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V O L 4 2019 I S S U E
use the San Francisco Match system to rank
applicants and match them to selected
fellowships. In most other countries including
Australia, selection is based on Curriculum Vitae
and reference letters followed by interview for
selected group of candidates.
My personal road towards craniomaxillofacial
surgery began with an undergraduate medical
course followed by internship, residency
and work as a surgical registrar before entry
into a five year plastic surgery program. This
provided me with a solid understanding of
anatomy, pathology, soft tissue handling and
reconstructive surgery.
Following this it was important
to apply to centres purely
dedicated to craniofacial
surgery where I could get
maximum exposure to this
specialty.
I was invited to spend my
first year of fellowship at the
internationally renowned
Australian Craniofacial Unit.
This unit was founded by
Professor David, an Australian
pioneer of craniofacial surgery.
He was one of a select group
of surgeons who were to learn
from Tessier and develop this
specialty around the world. In Professor David and Dr Monshizadeh operating on
1975 Professor David set up the a trauma case
South Australian Craniofacial Unit,
which later became the Australian Craniofacial
Unit and in the four decades since he has
devoted all of his time to the specialty,
treating thousands of patients with the help
of a dedicated multidisciplinary team. I was
incredibly lucky to be one of the last fellows
working with Professor David before his clinical
retirement in 2018. Not only was I able to learn
from a pioneer in the field but at a time when
he had reached the culmination of a lifetime of
hard work and dedication to his specialty.
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Early on during the fellowship Professor David
asked me to read the essay “On bullshit” by
philosopher Harry Frankfurt. I immediately
knew that this was not going to be any
ordinary fellowship. Apart from the important
theoretical and clinical education covering
all facets of craniofacial surgery, I was able
to learn the importance of interdisciplinary
relations and team roles and relationships.
In addition, I gained understanding of the
important hierarchal system within the health
sector and the role and impact of political
and government relationships/policies on
the provision of healthcare. These important
concepts are rarely taught, or even mentioned
and are crucial to understand and apply when
working in any unit.
The rewards of spending time at a dedicated
unit are unsurpassed. Rare craniofacial
syndromes are seen regularly, complex surgery
becomes routine and witnessing the daily
functions and setup of dedicated unit enables
one to understand how to make a unit work
incorporating a multidisciplinary and long
Professor David awarded 2018 South
Australian of the year
term approach. Patients are regularly reviewed
in clinic by the multidisciplinary team as
per set protocol based on their conditions.
Surgery requires multidisciplinary workup
and always involves the neurosurgery team
for intracranial cases. Regular weekly audits at
a multidisciplinary facial fracture clinic and 3
monthly unit audit allowed for assessment and
reflection of unit outcomes.
During this year I also completed a Master’s
degree in Craniofacial surgery. This unique
course, not offered elsewhere was also created
by Professor David to address the need for formal
theoretical teaching in craniofacial surgery
alongside clinical education. This course was
run through Macquarie university in Sydney
covering core knowledge in all major areas of
craniofacial surgery ; cleft, craniosynostosis,
trauma, tumours, orthognathic surgery, rare
clefts and evidence based medicine. The
principles taught through the evidence based
medicine unit were able to be applied to
research undertaken during the fellowship. The
importance of scientific enquiry, surgical audit
and application of evidenced based medicine
to surgical practice cannot be overemphasised.
Following my year in Adelaide I was accepted
to work at the Westmead children’s hospital
in Sydney. This fellowship included all aspects
of paediatric plastic surgery as well as cleft/
craniofacial surgery. It was extremely useful
to witness different techniques practiced
at this centre both in craniosynostosis and
cleft surgery. This included use of springs in
craniosynostosis and early secondary alveolar
bone grafting and delayed hard palate repair
in the cleft population.
Surgical exposure to different centres allows
one to directly compare and draw from both
positives and negatives. Ultimately, I finished
my second fellowship short due to a consultant
opportunity back in Perth where I have now
returned. I currently hold consultant positions
at the Perth Children’s Hospital and Sir Charles
Gairdner Hospital where I undertake work in
my specialty area of craniofacial surgery.
In summary prospective fellows should apply
for fellowships tailored to their training goals.
The advantages of working at a dedicated
craniofacial centre remain unsurpassed for
fellows who wish to become proficient in
all areas of craniofacial surgery. Failing this,
different programs should be selected so that
overall a comprehensive exposure is obtained
in all major areas.
Ultimately a fellowship is what you make it.
Every experience is a learning opportunity.
Most importantly remember to have fun along
the way!
I will end with one of my favourite quotes often
recited by Professor David. This quote is a line
from the poem by Sir Galahad; “His strength
was as the strength of ten, because his heart
was pure.” A pure heart fuelled by passion and
drive to better the lives of our patients is the
most important ingredient for success.
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