01 Jun 2019

Volume 7 Issue 2


From the Executive Editor

Words. In many respects I am not cut out to be an Editor, as a left-handed spatially based thinker I was always attracted to books with more pictures than words. However, this editorial role involves actually reading the words and that I find has its rewards; rather like revising for an exam and finding for the first time that the subject matter is genuinely interesting. The headline words on the front cover relating sport to surgery may lead the unwary to visualise a particular stereotype of a surgeon. The reality described in Richard Dodds’ article (page 26) guides us away from this assumption. To achieve expertise in sport or surgery requires effort as well as ability; and progress in each field is often the result of attention to detail and marginal gains.

Words can obscure or illuminate. Strangely, it sometimes seems that excellence is not our objective; we train, examine and practice to a level of competence. It is quoted to us in lectures that not everyone can be above average; this creates an image of a bland, mediocre profession. This belies the objective in our training and working which is to achieve a level of general professional excellence, this is highlighted in the Trainee section (page 46). We expect more of ourselves as each year passes, just as in sport today’s average is yesterday’s excellent. Phil Turner in his President’s notes (page 5) speaks of ‘Core values’ and the how the BOA and others are involved in setting and advancing standards. He then cautions that individual pressures may ensue and that we have then to be prepared to honour the second half of the Association’s mission ‘Supporting Surgeons’. The sporting analogy now becomes rather stretched; this is not just a game.

Words can conjure a reality and ‘What if’ scenarios are common in teaching. In a practical specialty simulation is now becoming more sophisticated and Duncan Tennant in the first in a series on simulation (page 43) explores how this should benefit both patient and surgeon.

Caring for patients, supporting surgeons are words that are easy to say, and indeed define our job. What is more impressive is when they are played out not for direct reward but when it is just the right thing to do. The specialty section on the involvement of UK Orthopaedics abroad describes this (page 50). Whilst providing direct individual patient care has its appeal and benefits, it is the considered contribution to the development and maintenance of a system of training others to deliver that care which has the greater potential.

When we mix surgery with the law, words are not just describing the issues, they are often the very essence of the issue itself. They are tools we must learn to use. The medicolegal section (page 38) is a reminder that effective communication is based on clarity, lack of ambiguity and consistency. That communication then needs to be recorded. The initial action and its record not only define the caring clinical interaction but are also key to ensuring fair consideration if there should be later problems. We must care for ourselves to best support patients.


Bob Handley, Vice President Elect



Subspecialty Section



Striving for excellence in surgical training: Reassessing the Trainee-Trainer relationship

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  3. Excellence by Design: Standards for postgraduate medical curricula. GMC. 2017.
  4. Improving Surgical Training. RCS England. 2015.
  5. Greenaway A. Shape of Training. 2013.
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Medical Student Learning in the Orthopaedic Operating Theatre: Educational Strategies for Surgeons

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  4. Musselman LJ, MacRae HM, Reznick RK, Lingard LA. 'You learn better under the gun': intimidation and harassment in surgical education. Med Educ. 2005;39(9):926-34.
  5. Randall S. The medical student in theatre--help or hazard? NATNews. 1991;28(2):13-4.
  6. Goldacre MJ, Turner G, Lambert TW. Variation by medical school in career choices of UK graduates of 1999 and 2000. Med Educ. 2004;38(3):249-58.
  7. Hexter AT, O'Dowd-Booth C, Hunter A. Factors that influence medical student learning in the operating room. Med Teach. 2018:1-6.
  8. Arraez-Aybar LA, Castano-Collado G, Casado-Morales MI. Dissection as a modulator of emotional attitudes and reactions of future health professionals. Med Educ. 2008;42(6):563-71.
  9. Stone JP, Charette JH, McPhalen DF, Temple-Oberle C. Under the knife: medical student perceptions of intimidation and mistreatment. J Surg Educ. 2015;72(4):749-53.
  10. Lyon P. A model of teaching and learning in the operating theatre. Med Educ. 2004;38(12):1278-87.
  11. Bowrey DJ, Kidd JM. How Do Early Emotional Experiences in the Operating Theatre Influence Medical Student Learning in This Environment? Teaching and Learning in Medicine. 2014;26(2):113-20.
  12. Fernando N, McAdam T, Cleland J, Yule S, McKenzie H, Youngson G. How can we prepare medical students for theatre-based learning? Med Educ. 2007;41(10):968-74.
  13. Ravindra P, Fitzgerald JE, Bhangu A, Maxwell-Armstrong CA. Quantifying factors influencing operating theater teaching, participation, and learning opportunities for medical students in surgery. J Surg Educ. 2013;70(4):495-501.
  14. Zundel S, Wolf I, Christen HJ, Huwendiek S. What supports students' education in the operating room? A focus group study including students' and surgeons' views. Am J Surg. 2015;210(5):951-9.
  15. Irani JL, Greenberg JA, Blanco MA, Greenberg CC, Ashley S, Lipsitz SR, et al. Educational value of the operating room experience during a core surgical clerkship. The American Journal of Surgery. 2010;200(1):167-72.
  16. Fernando N, McAdam T, Youngson G, McKenzie H, Cleland J, Yule S. Undergraduate medical students' perceptions and expectations of theatre-based learning: How can we improve the student learning experience? The Surgeon. 2007;5(5):271-4.
  17. Karani R, Fromme HB, Cayea D, Muller D, Schwartz A, Harris IB. How medical students learn from residents in the workplace: a qualitative study. Academic medicine : journal of the Association of American Medical Colleges. 2014;89(3):490-6.
  18. Martin TG, Clarke DR, Bowrey DJ. Medical students in theatre: setting the scene. Med Teach. 2012;34(4):337.
  19. Peyre SE, Peyre CG, Sullivan ME, Towfigh S. A surgical skills elective can improve student confidence prior to internship. The Journal of surgical research. 2006;133(1):11-5.
  20. Paige JT, Garbee DD, Kozmenko V, Yu Q, Kozmenko L, Yang T, et al. Getting a head start: High-fidelity, simulation-based operating room team training of interprofessional students. Journal of the American College of Surgeons. 2014;218(1):140-9.