The Rural American Surgeon

Stuart Ferguson returns for part two of his conversation on The Rural American Surgeon to explore the practical realities of providing urologic and general surgical care in the remote Shetland Islands.Stuart discusses the limitations that come with practicing in a small island hospital, including equipment decisions, limited critical care capacity, weather that can prevent patient transfers, and the need to know when a case should be referred. He then walks through his approach to transurethral resection of the prostate, including patient selection, equipment, safety landmarks, difficult catheter placement, and how elective urology experience helps when managing emergencies.The conversation expands beyond the operating room as Stuart shares his approach to charitable giving and how he and his wife make global health work in Zambia a regular part of their careers. He explains how rural surgery gave him the broad skill set needed to work in low resource environments and shares a case that demonstrates the value of being a generalist who can see the whole patient rather than a single problem. The episode concludes with practical resources for rural surgeons and an introduction to the Viking Surgeons Association.Key Takeaways00:00 Returning for Part Two With Stuart Ferguson00:48 Managing Kidney and Bladder Stones in Shetland01:37 How Often Stuart Performs TURPs01:48 Operating Rooms, Endoscopy, and Critical Care Capacity02:26 Patient Transfers and Scotland’s Retrieval Service02:54 When Weather Makes Transfer Impossible03:32 Selecting the Right Patient for a TURP05:14 Equipment and Safety Principles for TURP06:15 Cystoscopy and Identifying Key Landmarks07:33 Managing a Difficult Urethra08:19 Difficult Foley Catheter Placement and Guidewire Techniques09:23 Using Urology Skills to Manage Severe Hematuria09:59 Stuart’s Approach to Tithing and Charitable Giving10:50 Automating Giving Through a Separate Account11:27 Supporting Global Health Work in Addition to Giving13:05 Faith and Community in Shetland14:31 The Viking Surgeons Association and Rural Surgery Community16:09 Randy’s Path Into Rural Surgery18:44 Training Specifically for a Rural Surgical Career20:29 Creating Change Within a Small Rural Health System21:31 Making Time for Global Health Work in Zambia21:54 Stuart’s Connection to Rural Surgery in Zambia23:30 How Global Health Work Maintains Surgical Skills26:13 Why Rural Surgery Transfers Well to Low Resource Environments28:20 The Value of Being a Holistic Generalist29:30 Connecting Multiple Medical Problems Across Specialties30:18 Recognizing When the Patient’s Greatest Need Is Something Else32:45 Resources for the Busy Rural Surgeon33:24 AO Surgery Reference for Unfamiliar Procedures33:54 Primary Surgery for Low Resource Settings34:54 The Viking Surgeons AssociationResources Mentioned AO Surgery Reference Viking Surgeons Association Royal College of Surgeons of Edinburgh Faculty of Remote, Rural and Humanitarian Healthcare NHS Shetland

Stuart Ferguson, a consultant general surgeon in Scotland’s remote Shetland Islands, joins The Rural American Surgeon to discuss what it takes to practice surgery 200 miles into the North Sea and why he deliberately built his career around becoming a broad surgical generalist.Stuart shares his training journey from Glasgow and Northern Ireland to colorectal surgery, global health work in Zambia, and Scotland’s Rural Surgical Fellowship. He explains how the fellowship allowed him to build additional skills in urology, orthopedics, trauma, and obstetrics specifically for the needs of Shetland.The conversation also explores what surgical practice looks like for a population of roughly 22,000 served by three consultant general surgeons. Stuart describes a practice divided between general surgery, urology, trauma, and orthopedics, along with endoscopy and emergency procedures that would typically be divided among several specialists in larger hospitals. The episode concludes with a look at how he developed the urology skills needed to practice independently in such an isolated setting.00:00 Why Rural Surgery Creates a Broad Skill Set00:45 Meeting Stuart Ferguson and the UK Tradition of Calling Surgeons “Mr.”05:42 Stuart’s Surgical Training in Scotland and Northern Ireland07:30 Going From Colorectal Training Back to Generalist Surgery08:00 Scotland’s Rural Surgical Fellowship08:38 Building Skills in Urology, Orthopedics, Trauma, and Obstetrics09:21 How Many General Surgeons Serve the Shetland Islands11:51 What “Rural” Means in an Extremely Isolated Community17:01 Shetland’s Scandinavian History and Culture18:33 Serving 22,000 People With One Hospital and Three Surgeons19:32 Stuart’s Mix of General Surgery, Urology, and Orthopedics20:45 The Bread and Butter Procedures of a Shetland Surgeon21:17 Managing Complex Cases and Surgical Emergencies22:33 Endoscopy Without a Gastroenterologist31:09 How Stuart Built His Urology Skills After General Surgery Training32:08 Using the Rural Surgical Fellowship to Prepare for Shetland33:13 Training for Independent Urologic Practice 200 Miles Into the North SeaResources Mentioned●  NHS Shetland●  Royal College of Surgeons●  British Society of Gastroenterology

Dr. Amiri, program director at Marshall University, and fourth year surgery resident David Kanarowski join The Rural American Surgeon to discuss Marshall’s dedicated rural general surgery residency and how it prepares surgeons for independent practice in rural communities.They explain how residents spend roughly two thirds of their training at rural hospitals, gaining early operative experience without competing with other residents for cases. The conversation covers the broad skills rural surgeons may need, including C-sections, endoscopy, orthopedics, and procedures shaped by the resources available in their future communities. Dr. Amiri and David also share what Marshall looks for in applicants and why a genuine commitment to rural life matters. The episode concludes with a practical discussion of Dr. Amiri’s approach to robotic right colectomy.01:07 Why Marshall Created a Rural Surgery Residency02:26 Spending Two Thirds of Training in Rural Hospitals03:09 Preparing for a Career in a Small Town05:27 Tailoring Training to Future Rural Practice06:48 How Marshall’s Rural Residency Is Structured07:49 What Marshall Looks for in Rural Surgery Applicants09:03 Case Volume and Early Operative Experience09:53 Taking Call in a Rural Hospital10:43 Housing and Rural Rotation Sites11:56 Training with OB/GYN, Orthopedics, and Other Specialties13:59 Endoscopy and C-Sections in Rural Practice16:14 Finding Residents with a Rural Mindset17:02 Training General Surgeons Rather Than Specialists18:29 Fellowships That Can Benefit Rural Surgeons20:11 How Dr. Amiri Performs a Robotic Right Colectomy22:33 Medial to Lateral Dissection and Pedicle Ligation24:28 Using ICG to Identify the Middle Colic26:55 Bowel Transection and Stapling Technique29:05 Creating the Anastomosis30:44 Postoperative Care and Early Discharge31:26 Adapting the Technique Without a RobotResources Mentioned●       Marshall University

Dr. Anne O’Rourke, program director at the University of Wisconsin, joins The Rural American Surgeon to discuss how UW’s rural surgery track prepares general surgery residents for independent rural practice. She explains how the five-year program combines training in Madison with recurring rural rotations, giving residents experience with the broad skill set rural surgeons need, including endoscopy, C-sections, trauma stabilization, and general surgery. Dr. O’Rourke also shares what the program looks for in applicants and why courage, confidence, resilience, and exposure to practicing rural surgeons are essential for preparing the next generation of rural surgeons.00:45 Training the Next Generation of Rural Surgeons01:56 Why Wisconsin Created a Rural Surgery Track03:09 The Five-Year Rural Surgery Pathway06:58 How Rural Rotations Are Structured09:32 What UW Looks for in Rural Surgery Applicants11:16 Courage, Confidence, and Resilience in Rural Practice13:58 Training in C-Sections and Other Rural Surgical Skills16:03 Endoscopy, C-Sections, and Trauma Stabilization17:36 Preparing Residents for Independent Practice19:09 Why Exposure to Rural Surgeons Matters20:41 Why Surgeons Choose Rural Practice24:34 The Importance of Providing Care Close to HomeResources Mentioned●  University of Wisconsin Rural Surgery Track● Wisconsin Surgical Collaborative● North American Rural Surgical Society ● University of Wisconsin Rural OB/GYN Track● NRMP Match

Our “Training the Rural Surgeon” miniseries continues as Dr. Randy Lehman and Jacob Steffen are joined by Dr. Frank Wood from the University of Oklahoma and Dr. Barclay Stewart from the University of Washington to examine how residency programs are building the next generation of rural surgeons.Dr. Wood explains why Oklahoma created a dedicated rural surgery track, how residents train in Lawton, and why broad clinical exposure, culture fit, and teamwork remain essential for long term success in rural practice. The discussion also explores the workforce challenges facing rural Oklahoma as experienced surgeons retire and communities work to maintain local surgical care.Dr. Stewart outlines the University of Washington's PROGRESS program and the WWAMI model, connecting rural and global surgery training across the Pacific Northwest. He discusses flexible training pathways, regional partnerships, and how residents gain experience in diverse care environments while preparing for broad scope surgical practice.For medical students and residents interested in rural surgery, this episode offers two distinct approaches to developing surgeons who can serve rural, remote, and frontier communities.0:00 Intro00:55 Oklahoma's Rural Surgery Track08:08 What Programs Look for in Applicants13:51 Teamwork and Culture Fit18:53 Training Philosophy and Resident Development24:51 Case Volume and Early Operative Experience27:59 The WWAMI and PROGRESS Model33:51 Broad Scope Training Across Rural Sites38:35 Flexible Training Pathways43:28 Learning Care Delivery in Different Environments49:47 Matching and Program StructureUniversity of Oklahoma General Surgery Residency Programshttps://medicine.ouhsc.edu  University of Washington Department of Surgeryhttps://uwsurgery.org/ 🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/ Join us on Facebook:https://facebook.com/profile.php?id=61564305936854