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The Evolution of Surgical Education and Training

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Rebecca Williams
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How has your surgical training impacted you as a surgeon? In what way(s) do you think that this influences your role as a surgical educator? Please use this thread to share your thoughts with the other surgical trainees on the programme. Remember to comment on others' posts.

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Now that you have all had the opportunity to watch Mr Jose's webinar and to consider the evolution of surgical training, please share your own thoughts on how your surgical training has impacted your role as a surgeon and a surgical educator.

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When people ask me how I ended up choosing urology, I always say "I had the right trainers at the right time". I knew I loved surgery and ultimately wanted to become a surgeon, but there was a lot to choose from. I was lucky to rotate into urology in a department with a wonderful team and their support and training is what led me into urology. I know plenty of people with similar stories. Having good trainers can significantly shape our careers, just as much as bad ones can put people off medicine entirely (sadly I also know a couple of those). This made me want to become that trainer to someone one day.

On a different note, following on from Mr Jose's talk, it's very interesting to see the overall history of how our training came to be what it is today. I must admit I can see some benefits to the apprenticeship model previously used (and the very obvious pitfalls), and I wonder if we have not overcorrected? Yes rotating through different hospitals with different teams allows for a more broad exposure in clinical practice and population demographics, but as our clinical care becomes more and more standardised thanks to national and international guidelines, will there be that much difference in the future? Will that difference justify the toll the constant rotation and relocation takes in our personal lives? Specially as work-life balance is becoming more valued? Food for thought...

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Thank you Ines.

From history we learn that we often reinvent the wheel. 

There have been plans to reinstate the apprentice model in Medicine with intake after school.

It will be probably not as intense as the model in the past but keeping in with working time directives.

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I am deeply captivated by the profound insights shared by everyone and Mr. Jose's enlightening lecture that delved into the historical nuances of surgical training.

Surgery, like any other discipline, is about constant exposure, both in surgical and non-surgical contexts. The continuous rotation between departments, hospitals, and surgeons has not only enhanced my patience but also enriched my understanding. As Ines Pina's mentioned about standardization, I believe it remains invaluable but the essence of surgical skill lies in its inherent diversity; every surgeon imbues their unique touch, from prepping to procedure to suturing and even dressing. Eevryone does it differently with their own sense of good or bad. Remote features and VR can probaly in future help in learning technicalities from others and save time in rotations, the essence of non-surgical skills, such as effective communication and collaboration, still necessitates genuine face-to-face interactions.

Reflecting on my own surgical evolution, I resonate deeply with Ines Pina's perspective and it was mainly being around a very effective team and lead me to choose surgery. Initially trained on the job, I found myself ensnared in a cycle of relentless service provision, leaving little room for self-reflection. The emphasis seemed skewed towards academics surgery and knowledge. A mentor's wisdom struck a chord, emphasizing that sensibility, encompassing communication, documentation, timely action, and recognizing one's limitations, is more important than just being able to perform surgery. This revelation reshaped my approach; surgery became a profound teacher, highlighting my weaknesses and fueling a thirst for knowledge. Over a decade, I realized that the pinnacle of these traits lies in leadership and management. Being a leader transforms a mere technician into a catalyst for change, a realization that has profoundly shaped my perspective on the transformative power of surgical practice.

Jehan

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Thanks Jehan. Very insightful comments. Surgery unlike other medical specialties rely much on an individual's initiative and skills and it is important  to see and learn from people who have been doing it over the years. While simulators have their place I doubt if they will ever replace real life learning.

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Sandeep Pillai
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Hi, 

It was a great opportunity to listen to Mr. Jose talking about the evolution of surgical training in general and in the Western world and the UK in particular. It gave some valuable insights as to the shift of training from the more or less whims-based apprenticeship model where a trainee's future was determined by the trainer - for good or bad; to a more experiential type of learning generated and nurtured by repeated cycles of reflection and readjustment.

Addressing the question of how surgical training impacted my role as a surgical educator and a surgeon, I admire the enormous influence that my surgical seniors to this date had on my overall development, right from the early days of my training. From knot tying and suturing, simple dissection of cysts and swellings, demonstration of physical signs, concepts of surgical physiology, wound healing, critical care, and finally into complex surgical procedures, the list goes on. The training was not limited to surgery as they also demonstrated nonoperative technical skills and communication, how to do posters and presentations, and how to conduct teaching sessions in surgery. Looking back it had been a mixture of good and bad experiences thrown at me, but their overall effect had been to inspire me to become a surgical trainer myself and carry forward the goodness. 

I am equally eager to hear about your individual journies and experiences. Thank you

 

 

 

 

 

 

 

 

 

 

 

 

 

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Dear Mr Pillai,

Your thoughts are very interesting and informative for everyone in this group. Very insightful comments. You have outlined the evolution of your surgical training and experience very eloquently. You are absolutely correct - the senior surgical trainer has an enormous influence on the junior trainee and his/her career development/progression. We envisage this programme to encapsulate and address all aspects of surgical training. 

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Sandeep Pillai
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Thank you very much for those comments.

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Claire Joyner
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Mr Jose's talk was most interesting as I have not previously thought about the origins of surgical training especially not as far back as the 1700s.

It does still feel like our training is very much based on the apprenticeship model and our medical school was our grounding phase of our careers. It is easy for us to think that our role as a surgeon is very much a practical job however the majority of our weeks are not spent in the operating theatre. As I progress through my training I learn more that being a surgeon is equally about making the decisions about who to operate on and why (more in the elective setting than in trauma per se) but that not all patients would benefit from our interventions.

As Sandeep has mentioned above - our surgical trainers offer us much more than the practical aspect of surgery including those professional and communication skills as well as research and audit opportunities too. So much of our role is about imparting our knowledge and experiences onto more junior colleagues and students and the more senior I become the more I realise which bits of advice was most useful to me at varying stages.

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Dear Ms Joyner, 

Everything you have stated is accurate and we concur that surgical training is equal amount of (if not more) non-operative skills than surgical skills. In a standard consultant job plan, he/she will have only a maximum of 3-4 sessions a week that involves operating. Typically, it will one full day operating list, one half day list and another half day for oncall operating/trauma. So in a 11-12 session job plan, only about 25% of the time is spend operating. Then there are 2-3 sessions for outpatient clinic, MDT, ward rounds and maybe a peripheral clinic. In essence, 50% of a surgeon's time is non-clinical and non-operating. This 50% includes teaching, research, admin, supervising juniors, meetings, ARCPs, College commitments etc etc. 

So, to be a successful surgeon, one has to have operative, clinical and soft skills in equal measure. A surgeon is also a leader. A strong individual yet a good team player. Has to be decisive yet flexible. Must possess good communication skills. Must have good organisational skills. Should be able to teach. Should be able to train. Many many more traits...

A CT and ST programme aims to achieve some or all of the above qualities. The aim of this surgical education programme is not just to 'teach someone how to teach' but to provide a broad understanding of the soft skills and attributes required to become a successful surgical educator. We look forward to more interactions. Thank you.

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Sandeep Pillai
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Thank you, Claire, you did sum it up nicely!

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I completely agree with you in that 2nd paragraph where you say that being a surgeon is equally about making decisions on who to operate. I was well into my CT2 year when I had a conversation with one of my consultants about a difficult case/decision, and realised that probably the hardest thing to teach/learn in surgery, is to know when to make the decision to (not) operate. 

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Thanks Claire.

Couldn't agree more with your comment

"being a surgeon is equally about making the decisions about who to operate on and why (more in the elective setting than in trauma per se) but that not all patients would benefit from our interventions."

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Hi everyone, 

I have listened to Mr Jose, and it was very insightful as I really didn't have much idea about the history of surgery, and it was very interesting to actually know that it all started that early. Also, it was really interesting how the progression of training programmes in the UK has evolved and changed over the years and it actually really shows how difficult it is to try deliver training in best possible effective way. 

Answering your question on how my surgical training impacted me as a surgeon. In my experience as a surgeon, working in the UK has brought my attention many aspects to be honest. However, there are two main standing points for me personally I believe. One of them I've come to recognize that a surgeon's responsibilities extend far beyond the operating room as my colleagues mentioned in the discussion above. The role demands proficiency in numerous non-clinical areas, including teaching, audit, Quality Improvement Projects (QIPs), journal clubs, and participation in Multidisciplinary Team Meetings (MDTs). These aspects were an entirely new experience initially and it really takes years of practice and education as operating in order to be able to do these effectively   It is obvious that one cannot excel as a consultant without a profound understanding of these supplementary tasks.

Secondly, I have gained a deeper understanding of the psychological effect especially during surgical training can have. The demanding nature during training underscores the vital need for regular time off to relax and recharge. I think balancing the physical and emotional challenges of surgery is really important and cannot be overlooked.

 

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