My thoughts on attributes have been stimulated by Rich Diviney, who is a retired Navy SEAL commander and the author of the book “The Attributes: 25 Hidden Drivers of Optimal Performance.” He explained in a recent webinar, held by Chapman & Co Leadership, that of almost two hundred entrants onto a Navy SEAL programme, usually only about forty, graduate successfully. The programme is designed to test the resolve and attributes of the candidates. They are invited to withdraw from the programme by ringing a bell. This all seems extreme but what they inculcate in their teams is a high level of trust that drives high performance, often in the most extreme circumstances.
The Navy SEAL selection programme appears to be survival of the fittest of mind, body, and soul. The extreme testing results in a natural attrition and selection. I reflect that this was in many ways akin to the traditional apprentice model of surgical training where the part one exam was a significant hurdle to enter ‘training’ and the appointment to a senior registrar level almost signified the end as it implied that it was almost certain that the candidate would get a consultant post.
Training has evolved for the better, but I believe that the attributes required of the trainee are the same and they are fabulously summarised by Rich Diviney. I sat through his webinar reflecting on my own experiences and what is needed today in surgical training. It is hard and as trainers we should be helping trainees through the programme by believing in them. We do not need a bell in the courtyard to ring to signify resignation, but I have concluded that we are asking the wrong questions of our training programmes. Perhaps we should turn it round. Imagine a training programme that respects the person but is explicit about the roles and responsibilities and offers comprehensive coaching and mentoring. I have only found one such program in twenty years of running the Silver Scalpel Award and the Leonardo da Vinci Award for Training Excellence for the European Society of Cardiothoracic Surgeons (EACTS). So, the question is ‘can you fail a trainee in a timely, constructive, fair, and transparent manner such the trainee thanks you for your career advice and guidance?’ The winner of the Leonardo da Vinci Award was able to do exactly that and produced letters from those trainees who were now phenomenally successful in other careers. The unit philosophy was founded on mentoring and support. We do not have to have trainees ringing a bell to leave a programme but by the same token we all need to be honest. I have seen many ‘trainees’ treading water and filling rotas to provide and sustain service - ‘rota fodder’. Furthermore, it is apparent and discussed behind closed doors and in the coffee breaks of some ARCP meetings that they are not going to reach consultant grade. Are we really being honest and transparent? Is this fair? Are we realising people’s potentials and guiding their careers or are we selfishly keeping quiet as it makes the job and our lives more comfortable and easier at every level?
I proffer my take on the attributes, described by Rich Diviney, whilst reflecting on my training and experience and observations as I feel they are very pertinent to the field of surgery. Attributes are elemental and how we show up. These inform behaviours. The trainer needs to be able to help the trainee realise these attributes. There is not a perfect recipe; we are all different and bring different and necessary skills to the table. It is also possible to have too much of one attribute and not enough of another, but role modelling, coaching, and mentoring will help get the best out of the trainee and yourself. The trainee and trainer attributes need to be complimentary. There are potential good matches and others that result in discourse. Matching of trainers and trainees has been considered but I do not believe we have enough information to find ‘eHarmony ‘at present but there is a thought!?
Grit has been described by Carol Dweck in her seminal work looking at children who succeed. It appears to be one of the most determining factors of achievement. She puts this in the same context as the phrase ‘growth mindset’. It is okay to fail and not succeed. We learn more from our failures than our successes and our ability to bounce back defines resilience. This is of course dependent on active reflection and feedback.
The good trainer can help by encouraging and mimicking reflection by revealing their own fallibility and willingness to learn from the trainee. It is important to acknowledge that it is okay to fail and create a safe place to fail. In doing so the trainer demonstrates courage in being confident in their own strengths and weakness.
The surgical career is demanding at all stages. It does require discipline, confidence, and initiative. It is important for both the trainer and the trainee to seize that day and make every day a training opportunity. I encourage all trainees at every level to ask themselves what value they are adding to add to their CV over the six-month period in the rotation. Sadly, many drift like kelp in the ebbs and flows of the programme tides. They may not have direction and need encouragement.
Drive can be reinforced with the establishment of a training contract. These attributes need to be mimicked by a trainer who is open-minded to other perspectives and ideas. The trainer needs to stand out for good reasons and be a role model. The best accolade to receive from a trainee is that they want to be like you. Narcissism can be taken the wrong way but years of running the Silver Scalpel award has highlighted the fact that the best trainers are, above everything else, humble.
We all work in what can be regarded as the ultimate service industry. We have the privilege of healing and caring for patients in the most holistic sense. Empathy and dedication to service is a selfless calling. We are often presented with acute situations that demand us to be considerate yet decisive in our actions.
Once the knife breaches the skin, we have entered a lifelong contract with our patient and the scar is our indelible signature. You may operate on many people in your lifetime and will not remember their names or faces. However, that patient will look at the scar and remember everything about their encounter with you for the rest of their lives: all words and actions included. We are, therefore, accountable and must be willing to be held to account. Surgery requires authenticity and accountability.
A surgeon does require mental acuity and needs to be vigilant. Situational awareness is paramount in theatre and has a direct impact on patient safety. Learning complex procedures like learning to play a piece of music can only be done in ‘chunks.’ The daily activity of the surgeon does require the ability to frequently switch focus. This can be very rapid in many clinical situations.
We have this preconception that teaching, and the delivery of our service are mutually exclusive. They are not. Good training and good service go hand in hand. Every day is a training opportunity. This requires the trainer to be resourceful and to be able to switch tasks. We need to abandon preconceptions; ‘because that is the way I have always done it round here’ stifles creativity. As individuals, teams, and organisations we need to abandon preconceptions.
Humility, integrity, and humour are shared attributes that are appreciated and valued by the whole team. These attributes are included in the Silver Scalpel Award. The trainer and the trainee are a team. These attributes need to be mirrored and role modelled every day.
As trainers we need to behave in a way that generates trust with listening, accountability, and empathy. Trust is a human emotion that generates belief and this needs to be justified. It is belief that engenders trust and is the first step to realising growth. Uncertainty and anxiety lead to fear. This drowns ability and has the potential to snuff out aspirations.
The attributes of the trainer need to mimic and enhance those of the training surgeon but above all the trainer need to be self-effacing, creative, authentic, humble and fallible. We all can recall our best teachers as they were the ones who inspired us and brought out the best in ourselves, by being themselves.
Nobody said it is easy. It is said that the ultimate of human knowledge is knowledge of yourself. How do your attributes measure up and can you, the trainer, and trainee alike, reflect on your own attributes as strengths and weaknesses?
To find out more about Rich Diviney’s work, please go to https://theattributes.com/
You can also take his Attributes Assessment which is a self-assessment tool that measures the essential components of Grit, Mental Acuity and Drive.
About the author:
David O'Regan is the Director of the Faculty of Surgical Trainers. He has been a Consultant adult Cardiac Surgeon in Leeds since 2001.
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