or his “hip socket” perfectly

– The physicians and biomedical engineers went to all this trouble because this patient had already gone through a failed total hip arthroplasty and they wanted to make sure they got it right this time

– This was my favorite clinical experience because I had never seen orthopedic surgeons and biomedical engineers work together in the OR before

Most profound cultural

experience

– The Maori People

– The Maori are the indigenous people of New Zealand

– I was fortunate enough to attend a traditional Maori feast and ritual one weekend in Rotorua

– We learned about traditional face markings, home decorations, and rituals important to the Maori people

– Most importantly, we learned about their origins and how they were colonized by the British and forced to sign treaties they didn’t want to be a part of

– Sound like anything else in American history?

Pictures

References

– Interviews with: Dr. Stewart, Mr. Twaddle, Mr. White

– https://www.mcnz.org.nz/get-registered/registration-policy/special-purpose-scope-policy/post-graduate-training-requirements/

– https://medicfootprints.org/new-zealand/medical-academic-training-opportunities-nz/

– http://learnanythingfree.com/celebration-happiness-45-maori-haka-new-zealand/

– http://www.justmaps.org/maps/oceania/newzealand/auckland.asp

– Greg’s iphone: every picture except for maps and maori culture picture