The view from here
Cutting edge: teaching future surgeons Sarah Al-Himdani and Lopa Patel, Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, UK
A
s junior trainees aspiring to be the consultant surgeons of the future, we are well aware of the challenges in balancing the demands of service provision with high-quality training in order to develop sound competence levels. Both the European Working Time Directive, which limits doctors to a maximum 48-hour working week, and the changing landscape of the National Health Service in the UK have meant less time in theatre for teaching and training. Sir John Temple, chair of Medical Education England, undertook an independent review to assess the impact of the 48-hour week on training. His subsequent report echoed our thoughts perfectly, stating that junior trainees are being compelled into service delivery, with the likelihood that training and education will suffer as a consequence.1
The future, however, is bright. Health Education England, an organisation responsible for education and training in the health sector, have responded with the national ‘Better Training – Better Care’ initiatives.2 These strive to provide greater supervision for trainees, improve service delivery, to support training, and maximise training during work hours. A tall order you say? In our experience, the consultantsupervised, trainee-led operating initiative at the University Hospital of South Manchester has delivered just that. Throughout the academic year of 2012/13 we have been privileged to be part of this novel teaching initiative. Each month approximately four such lists were being conducted in surgical specialties. We experienced two lists a month in breast and plastic surgery, including
excisions of cutaneous lesions and mastectomies. The most beneficial aspect of this initiative from our perspective was the opportunity to follow patients through their entire journey from pre-operative assessment to discharge post-procedure (Figure 1). This allowed us to not only provide continuity of care for patients but also to continually learn throughout the entire process.
We are well aware of the challenges in balancing the demands of service provision with high-quality training
Further benefits of these lists included gaining multidisciplinary teamworking skills, learning to lead theatre lists and practising safe surgery via thorough team briefs. Additionally, having protected, one-to-one consultant supervision for key index procedures, and having opportunities to complete formal work-based assessments, as proof of competencies, made the experience even more worthwhile.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 397–398 397
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Initiatives such as these may be the key to training the next generation of surgeons
the combination with simulation sessions for further familiarisation of surgical techniques would make this initiative even more compelling.
1. Preop 8. Discharge
2. WHO checklist
Trainee Input
7. Postop care
3. Scrub & Prep
4. Operate
6. Recovery 5. Opnote
Figure 1. Stages of the surgical pathway for trainees involved in the ‘Better Training, Better Care’ scheme
In practice, protected teaching is hard to come by; therefore, to have all these opportunities provided is almost too good to be true. We suggest
Reflecting on our journey as trainees over this year is insightful. It feels like we have grown to become better, more competent and confident trainees at a pace much faster than we would have without this teaching incentive. And whereas we were initially sceptical of the initiative, we are now true enthusiasts. Perhaps the most optimistic message we come away with from our experience is that despite drastic changes in our working environment,
training is also changing at perhaps an even faster pace. We remain equally eager to learn in less time, and initiatives such as these may be the key to training the next generation of surgeons. REFERENCES 1.
Temple J. Time for training: a review of the impact of the European Working Time Directive on the quality of training. May 2010. Available at http://www.mee.nhs. uk/PDF/14274%20Bookmark%20 Web%20Version.pdf. Accessed on 18 August 2013.
2.
NHS Health Education England. Better training Better Care. Available at http://hee.nhs.uk/ work-programmes/btbc. Accessed on 18 August 2013.
Corresponding author’s contact details: Sarah Al-Himdani, Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, Southmoor Road, Manchester, M23 9LT, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None to declare. Ethical approval: Not required. doi: 10.1111/tct.12152
398 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 397–398
tct_12152.indd 398
7/7/2014 8:18:59 PM
Cutting edge: teaching future surgeons Sarah Al-Himdani and Lopa Patel, Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, UK
A
s junior trainees aspiring to be the consultant surgeons of the future, we are well aware of the challenges in balancing the demands of service provision with high-quality training in order to develop sound competence levels. Both the European Working Time Directive, which limits doctors to a maximum 48-hour working week, and the changing landscape of the National Health Service in the UK have meant less time in theatre for teaching and training. Sir John Temple, chair of Medical Education England, undertook an independent review to assess the impact of the 48-hour week on training. His subsequent report echoed our thoughts perfectly, stating that junior trainees are being compelled into service delivery, with the likelihood that training and education will suffer as a consequence.1
The future, however, is bright. Health Education England, an organisation responsible for education and training in the health sector, have responded with the national ‘Better Training – Better Care’ initiatives.2 These strive to provide greater supervision for trainees, improve service delivery, to support training, and maximise training during work hours. A tall order you say? In our experience, the consultantsupervised, trainee-led operating initiative at the University Hospital of South Manchester has delivered just that. Throughout the academic year of 2012/13 we have been privileged to be part of this novel teaching initiative. Each month approximately four such lists were being conducted in surgical specialties. We experienced two lists a month in breast and plastic surgery, including
excisions of cutaneous lesions and mastectomies. The most beneficial aspect of this initiative from our perspective was the opportunity to follow patients through their entire journey from pre-operative assessment to discharge post-procedure (Figure 1). This allowed us to not only provide continuity of care for patients but also to continually learn throughout the entire process.
We are well aware of the challenges in balancing the demands of service provision with high-quality training
Further benefits of these lists included gaining multidisciplinary teamworking skills, learning to lead theatre lists and practising safe surgery via thorough team briefs. Additionally, having protected, one-to-one consultant supervision for key index procedures, and having opportunities to complete formal work-based assessments, as proof of competencies, made the experience even more worthwhile.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 397–398 397
tct_12152.indd 397
7/7/2014 8:18:57 PM
Initiatives such as these may be the key to training the next generation of surgeons
the combination with simulation sessions for further familiarisation of surgical techniques would make this initiative even more compelling.
1. Preop 8. Discharge
2. WHO checklist
Trainee Input
7. Postop care
3. Scrub & Prep
4. Operate
6. Recovery 5. Opnote
Figure 1. Stages of the surgical pathway for trainees involved in the ‘Better Training, Better Care’ scheme
In practice, protected teaching is hard to come by; therefore, to have all these opportunities provided is almost too good to be true. We suggest
Reflecting on our journey as trainees over this year is insightful. It feels like we have grown to become better, more competent and confident trainees at a pace much faster than we would have without this teaching incentive. And whereas we were initially sceptical of the initiative, we are now true enthusiasts. Perhaps the most optimistic message we come away with from our experience is that despite drastic changes in our working environment,
training is also changing at perhaps an even faster pace. We remain equally eager to learn in less time, and initiatives such as these may be the key to training the next generation of surgeons. REFERENCES 1.
Temple J. Time for training: a review of the impact of the European Working Time Directive on the quality of training. May 2010. Available at http://www.mee.nhs. uk/PDF/14274%20Bookmark%20 Web%20Version.pdf. Accessed on 18 August 2013.
2.
NHS Health Education England. Better training Better Care. Available at http://hee.nhs.uk/ work-programmes/btbc. Accessed on 18 August 2013.
Corresponding author’s contact details: Sarah Al-Himdani, Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, Southmoor Road, Manchester, M23 9LT, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None to declare. Ethical approval: Not required. doi: 10.1111/tct.12152
398 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 397–398
tct_12152.indd 398
7/7/2014 8:18:59 PM
