Why is Surgical Training so Brutalising?
Surgical training is learning how to be abused. Registrar's are treated like subhumans.
Often they are treated to such conflicting advice as:
"In my day we didn't get trained like you guys do. We just had to learn from our mistakes"
"I did hundreds of hours more of operating than you - how on earth are you going to be experienced enough?"
So what do they want? Hundreds of training cases or thousands of non-training cases? I would suggest that like in sport, a few hours with an appropriate trainer unleashes far more than many hours with an inappropriate trainer.
As one of my excellent trainers has said to me (and he learnt it from his golf pro):
"What does practice make?
Perfect Practice Makes Perfect!"
So why do we persist in making surgical registrars run the gauntlet? Long hours, aggressive trainers, service provision in clinics and lists, administration duties and a wish to break them down? Is this a plan to make the infantry better?. Except with (in theory) the brightest and best?
Now some places have moved into the 21st century with supported training, gradually increasing responsibility and appropriate compensatory rest.
It is inevitable that trainees do more and more as the time goes on, but there has to be give and take - the boss still needs to supervise, and maybe take on more of the admin duties so that the clinical aspects can be taken care of. This is done by the very best trainers and trainees in tandem. They understand that time has moved on and that medical expertise is far more in depth in certain areas, and what they were taught is often no longer of interest or importance. Instead of one option we now have 10 or 15 to know and understand. Intensity of work is far higher with huge levels of oversight and reporting of outcomes. There are no dark little corners anymore.
So where does that leave us then? With hundreds of type A personalities that have ground their way through to be at the top, training a cohort of people who have morphed from pure type A to a more relaxed (but still intense) generation. This is a generation where work does not equal life. Where family is important. A generation who realise that they have to work until their 70s, and yet will still be poorer than their parents. A generation where nothing is certain or triple locked.
The balancing will happen, but it will take time, and there will be significant wastage of excellent trainees who are not willing to put up the abuse and mundane. The ones who will trade long hours and no recognition for high salaries, happy lifestyles and stress due to poor sales not dying patients.
One day we will look back and wonder if we could have seen it coming. We could and we did. No one was listening to the canaries.