Editorial

Dear readers,

You hold yet another issue of our journal in your hands. I had been thinking for a long time about the topic of this editorial. This time, the topic will not be about journal content, which you will read in a few moments of course, and it will not be about what we have achieved in the past either or about what we could achieve in the future. I think that a very interesting current topic for all of us, plastic surgeons, is the educational system in our country and the changes taking place now.

In the past, plastic surgery was a specialization, in which it was possible to specialize only after the basic experience and first-grade examination in general surgery. From a retrospective point of view, it can be said, that this system had made sense. Those of us who have gone through this educational system still appreciate the need to acquire basic expertise in general surgery that we often use in our practice, so we are also able to tackle the problems and complications that are not related only with plastic surgery.

Then there was a change from a two-stage to a one-stage educational system, when plastic surgery became a basic specialization. The goal of this specialization was to provide sufficient training to doctors after graduation from medical school up to the plastic surgery attestation. It was not a simple task, but the plastic surgery society and its representatives tried to set up rules that would make sense and on the other hand, which would not complicate access to specialization to all who have the interest and ability to be good plastic surgeons. It was not an easy task to accomplish this within the one-stage educational system.

However, it would not be a serious problem if such system remained stable even in the long run. Unfortunately, this did not happen. For a variety of more or less justified or unjustified reasons, there have been repeated changes to the plastic surgery training program rules where plastic surgeons have been educated and certified at one moment according to several different educational programs with different requirements for obligatory practice, internships, courses, and practical skills. There were totally five changes in the plastic surgery curriculum within the last 13 years, so we have versions of the training program of 2005, 2009, 2011, 2015 and 2017! These frequent changes sometimes fundamentally altered the requirements for the extent of the obligatory education without fulfilment of which no one could be accepted for the final attestation exam.

These changes did not reduce the requirements for professional knowledge or practical skills, but there was, in particular, a continuous pressure to shorten the total required educational time before the attestation exam. But this effort must have a reasonable limit. In the historical two-stage education system, three years of general surgery and five years of plastic surgery training were mandatory, totally it meant eight years of training. According to the latest requirements from 2017, education should last for 30 months in general surgery, followed by 30 months of training in plastic surgery including obligatory internships and courses. The situation that it would be possible to acquire sufficient professional ability and especially practical skills in plastic surgery during such an extremely short period of time is not considered by the representatives of our professional society to be realistic and therefore it demands prolongation for at least one more year.

In the year 2017, the representatives of the society updated the training program to meet the legal requirements and, at the same time, to enable training of sufficiently educated specialists in plastic surgery. The extent of obligatory internships and courses was modified, the extent of theoretical training was updated with new topics, and the requirements for practical skills were adjusted by modification of the spectrum and number of required operations and assistances, etc.

Unfortunately, it is sad and frustrating that even at the end of year 2018 we still do not know the final rules of education that were adopted in the middle of 2017. Other specialities that are related to the scientific focus of our journal, e.g. burn surgery, maxillo-facial surgery, stomato-surgery or hand surgery face similar problems.

Uncertainty in education subsequently influences the situation in our specialization, so in the future, it may be a barrier for possible candidates to enter to plastic surgery, it may complicate the situation of doctors already in specialized training, and cause a shortage of plastic surgeons and disintegration of established teams of super-specialized plastic surgery care.

It is therefore my great wish, and also a great wish of other representatives of plastic surgery society, to stop this uncertainty as soon as possible, so that the extent of training enabled preparation of well-educated plastic surgery generation and mainly to keep it stable for a significantly longer period of time than the recent educational programs. So we will see.

Inspirational reading wishes

Aleš Fibír, M.D., PhD.

Editor-in-chief

Acta Chirurgiae Plasticae