Applications of Bioprinting and Stem Cell technologies in Orthopaedics have life altering implications for patients who are suffering from cartilage loss !
Arjun Naik, our next pathbreaker, Clinical Fellow (Trauma & Orthopaedics) at King’s College Hospital NHS Foundation Trust (UK), evaluates and treats patients through surgical interventions, with a main focus on bone repair.
Arjun talks to Shyam Krishnamurthy from The Interview Portal about the role of reconstructive surgery in treatment of long-term diseases such as arthritis of the joints, sports injuries, and deformity correction.
For students, modern medicine requires a good blend of technology , problem solving aptitude and communication skills in order to make lives healthier and better !
Arjun, what were your early years like?
I was born and raised in Dubai when the country was well known for its sun and desserts. My father was in the logistics business and mother was a homemaker. Part of my schooling took place in Dubai and the latter half in Mangalore, India.
I won several accolades for swimming and was part of the school team in table tennis. Sports instilled the quality of persistence, determination, and teamwork in me.
As a hobby, I enjoyed learning new skills that I could use in the future. Mum instilled independence in me and my sister from an early age. She made sure we did all the household chores in spite of having domestic help. This was crucial in helping me to adjust and live happily outside of my comfort zone
Being a sick child who frequented doctors, I aspired to become a doctor from a very young age. The way I was consoled and treated by doctors piqued my interest. However, during the next few years my ambitions shifted to wanting to be an automobile engineer, businessman, builder or continuing in my father’s profession.
I believe no matter what career you select; you have to be the best at it. The only way you can be the best at something is when you enjoy it and if you want to enjoy it, you need to love it. This resonated in my mind, and I always enjoyed biology throughout my schooling days. I scored well in my 10th and 12th which took me to the crossroads of each one’s life- Which career is best for me?
What did you do for graduation/post-graduation?
Because I was so passionate about biology, I decided to pursue the most obvious undergraduate path: MBBS. I spent five and a half years in Mangalore’s K.S Hegde Medical Academy. I was a member of the student council and vice president throughout this period because I thought extracurriculars were vital. Living in my books might get me through the course work, but it would never prepare me for the hard reality of practising medicine.
I even worked extra shifts at private hospitals during my final internship year because I wanted to get as much experience as possible to help me become a well-rounded doctor, and these experiences gave me a taste of what’s out there. I subsequently enrolled in Father Muller’s Medical College, Mangalore for a postgraduate programme in Orthopaedics and Traumatology, which was the sole speciality I wanted to study and graduated three years later with MS in Orthopaedics and Traumatology.
I started working as a senior registrar at Manipal University, Mangalore where I passed the DNB exam and added another feather to my cap, I moved to London to study an MCh in Regenerative Medicine (a future specialisation) and have worked for the NHS ever since.
What prompted you to pursue such an offbeat, unconventional and uncommon career?
As I mentioned before, I fell ill a lot when I was younger and used to see the doctor every other week. I really admired my doctor’s mannerisms- his professional yet compassionate attitude towards his patients and the respect it earned him. This encouraged me to pursue a career in medicine.
My interests ofcourse shifted throughout my adolescence. In 8th grade, from the day I met my brother-in-law (who is a doctor) for the first time, I was in awe of the medical field. I witnessed a lot of job losses during the 2008 recession. This made me realise that financial stability is very important and this was the year when I had to make my choice. I scored well in my medical entrance exams and therefore it was a no brainer, and I pursued medicine.
I’ve always been interested in repairing broken items around the house. I enjoyed the technical aspects of it, such as the use of screws, bolts, and a hammer. Due to its similarity with Orthopaedics, I adored this speciality throughout medical school. I was fascinated by how Orthopaedists mended fractured bones and had the patient walking the next day. From my second year of medical school, I knew I wanted to study orthopaedics, and it was never a tough decision.
Some Tips: List the type of skills you enjoy doing. These should include abilities that you use daily, such as maths, do-it-yourself (DIY) projects, coding, or fixing electronic devices. This will give you an idea of what kind of activities you enjoy. Look at jobs that provide you with the same type of activities because, at the end of the day, you need to enjoy your work. For a postgraduate degree, you will start developing interest in a particular field during your undergraduate days. Hold onto it for your long-term plans
Can you talk a bit about our career path?
It takes a lifetime of dedication towards studying and reading, as well as sacrifices in order to pursue a career in medicine. As previously said, my interest in medicine began in elementary school because of my passion for biology. My communication skills instilled confidence in me that my patients will get the best quality of service. I attended coaching classes during my pre-university to ace the entrance exams for medicine. In MBBS, I enjoyed Orthopaedics and wanted to pursue it.
I studied for my admission examinations during my internship and was able to acquire a position in a non-profit medical college hospital that predominantly served patients from low socioeconomic backgrounds. I saw a lot of pain and realised how fortunate other countries are to have free healthcare. I’d like to learn more about the notion and develop a model for making high-quality healthcare accessible to low-income patients in India. I began working for Manipal Hospitals after completing my orthopaedic studies and passed the Diploma National Board (DNB) exams.
I applied for a fellowship in knee surgery and was accepted into a twinning masters degree (MCh in Regenerative medicine) and knee fellowship at Canterbury Christchurch University, UK. The twinning program consists of my 2 separate programs ( knee fellowship and masters degree) combined into one.
I was selected as my portfolio had all the requirements fulfilled in terms of research publications, presentations in national and international conferences, extra curricular activities and an adequate number of surgeries performed during my Orthopaedics training.
The masters program aimed at teaching and training us in the role of stem cells in regenerating articular cartilage of joints to treat cartilage loss which causes osteoarthritis in the long term. We dedicated a lot of time observing the harvesting and growth of cartilage in the laboratory which was an exciting experience. We were also taught the uses of 3D printing technology in Orthopaedics. This involved printing patient specific instrumentation for surgery which helps reduce human error during operations. The other aspect of my master’s degree taught us the fundamentals of research and how it can be used to improve patient care. For six months, I had to attend classes twice a week, followed by a dissertation and research project on 3D printing. My dissertation taught me how a plain CT scan can help in designing and developing specific instruments required for specialist surgeries with help of 3D printing the instruments. It was an inspiring experience. We were also given lessons on research techniques as well as producing and critiquing research papers. I enjoyed my time at the university because it felt like I was back in school.
I worked on my knee fellowship honing my surgical abilities. This entailed consulting patients in clinics and operating on knees under the supervision of a senior surgeon. I came across some groundbreaking techniques on cartilage repair surgery for athletes and sportsmen. Due to the repetitive microtrauma they suffer during their career, the cartilage wears off. If left alone it leads to osteoarthritis. Therefore, they were treated with key-hole surgeries where bone marrow from the hip was harvested with a needle and the stem cells were isolated. This was then prepared and injected into the areas of cartilage loss (arthroscopic keyhole surgery) to regenerate new cartilage in 2-3 months. My senior consultant (surgeon) was also my mentor. He trained me in surgeries as well as administrative activities. Shadowing him I learnt the rules of the private practice game which I may need in future. He was involved in multiple research and business projects all over the world and I used to help him out in the day to day running of these activities which also helped me with new skills such as time management, organization, communication and planning. My time spent with him broadened my horizons and allowed me to consider options beyond orthodox clinical practice. It brought out the inner entrepreneur in me.
Briefly, this program taught me the basics of stem cells (in the lab) and its use in Orthopaedics which I then experienced when carrying out the cartilage repair knee surgeries. This helped me understand the entirety of this field and the potential it has for the future.
Good communication skills were given to me as a gift, and they have benefited me a long way. It expands your network and opportunities. For three reasons, I enjoy attending conferences and meetings. To begin with, it informs you of the most recent breakthroughs in your field. Second, you can travel to fresh and lovely places, and third, it aids in networking. Since my first year of medical school, I’ve been attending conferences for presentations on a regular basis. This trend persisted, and I began giving presentations at orthopaedic conferences all over the world, including India, Oman, South Africa, and the United Kingdom. It also helps me to understand diverse cultures and individuals, extending my perspective on life. At a symposium in Capetown, I met the founder of Orthopaedic Principles. The channel was new and scarcely active at the time. We were able to maintain contact for a long period, which allowed me to contribute a chapter to his trainee textbook. We worked together during the lockdown to ensure that no one ever had to pay for Orthopaedic knowledge by establishing one of the largest data banks of online videos on Youtube. This is an excellent example of how networking can be beneficial.
Tip: Whatever path you choose, you must first determine what your life’s purpose is and what you hope to accomplish. Opportunities will constantly come knocking on your door if you work hard. Networking and strengthening communication skills are critical since others will only know how good you are at what you do if you can communicate effectively with them.
How did you get your first break?
My first break came when I was chosen for a knee fellowship in London. I applied for the programme, and after a difficult interview, I was chosen for the program, where I was lucky enough to be awarded a Scholarship as well at Canterbury Christchurch University under the eminent Professor Anan Shetty. It was a once-in-a-lifetime opportunity for me to leave my hometown and relocate to a new country with a different culture and people. Overnight, I realised I had transformed from a boy into a man. It instils incredible maturity in you. Nothing compares to the experience of attempting to figure everything out on your own. Following my fellowship, I received my second break when I aced my interview and was offered a position at Kings College Hospital in London, one of the top institutions in the world.
Tip: My life slogan is to constantly say ‘Yes’ when presented with opportunity/challenge. Even if you can’t figure it out when asked, you can always learn new skills and find a means to reach new heights and attract attention in today’s competitive world.
What were some of the challenges you faced? How did you address them?
To be completely honest, I was fortunate to receive a solid education throughout my childhood and have not had many financial troubles, which I regard to be the greatest difficulty in one’s life. When I moved to London, however, Zimmer, an Orthopaedic implant business, supported my knee fellowship. I did not receive my salary for 6 months due to a few problems. They promised to reimburse me, but I had to make it through those months without earning anything. This was one of the most difficult periods of my life. I borrowed money from my parents, but only for a few weeks. I realised I needed to get back to work in order to pay my rent and grocery payments. I applied for restaurant employment but was turned down since I was a doctor. I realised the problem was that I am a doctor. As a result, I began to conceal the reality and applied for a job at a doner kebab shop. They hired me because they thought I was a student. Chopping vegetables, cleaning, cutting, marinating and frying chickens, cleaning the sink and floor were all part of my job. I was a surgeon by day and butcher by night ! I used to work in my fellowship from 9 a.m. to 5 p.m. and then hustle from 6 p.m. to 3 a.m. to start my job. Dipping my hands into the icy cold water to clean the chicken and cut them up taught me more life lessons than any textbook. After 3 months, I signed up for a medical locum agency that could provide me with jobs on weekends. I started getting paid in my fellowship 4 months from my kebab shop job and that’s when my life stabilised.
Every day, in my opinion, is a struggle. Some are little problems that don’t require much planning, while others are larger challenges that can be more difficult to conquer. It is simple to give up and accept the consequences. But no one has ever been successful by doing so. The key is perseverance and determination. Never give up.
Tip: The principle of “survival of the fittest” is not limited to the jungle. It is also felt in the real world by humans. When I was short on cash, it would have been easy to give up and return home, or I could take charge of my life and find a way to make ends meet.
Where do you work now? What problems do you address as an Orthopaedic Surgeon?
I currently work in King’s College Hospital London. I am a Senior Orthopaedic fellow. My job entails evaluating patients in clinics and developing treatment plans for them. Surgery is performed on patients who require it. Our main focus is on bone repair. We also do operations and injections into joints to treat long-term diseases such arthritis of the joints, sports injuries, and deformity correction. During my on-call days, I attend to emergency patients with my colleagues and provide immediate first aid treatment as well as treatment plans.
Since I was a child, I’ve always enjoyed repairing broken objects. This continued into medical school, where I discovered a common ground in the use of screws, plates, a hammer, and a chisel to repair bones. I learned how to operate during my orthopaedic training, and I’m currently working on improving my skills. Every day, I begin work at 8 a.m. We have a handover meeting where cases from the previous day and night are discussed, and decisions are made by numerous surgeons. This is followed by a clinic or operating theatre session. Few days a week I conduct ward rounds and teach/train the junior doctors. This can be anything from discussing a topic, to supervising procedures that they are carrying out. However, the element of my job that I enjoy the most is operating. I enjoy putting damaged bones back together and repairing torn ligaments. The delight I see in my patients’ eyes when they walk into my clinic after surgery is priceless.
How does your work benefit society?
Pain is suffering, and in my line of work, patients’ and relatives’ emotions run high. All they can think about when they’re in pain is someone to take away their suffering. That’s where a doctor’s role is crucial, by instilling confidence in a patient that he is the best candidate for the job. Everyone believes that the most essential component of our profession is treating people. I believe it is more vital to instill confidence in our patients. We often notice newspaper articles about assault on healthcare workers including doctors. The reason for this goes back to my statement on emotions, which occurs due to difficult patients, lack of communication, misunderstanding or critical conditions beyond recovery, which in-turn lead to incidents like this. Part of my job entails treating patients and providing the best evidence-based therapy options feasible within the scope of practice. We get patients back to their preinjury level of quality of life as soon as possible by fixing broken bones or repairing torn muscles/tendons. Every patient should be treated as if they were a member of our own family. Only then will we be able to treat them with compassion.
Teaching and training junior doctors is another component of my job. Ward round discussions, case-based discussions, supervision of procedures and offering feedback for improvement are part of a daily routine. Conducting courses for junior and middle grade doctors keeps our knowledge updated while also assisting in the development of tomorrow’s doctors. I am also actively involved in quality improvement projects and clinical audits to identify areas that can be rectified within the department. This is the most important lesson I learnt from the NHS.
Can you tell us about a specific memorable work that is very close to you?
There were no regional training sessions for FRCS exams at my hospital, though I have prior experience in conducting courses. Therefore, I teamed up with a few consultants and hosted the first FRCS Trauma and Orthopaedics course onsite at our hospital. This was live streamed on YouTube for free and received over 3000 views in just 24 hours. Other organisers requested us to conduct joint teaching courses with them on a regular basis after the course was a success. I oversaw the entire process, from planning to logistics, and this was one of the most difficult problems. I’ll never forget how much the department appreciated this course during their monthly consultant business meeting.
Your advice to students based on your experience
Choose wisely! Do not get influenced by parents or friends. Enlist your interests. Match your strong characteristics to occupations that profit from them. Examine the interviews on this site to obtain a sense of each career that meets your requirements.
Medicine is no longer a ‘noble’ profession. It is just a profession and rightly so. To succeed in this sector, you must put in a lot of effort, sacrifice, determination, and perseverance. When it comes to dealing with emotions, good communication skills have surpassed all other qualifications and are now the most critical requirement. If you’re looking for a way to make money quickly, medicine isn’t for you. We are rewarded by the blessings of patients. Modern medicine has become a race of degrees and alphabets against your name, so prepare to answer lots of exams. It is possible to sail through a medical career if you possess a reasonable intelligence quotient. As a doctor, you must be available 6-7 days a week. In some cases, it can be done over the phone rather than in person in the hospital. The field of medicine is highly respected, and you should have a strong interest in human biology if you wish to become a doctor
I am currently training in the UK to become an Orthopaedic consultant. Having completed training in one country does not necessarily give you a practice license in another country. Each country has its own set of training requirements to become a consultant. I intend to specialise in knees and shoulders (sports medicine). I am also passionate about administration. I plan on pursuing hospital administration as a second role. This would involve roles such as clinical lead and medical/clinical director.
On the academic front, at my hospital, I am working on establishing a yearly regional junior doctor and FRCS teaching course. Hopefully in the years ahead, I will be able to also assist in the resolution of healthcare challenges in the best interest of patients, through collaborations in India. I believe that privatising healthcare with low-cost insurance for patients is a good idea. The doctor and the patients are both pleased in this way.