Lifting the trophy!

The Scottish rugby union team need to be congratulated on winning the Calcutta Cup. The team entered the stadium with purpose and were clearly on a mission. To me, the most inspiring moment of the whole day was the captain, Stuart Hogg, standing back to allow the debutantes to lift the cup. That was the very definition of servant leadership and resonated with me. We need to enable our trainees to celebrate success and let them lift the trophy.

The most important to thing to ask as a trainer is ‘what am I doing today and how can I involve the trainee?’ It is the trainer’s responsibility to seek opportunities for development that is afforded and created by the working day. The role of the trainer is to lead and to serve.

I recall working for a very eminent surgeon who was lampooned by the student Christmas show for expecting ‘the world to revolve around me’. We all knew when we were asked to do some research and write a paper that he would always put his name as first author. Sometimes, we would get an acknowledgement in the paper but rarely authorship. This was not an act of Hogg but an act of hogging!

The learning process starts with recognition that engenders a sense of belonging and affirmation of identity. Recognition and celebration are then realised as the higher needs. 

Trainee safety and recognition are basic needs. Belonging and trust are the relatedness needs. Self-actualisation of the trainee comes through purpose and celebration of their valuable contribution to the team.

The trainer should invite and encourage participation in every clinical area by sign posting and signalling opportunities to learn and grow. Another trainer said to me that “his role was to sit on the buckboard with me and only take the reins when needed”. That must go hand in hand with recognition and celebration of effort.

Participation, belonging and celebration extend to the team that, as community of practice, need to share educational values that should include all members of staff in training. Since we are working to learn and learning to work and the nature of our business is vicarious, these principles apply to everyone all the time.

Purposeful and meaningful activity will only thrive in a culture of respect and trust. Much of what we learn is situational and experiential and thus very context defined. Learning in the workplace comes through participation. This really depends on how people feel. Language and behaviours count and set the scene and enable people to feel safe. It is important to allow the trainee to integrate and assume responsibly. Does the team inculcate a sense of belonging through respect for each other? Moreover, does the team celebrate success?

This philosophy extends to the whole organisation and the workplace culture. It is ironic that many organisations are called Teaching Hospital Trusts. The role of the organisation is stated in the name. Teaching affords development opportunities for the staff and enables them to grow. This is the intrinsic motivation factor that goes hand in hand with trust. Trust is also in many of our organisations’ titles – but do we really trust and value our staff?

The return on investment is obvious. A Chief Financial Officer once stated, “We cannot afford to train” but was appropriately challenged by Richard Branson who countered, “We cannot afford NOT to.” Learning is a work activity. Our organisations need to apply some education theory to the way they are structured and, more importantly, consider the role of education in their purpose. Happy staff make for happy patients. The Baptist Memorial Hospital in the USA reviewed their strategies and decided that the only strategy that counted was to ‘WOW’ the staff. Not many years after implementing what was considered a ground-breaking strategy, the organisation won the coveted Malcom Baldrige National Quality Award.

There needs to be a change in thinking at every level of medical education. Above all, it is a social construct that depends on relationships. The conditions should enable teaching by affording time and space. However, I believe we underestimate the informal and experiential learning that is happening all the time. The working day presents many opportunities to learn.

The Silver Scalpel Award for the best trainer of the land attests to the fact that good service and good training go hand in hand. There is no conflict. We do need the scaffolding and we do need to recognise that education and training is an imperative. #notrainingtodaynosurgeonstomorrow.

I believe it is a philosophy – just a way of thinking if you like. The Scottish Rugby captain demonstrated that in spades. It was instinctive and clearly was just a reflection of the way he thought. There was no hesitation in asking the debutantes to take the cup. Wouldn’t it be amazing if all leaders – trainers and CEO’s – thought the same way and shared the cup?

P.S. At the next match the same captain was asked to comment on a red card shown against one of the team for foul play. He did not BLAME the individual concerned. On the contrary, he reflected that it was the team responsibility and an area for learning. Perhaps this focus should be another Blog!?

If you have any questions or comments regarding this blog post or any previous posts please email fst@rcsed.ac.uk

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.