We Need To Recognise The Surgical Trainer

An article by Professor Sir Bruce Keogh

Foreword by David J O'Regan, Director of The Faculty of Surgical Trainers (FST) and Lolade Giwa, President of the Association of Surgeons in Training (ASiT)

All training doctors need to be applauded for their response to the COVID-19 crisis. We acknowledge the impact on surgical training and the concerns expressed about the lack of-hands on training opportunities. Many are worried that the burden of reducing the waiting-time backlog for elective surgical procedures and the need for service provision will eclipse the need to train. We all acknowledge #notrainingtodaynosurgeonstomorrow and we echo Professor Keogh’s concerns. 

Sadly, the system in general does not recognise the importance of a good teacher. Glen Burley, Chief Executive of the Wye Valley NHS Foundation Group (FST Blog 30 September 2020) was the first Chief Executive Officer to publicly recognise the value of an excellent surgical trainer following the award made to a general surgeon within his trust. Mr Edmund Leung, a general surgeon at Hereford County Hospital was the worthy winner of the Silver Scalpel Award in 2019, proudly acknowledged by Mr Burley as he shared ‘…we were all delighted that Edmund Leung received the recognition that he deserved, and we were all happy to bask a little in the glory. Herefordshire is a little off the beaten track from an NHS perspective, but in the Trust, we have a great culture and some real pockets of excellence to be proud of.  Being welcomed, supported, and feeling part of a team are experiences which hopefully lead trainees to return to be our consultants of the future.  A teaching culture is a learning culture, and this brings with it, innovation and service improvement which benefits our patients.’ 

The finalists for the Silver Scalpel Award 2021 demonstrated that despite COVID-19 restrictions, they were able to deliver outstanding teaching that went hand in hand with good service.

There is an obvious return on the investment. It is a win-win situation all round starting with the patient, but also for the trainee, the trainer, and the organisation. 

It is a philosophy that starts with the trainer – The Association of Surgeons in Training (ASiT) celebrates the trainer through the Silver Scalpel Award. The Faculty of Surgical Trainers (FST) is committed to training excellence and offers post nominals to trainers who meet the FST framework of standards of training that are accepted by the General Medical Council. We can identify good trainers up and down the land and in every specialty. Together, FST and ASiT are identifying the future surgical educators through the Silver Suture Award that recognises the best trainee trainers. 

The Faculty of Surgical Trainers offers the opportunity for the surgical educator to develop themselves through the ISCP trainer feedback tool and now provides an opportunity for the surgical trainer to develop their theoretical knowledge through our recent collaboration with Imperial College London’s, Masters in Surgical Education program.

ASiT and FST ask the system to acknowledge the ‘professional educator’ who is every bit as important as the ‘academic surgeon’. As we think about the COVID-19 recovery, we ask that you join us in our efforts to encourage the system to celebrate the good surgical trainer and put them at the heart of the recovery. The patients and trainees of today and tomorrow deserve that we stand up for our trainers.

We Need To Recognise The Surgical Trainer 

Reflection from Professor Sir Bruce Keogh

“Surgery is difficult. The training is tough. Becoming a surgeon is a long intellectual and technical apprenticeship down a well-trodden, erratic path of aspiration, elation, introspection, and self-doubt which can be emotionally taxing. Whilst the acquisition of technical competence is vitally important, it is not enough on its own. A well-rounded surgeon will be characterised by a subtle blend of confidence and humility, with well-honed clinical judgement based on up-to-date knowledge and the ability to learn from the good and the bad. In La Philosophie de la Chirurgie, the French vascular surgeon Henri Leriche made the observation that, “every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures”. The reflective learning never ends and is the basis for the public’s trust. The building blocks of surgical training are also the foundations of future surgical excellence in the NHS. 

There is evidence that organisations that take research seriously have better clinical outcomes because research brings focus, smart minds, and money into the organisation. In contradistinction, there is a common perception that surgical training is an institutional burden of necessity - surgeons must be trained but the price is reduced theatre efficiency and additional complications leading to a longer postoperative stay. However, there is a counterargument that a smarter, more structured focus on training with a greater emphasis on mentored preoperative assessment, coupled with supervised and targeted technical competency development will accelerate the development of young surgeons which will translate into improved clinical outcomes and efficiency. 

We are now emerging from the heat of the pandemic with a massive surgical backlog and young trainees eager to catch up on lost operative experience. My worry is that in the scramble to tackle surgical backlogs, training will be sacrificed on the altar of efficiency. This will dishearten talented young professionals and risks a longer-term impact on the quality of surgery in coming years. But this is not inevitable. 

Over the last decade I have had the privilege of judging the winner of the Silver Scalpel Award on behalf of the Association of Surgeons in Training. The finalists have all been dedicated, innovative role models. There may be merit in marshalling their expertise to consider how surgical training could help NHS recovery rather than fall victim to it. 

Now is a reset moment – a unique opportunity to consider how a different approach to surgical training could part of the solution as we endeavor to expand NHS capacity.”

Professor Sir Bruce Keogh KBE, FMedSci

Chairman

Birmingham Women’s and Children’s NHS Foundation Trust

Steelhouse Lane

Birmingham B4 6NH