The relationship between the trainer and trainee is founded on trust in that we are in it together and share the same purpose. Traditionally and colloquially people often cite that trust needs to be earned i.e. you do the right things and I will trust you and ‘do right by you’?
The training system is designed to assess COMPETENCY and CONSISTENCY with a combination of formative and summative assessment throughout a trainee’s tenure. This is translated at APRCP into a decision that determines if someone has met the standard and at the right stage to advance – the numerical score of four equates to a failure and a one a pass. It goes a long way to dehumanise the individual and ignore their needs. I have witnessed trainees in leave ARCP meetings totally deflated as they have been berated because they could not do a bottom end coronary anastomosis in under ten minutes. I fear that we may be complicit in systemising the individual and blunting their performance.
The process itself reinforces a tick box approach to learning and a satisfactory will do. We often interpret this as okay, but the Oxford English dictionary requires ‘fulfilling the conditions of or meeting the requirements or’: Many will tick a box for okay and few will take the time to determine if the role or task fulfils the requirements of training. This is very much a transactional relationship. It is very unilateral and requires the trainee to fulfil those conditions to earn the trust of the trainer and the system. The fulfilment of this transaction condescneds the right of passage to the next step.
Trust however should include CHARACTER and COMPASSION. Trust exemplified in character is open and honest and true to their word – the key value prized among many is integrity. Does the individual walk the talk, and seek and respect other opinions? Do they listen in the present? Are they able to walk in other shoes and do they show empathy? Does character respect the person and can they demonstrate compassion and empathy? This relationship now becomes transformative. Trust is no longer learned but it is generative. This demands of both the trainer and trainee as it becomes restorative and empowering. It requires effort and the commitment of both the trainer and trainee to self-develop. Happy trainers make for happy trainees and vice versa.
Confidence comes from not being afraid to make a mistake – this is the psychological safety. Training should happen in the intersection of confidence and competence. This is the nurture and is often cited in the nominations for the Silver Scalpel Award.
Surgeons are often nervous about addressing perceived failing trainees for fear of recrimination and slurs. This fear can be mitigated by understanding that the competency and consistency of trust can be agreed in a job plan – What does trainee want from the job and what can the trainer offer you? The competency and consistency are defined in the role; this applies to both parties. Any observations that are not complimentary or reinforcing should be specific and related to the role as defined and agreed in a job plan. The person – individual, identity, opinions and values – must be respected and acknowledged. This does not mean that these subjects are taboo, but they are addressed through appreciative enquiry and a commitment of both the trainer and trainee to better themselves. Modern coaching tools and 360 forms are invaluable to this development process, provided they are done with a generosity of spirit and a willingness to listen and learn. The Faculty of Surgical Trainers encourages the development of all trainers – training is more about the trainers than the trainees.
Trust requires courage – courage to let go and be yourself without all the accoutrements of status or the prized nominal-alphabet-suffix-collections of capital letters showcasing professional qualification and status. The latter is meaningless without authenticity. We invite all our trainers to be themselves; be you and believe in your trainees.
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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