#OperationEqualAccess - Dr Constantinos Mavrantonis Interview

Where There is a Will There is a Way: The NoDE Institute

ZG CMDr Constantinos Mavrantonis is a colorectal surgeon, Director of the 6th Department of Surgery – Hygeia Hospital, in Athens, Greece and Member of the Hospital’s Scientific Board. He is the founder and Chairman of the NoDE Institute, a not-for-profit organization for easy access to specialized postgraduate tutoring and proctorship.

Zoe Garoufalia (ZG): Dr. Mavrantonis thank you very much for agreeing to this interview. This month ESCP is focusing on diversity, equity and inclusion on research and training in surgery and on how we can overcome potential barriers in this domain. As a highly esteemed and recognized expert in the field of colorectal surgery in Greece, could you please share with the society a few words about your background and training? Did you ever experience challenges during training and how did you overcome them?

Constantinos Mavrantonis (CM): I finished my training in general surgery in Greece and did a fellowship in colorectal surgery at Cleveland Clinic Florida. I had the fantastic opportunity to train with Dr. Steven Wexner whom I still consider a mentor.

During my fellowship, I was terribly keen to do surgery and any time away from the OR seemed a waste of time. The department, however, apart from surgical training, was oriented towards the full spectrum of surgical education: indications and contraindications, technical skills, postoperative care, follow-up, anorectal functional tests and, very importantly, getting published. It took some time, but eventually I got to appreciate that a surgeon’s training needs to be well-rounded.

ZG: Based in Greece and having visited your career colorectal centres around the globe, how accessible is colorectal training in Greece? Are there any specialized centres that offer accredited fellowships or dedicated colorectal training?

CM: Actually no. There are quite a few postgraduate courses which, however, include mostly lectures from the amphitheatre. The syllabus covers the range of colorectal disease but, they lack the surgical coaching that is crucial in colorectal training.

ZG: In your opinion, how inclusive is surgical education and training in Greece? Is there equity at residency level?

CM: I believe that the problem in surgical residency training in Greece is the huge workload hospitals are facing, especially during the Covid era. Residents spend a lot more time in the wards and less time in the OR. This increases competition among surgical residents at unprecedented levels. I don’t believe that there is discrimination as such in teaching hospitals, but residents who may be less aggressive will get less time training in the O.R. and will stay behind in development of surgical skills; Which makes it a vicious circle as, the less they operate, the less confident they become, excluding them even more form practical training. And, generally in our society, women tend to be more timid in this predominantly male environment.

ZG: You are the founder of NoDE institute, a not-for-profit organization for easy access to specialized postgraduate tutoring and proctorship. Could you tell us a few things about this? When and why did you decide to form this institution?

CM: In 2008 I started organising laparoscopic colorectal surgery courses, along with my colleagues at the department I directed. These included live surgery, development of laparoscopic skills on simulators and animal models, and tips & tricks sessions. Gradually though, it became apparent that this was completely inadequate, and the courses increased in duration and went from one two-day course to four two-day courses, plus numerous hours of private tutoring on simulators. What made a huge difference though, were the four days throughout the year for each trainee, of practical training on human cadaveric models in a complete OR setting. Currently, our trainees operate in a regular OR with a scrub nurse and one experienced trainer at their side, at every stage of the operation.

This evolved in a five-step training in colorectal surgery, with the above courses being Level-1, spending time at the department and scrubbing-in being Level-2, telementoring and surgical coaching for trainees' first cases being Level-3, TaTME cadaveric dissection course being Level 4, and robotic colorectal surgery being Level-5.

And this led us to appreciate the need of such courses for all surgical specialties which, in turn, led us to create the NoDE Institute, a not-for-profit organization for postgraduate practical training in surgery. The NoDE stands for Network of Doctors’ Education, which is exactly what it is about. During our professional lives, we achieve education not only by learning, but also by teaching.

In the four years of its existence, apart from the regular NoDE trainers, another 124 physicians have taught at courses, and 878 surgeons have received practical training from us, at no charge. All this is based on doctors volunteering to teach doctors.

At this moment quite a few surgical departments from Medical Schools around Greece have trusted the practical aspect of their postgraduate courses to us.

ZG: Through NoDE you succeeded in organising medical-aid missions. Could you tell us more about these missions and their purpose?

CM: Actually, it was only one mission in Uganda in 2019, as the lock-down that followed, made us cancel subsequent plans to return. Hopefully we’ll do so next year. Apart from the medical aid mission, we had the opportunity to organise a colorectal course at the Medical School along with our remarkable colleagues there.

ZG: How can one become member or get in contact with NoDE institute (e.g for training)? Is it only open for Greek/European surgeons? Can surgeons from other parts of the world apply to attend seminars?

CM: The NoDE was created to provide Greek surgeons with access to the postgraduate practical surgical training, that they would otherwise seek abroad. Occasionally however, we do have colleagues applying from abroad and we always do our best to accommodate them. It isn’t a society, so it has no members. People come to offer training or to receive training, or both.

ZG: How would you advise young surgeons out there, budding colorectal experts, who try to achieve the best available training?

CM: It depends, I believe, on whether there are accredited colorectal fellowship programs in the country they reside in. If not, it is probably worth moving abroad for two to three years to enrol in a Fellowship Training program and have the opportunity to pursue a comprehensive curriculum, master surgical technique and attain competence.

ZG: Thank you for your time!

CM: Thank you kindly Dr. Garoufalia for the opportunity to share.

Learn more about the NoDE Institute.

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