Plastic surgery is the youngest profession among surgical practices in Russia. In fact, only in May 2013 was the order of providing services for plastic surgeons approved by the Russian Ministry of Healthcare. The profession of plastic surgery is separate from general and head and neck surgeries, and was established in 2008, requiring a separate license to practise.
Special training for plastic surgeons also began in this year, and a number of departments of plastic surgery opened in major Russian medical universities. Before 2008, surgeons were practising plastic surgery, but it was not recognised as a separate profession that needed a separate license or training, for example. Rather, cosmetic surgery was included within the scope of a general surgeon.
Owing to this lack of recognition, it was impossible to officially create departments of plastic surgery in hospitals or open private clinics of plastic surgery. Naturally, there were clinics offering plastic surgery as early as the late 1990s, but they had no official status as such. These restrictions were therefore hampering the development of the profession.
Joint efforts of leading Russian surgeons have allowed the profession to appear as a separate entity. Many plastic surgeons began getting their licenses in 2008, and in 2009 they started to work under the title of Plastic Surgeon with official recognition of the specialty.
During 2009–2010, further laws and regulations describing requirements for plastic surgeon qualifications and educational background were issued by the Ministry of Healthcare. As the majority of plastic surgeons applying for certification training for licensing were already experienced in the field, a ‘fast track’ 6-month training course was introduced. Surgeons were successfully graduating from the programme and obtaining their licenses.
With time, however, it was found that owing to a breach in the new regulations defining requirements for plastic surgery, any certified medical doctor could apply for the programme and obtain a certificate of completion by graduation. It turned out that some physicians and surgeons without experience in the field applied for the programme, which had been mainly created for the formal recognition of existing plastic surgeons and obtained their paperwork.
With this in mind, Academician Milanov, Professor Nerobeev and Dr Natalia Manturova initiated a new move to change the existing regulation and demand much tougher rules for acquiring the profession of a plastic surgeon.
At present, there is an inquiry to the Ministry of Healthcare for minimal requirements for future plastic surgeons. These requirements include a 5-year surgical resident programme for plastic surgeons: the first 2 years comprising general or head and neck surgery, and then 3 years of plastic surgery. The programme is supported by majority of Russian plastic surgeons and implementation will set improved standards of professional education for plastic surgeons in Russia.
The next step planned by the Moscow Healthcare Department is to create positions for plastic surgeons in large community emergency medicine hospitals. The idea behind this revolutionary approach is an increasing demand for quality emergency medicine in cases of injuries involving the face and extremities, from life-saving manipulations to the consideration of quality of life. The other beneficial point for the patient is a strong microsurgery background that is usual for a good plastic surgeon. This helps in reconstructive procedures and cases of traumatic superficial injuries or burns.
Plastic surgery is a complicated profession that requires exceptional knowledge of anatomy and great practical skills. As a fast developing state-of-art specialty, plastic surgery includes more and more high-tech additions that require a very good understanding of cellular biology and physiology, and even technical knowledge. Plastic surgeons played an important role in creating 3D modelling and the design of new instruments and devices to fulfill needs of advanced technologies used in the modern plastic surgery.
The tendency of decreasing the volume of a surgical manipulation towards less invasive surgery created a closer relationship between plastic surgery and cosmetology, and an introduction of powerful but small volume interventions.
One of major trends in developing plastic surgery during this decade involves cellular technologies. Cellular technologies include fat grafting and PRP, as well as complicated constructions that involve the use of acellular biological matrixes and other scaffolds. The incorporation of these biological technologies created wider ranging departments known as ‘Department of Plastic and Reconstructive Surgery, Cosmetology and Cellular Technologies’, such as that established by Dr Manturova for the postgraduate training of plastic surgeons in RNRMU.
To provide excellent knowledge and skills for postgraduate students, both surgeons and biotechnology specialists are involved. While students continue to spend time in the operating room and are lectured by high-rank specialists in plastic surgery, they also receive a full course of lectures and seminars on cellular technologies. This course includes basic knowledge of cellular biology, introduction to available cellular technologies and modern legal regulations in this field. Students are being taught at actual cellular facilities and introduced to major techniques of obtaining and preservation of ADSC.
The ability to obtain ADSC allows a plastic surgeon to play a prominent role in general medicine. ADSC may be used not only for aesthetic treatments but also for modern treatment of severe and socially important diseases like autoimmune diseases or cardiological conditions. Furthermore, preservation of ADSC for future invasions is also starting to be part of the plastic surgeon’s responsibility.
By the end of the course, students should have a good understanding of risks and benefits of working with ADSC including other than pure plastic surgery applications, helping them to understand the importance of a broad medical education.
The other requirement for students planning to enter training at the department is a good command of English. Teaching by leading American and European plastic surgeons becomes part of a regular training in the department of Dr Manturova. International training is done not only by means of teleconferences and telelectures, but also by seminars and conferences held in Moscow by English speaking professors.
With Russian plastic surgery becoming more and more internationally recognised, some foreign students have started to visit the department. More and more frequently, Russia becomes a place for international educational and collaborative events.
In 2013, RNRMU became the first Russian medical University to obtain International University status, in addition to National Research University. These achievements led to the rapid development of medical studies, including plastic surgery in Russia. Partnership with major research Universities allows surgeons to use the newest achievements of biomedical scientists, therefore being part of a major trend of modern medicine development towards personalised and translational medicine.
Understanding of contemporary trends in medicine and necessity of international collaboration are used in the training process for Russian plastic surgery postgraduate students and play an important role in preparation of the highly skilled well-trained professionals with a broad biomedical education.