Untitled Page

To the Editor

Christian Bang
Christian Bang

I would like to comment on Professor Richard Reznick's concerns about surgical training in Canada.

Upon completion of my residency in Denmark, I was keen to experience a new training environment. While taking a course in New York, I learned about Toronto; I was advised that its microsurgical centre was world class. I applied for a position in Toronto and during 2001 and 2002 I spent a total of one year as a microsurgical fellow in plastic surgery at the Toronto General Hospital. I was not disappointed for a single second with my experience. Dr. Peter Neligan and Dr. Ralph Manktelow acted as my mentors. Indeed, they have both been the most important colleagues throughout my career, clinically and personally. Several other surgeons also contributed greatly to my extraordinary Toronto experience. It was gratifying and stimulating to work with a team of skilled surgeons, all of whom took part in the clinical and theoretical training. In many ways, my year in Toronto represented an important turning point in my life, and it is with great gratitude that my family and I reflect upon that time in our lives.

I fully acknowledge the concerns outlined in Dr. Reznick's article. To bolster his argument, I would like to describe the Danish post-graduate training, which is similar to that in other European countries. In my opinion, there are two key differences between the Danish and the Canadian systems.

Firstly, the Canadian post-graduate educational system is characterized by the very serious way in which students, residents and staff work together. The students and residents are regarded by the staff as valuable resources, and in many ways, as colleagues. This creates an inspiring environment in which residents, at an early age, may take part in the department's diagnoses of patients and treatments at an advanced level.

Secondly, the Canadian physicians work significantly more hours than their Danish counterparts. Whether positively or negatively, the very strong union culture within Denmark significantly influences the residents' lives. One of my younger colleagues is a resident at a university hospital and currently is on-call every fifth weekend as well as once a week. As a result of this schedule, he works only three days a week (including his on-call time). He has six weeks of vacation time plus four extra days off due to the fact that he has young children. An additional five weeks are scheduled for courses. A system thus structured fosters deep frustration amongst the doctors. Surgical training suffers dramatically. Under the existing system, it is impossible to acquire the necessary surgical skills and clinical bedside experience. A common complaint expressed by Danish patients is that they meet too many different physicians. Consequently, there is a lack of continuity in the care and treatment of the patients, and no significant doctor-patient relationship can be established.

The pendulum has swung too far in Denmark. Ultimately, it is the patients who suffer when there is insufficient post-graduate education and very stringent restrictions on physician working hours.

Christian Bang
Odense, Denmark

Skip Navigation Links