The Surgical Trainer

Abstract

The ‘no training today, no surgeons tomorrow’ campaign on social media has been a rallying call for all surgeons worldwide to prioritize training as part of the COVID-19 pandemic recovery process. The campaign calls for all trainers to treat every case as a training opportunity. However, this raises some important questions. Who are the surgical trainers responsible for these changes? Are modern surgical trainers defined by a role within their department? How can such contributions to training be recognized? These questions are discussed within this perspectives article, including the need for the professionalization of the trainer role and how contributions to training can be formalized and supported within departments and at a national or international level.

Background and Discussion

The ‘no training today, no surgeons tomorrow’ campaign on social media has been a rallying call for all surgeons to prioritize training as part of the COVID-19 pandemic recovery process.¹

The temporary cessation or reduction in diagnostic services, outpatient clinics and elective operating during the pandemic has resulted in a surgical backlog that exists across the world, not only in the United Kingdom (UK) where the authors practice clinically. Surgical trainees in the UK, have experienced a significant loss of operative experience due to the pandemic as hospitals have focused on streamlining consultant-led clinical services to meet the sudden increased demand for healthcare and elective operating.¹ Training, however, cannot be allowed to take a backseat, despite increasing service delivery requirements if we are to maintain a safe and effective surgical workforce.

There is an increasing need for consultant surgeons globally, and subsequently, there is little interest in increasing the duration of surgical training despite reduced training opportunities over the last 2 years. In addition, the introduction of punitive pension taxes in the UK is resulting in many senior consultants retiring earlier than expected, potentially reducing training and mentorship opportunities for early-career surgeons.² This loss of a generation of experience includes a large volume of competency and failure, culminating in tips and tricks that could be helpful to the next generation. The social media campaign ‘no training today, no surgeons tomorrow’ led by the UK Joint Committee for Surgical Training (JCST) calls for all trainers to treat every case as a training opportunity and encourages an open dialogue between trainer and trainee to enable the development of learning objectives for all clinical encounters in an effort to make up for the reduction in operating during the pandemic.¹ Only through the prioritization of training will the profession continue to meet the increasing demand for safe and suitably qualified consultant surgeons.

This raises some key questions. Who are the surgical trainers that this campaign refers to? Is it the Departmental Professor of Surgery, the Training Program Director, the nominated Educational or Clinical Supervisor or the consultant on the shop floor? What defines the modern surgical trainer?

In 2016, the UK medical regulatory body, the General Medical Council (GMC) created a generalized system of approval for trainers in secondary care using a framework devised by the Academy of Medical Educators (AoME) to represent the vital domains of training and education.³ The Faculty of Surgical Trainers (FST) of the Royal College of Surgeons of Edinburgh adapted this framework to create a surgery-specific system of trainer approval.⁴ This set of standards enables clinicians to obtain recognition for their contributions to surgical training mapped to the AoME domains (as shown in Table 1 ), which is formally recognized by Membership or Fellowship of the FST and complies with the GMC trainer approval process. The FST standards recognize clinicians of all levels that act as surgical trainers, and all surgeons are encouraged to apply for formal recognition by the FST.⁵

TABLE 1.

The Seven Domains Comprising Standards for Surgical Trainers Framework

Standards for Surgical Trainers Framework Areas
1	Ensuring safe and effective patient care through training
2	Establishing and maintaining an environment for learning
3	Teaching and facilitating learning
4	Enhancing learning through assessment
5	Supporting and monitoring educational progress
6	Guiding personal and professional development
7	Continuing professional development as an educator

The need to understand educational theory is becoming a desirable attribute of a trainer but should it become a requirement? Pursuit of a higher degree in education is often done out of hours but should it be incorporated into undergraduate and postgraduate training to prepare clinicians for this role early in their career?

While training is pivotal to the role of a surgeon, many colleagues may overlook their contributions to training and surgical education. These contributions are often made on ward rounds, in theatre, clinic, and formal teaching responsibilities, research and leadership roles. Often this knowledge exchange is a lot more informal, e.g., over a cup of coffee and more frequently spills over into clinician's personal time, i.e., out of hours. This is an insidious creep on work-life balance for both parties and should be formally recognized.

The quality of surgical training directly impacts the quality of surgical care and patient education.⁴ Our experience with the Silver Awards of the Association of Surgeons in Training (ASIT) highlights that the education of the patient and the trainee goes hand in hand. Good service equates to good training. There is no tension or conflict. We believe that this is a philosophy that underpins ‘the way things are done around here’ in the units of the Silver Scalpel Award Winners. Is this nature or nurture? Perhaps both, but good practice can be learned and taught. What is needed is for the system to celebrate and recognize good training at every level. Individual organizations must recognize and prioritize individuals’ commitment to surgical training if they are to achieve their quality of care and patient satisfaction goals. The professionalization of training by formalizing this commitment with recognition by the GMC and membership of the FST enables organizations to recognize this work. However, we note that this commitment is more than the current allocation of time in the average job plan. The next vital step is for this commitment to be facilitated and rewarded by the appropriate allocation of time and remuneration.

The modern surgical trainer may no longer be defined by formal training positions within academic institutions, i.e., Professor of surgery, but should be determined by their contributions, behavior, and commitment to the development of the next generation of surgeons. All surgeons can be trainers if they wish and have the opportunity to make a significant impact on the training, education, and development of junior colleagues. The authors hope that recognition of clinicians’ contributions to training and measures of trainee success will soon be formally recognized by institutions, akin to the recognition currently given to academic clinicians by universities that measure the impact of grants and publications. We question the current lack of emphasis placed on training and the bias of academic measures of success. Where and when have we lost the focus on education, which is an obvious investment in the future of healthcare? Do we now need Professors of Surgical Education to promulgate education theory and practice for the benefit of the trainee and the wider team? The FST endorses the need for educationally trained surgeons, and they are in partnership with the Masters in Surgical Education offered by Imperial College, London which aims to facilitate this training.

Awards such as the Silver Scalpel, Silver Suture, and Silver Scissor awards have been created by ASiT, and supported by the FST, to recognize the outstanding contributions to surgical training by surgeons of all levels, from early-career trainees to consultant surgeons.⁶ Trainers are nominated for these awards by trainees who are best placed to identify a good trainer. What appears to define an exceptional trainer in these nominations is a shared ethos of mutual respect between trainee and trainer. Trainees celebrate when ‘trainers believe in them and make the best of the individual within’. The development of such a relationship enables trainers to educate, coach and mentor their colleagues, creating a safe, inclusive, nurturing environment for trainees to develop their knowledge, skills, and clinical practice. Developing this relationship with trainees is a conscious investment in the future of surgery and appears vital to providing outstanding training.

The FST hope that the creation of training standards will help organizations to recognize, value and reward their trainers, as well as encourage clinicians to reflect on the contributions they already make to training their colleagues and whether anything more can be done to help develop and improve the training of tomorrow's surgeons. After all, #notrainingtodaynosurgeonstomorrow.

AUTHORS' CONTRIBUTORSHIP

RE wrote the first draft of the manuscript. RE, PAB, AWP and DOR were all involved in the manuscript editing process and all approved the final version for publication.

CONFLICTS OF INTEREST

All authors are affiliated with the and are Members or Fellows of the Faculty of Surgical Trainers. RE was the Silver Suture Winner 2022, PAB was the Silver Scalpel Winner 2022, AWP was a Silver Scalpel Finalist 2022 and DOR is the immediate Past FST Director, and founder of the Silver Scalpel Award in 2001. There is no financial incentive or gain for any author as a result of this publication.