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'Per ardua...'Training tomorrow's surgeons using inter alia lessons from aviation

2006; SAGE Publishing; Volume: 99; Issue: 11 Linguagem: Inglês

10.1258/jrsm.99.11.554

1758-1095

Courtney Jackson, K. P. Gibbin,

Innovations in Medical Education

It is incumbent on today's surgeons to produce the next generation of well-trained and qualified surgeons. There are many aspects to becoming a surgeon (or becoming a ‘better’ surgeon). First, there are the intellectual aspects, the learning of anatomy, physiology and the like. Then there are the practical skills, the manual dexterity, and the tissue handling skills. Additional aspects include leadership, good decision-making, judgement and good communication skills. Whilst some of these abilities are innate in a trainee, many must also be taught and all will need to be assessed. Generations of surgeons have learnt largely as an apprentice. As this model has been effective, why change it? There is a dramatic reduction in operating exposure amongst current trainees as compared with their predecessors, who were trained as Registrar and then Senior Registrar. This has arisen from the Calman review of training in the recent past. Hours of work and length of training will be further shortened by the implementation of both the European Working Time Directive1 and the introduction of the ‘Modernising Medical Careers’ programme.2 All surgical specialties are being required to reduce the overall indicative length of training, but with assessment of that training against a background of required competencies. Additionally, whilst the majority of surgeons are of a high calibre, a few still conform to old stereotypes of poor communicators—or, worse, lack technical skills. Particularly in today's litigious society, neither is acceptable. Training must encompass all aspects of becoming a surgeon and failing trainees must be identified and supported, or even directed to alternative careers. With these factors in mind it is important to assess how to improve on the current training in order to obviate the effects of the reduction in the time available for it. Authors have often looked to other industries, particularly the aviation industry, for parallels that can be applied. We can also take examples of best practice from other countries. This article aims to draw on both arenas to discuss training methods and risk management in surgery.