Historically, trainee surgeons served as an apprentice to senior, learned, experienced surgeon. They would have consistency in learning – both parties getting the measure of one another. The trainer would know implicitly how competent an apprentice was, based on regular cooperation. Good habits (and bad) would be passed on from trainer to trainee, like surgical DNA.
The ‘surgical firm’ echoed these origins and lived on for many years. A relatively consistent team of consultant, registrar, house officer – working long hours but with continuity of care and (hopefully) esprit de corps could be an efficient and fulfilling training environment.
These models have been serially eroded to almost non-existence in the current era. One of the main drivers has been the EWTD and a move towards shift working. The drivers for working fewer hours have, in many instances, come from honourable motivations: safety, improving work-life-balance. However, the unintended consequences have perhaps been equally damaging. Med Twitter is awash with disillusioned surgeons who feel rudderless, under-trained, and a rather anonymous cog in a big machine, moving from rotation to rotation without direction.
Being a surgical trainer has also been rather undermined. The pressures on consultants from the NHS are often at odds with providing a high-quality training environment. The current government focus, post covid and in the midst of recession, is demonstrably not on training future surgeons.
No training today, no surgeons tomorrow. How can we improve matters? Some advocate a move back towards firm-based systems and a sensible relaxation of working hours rules. We must also acknowledge that being exposed to multiple different ways of working – and different consultants – can be hugely valuable. A longer-term surgical mentor, present over the course of training, might also help to imbue a sense of continuity and understanding of trainee-specific goals. And, of course, utilisation of technological training advancements that work - surgical simulation being a keystone example.
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh