What we have learnt from junior doctors: an allegory on youth
By Yusuf Michla and Caroline Hing
As teachers and supervisors, we are often reminded of how best to teach and what makes a great mentor, but we forget that the flow of knowledge works in both directions. What keeps us in the NHS, if it is not the joy of working with people and continuous learning. While as consultants we tend to find our job and stay there, an endless stream of younger colleagues flows through, with enthusiasm, endless questions and their own take on things.
So what have we learnt…
Everyone has demands on their time, from family in all its myriad forms and generations, to quirky hobbies and interests. I’ve learnt about Indian music and received an amazing cookery book I still refer to from a past trainee. Many an operating list was spent discussing food and the wonders of India.
I’ve heard about new places to travel too – now on the list is Beirut and Lebanon, as well as Israel. Conversations around world politics often follow those on food, as we seek to understand how history and borders have shaped politics and viewpoints. More places to add to the list – trying to understand roots and travel, how people have journeyed to the UK for work, with some deciding to stay and others just passing through, on to another adventure.
Sports and recreations often feature. Yes, the usual about who won the football, but also conversations around where best to ski in northern Norway and how best to disappear off-grid into the wilderness. Tips on gear and clothing, sites to see and places to go.
“But Mr/Miss So-and-so does it this way.” Infuriating at first glance, then curiosity gets the better of me, and I want to know what they do and how is it better/worse than what I do. Always good to be challenged, makes us re-think what we do. Like bees, trainees come with ideas to ‘cross-pollinate’ before moving on with some of mine to new pastures.
Different shapes and sizes
Learning to work with different people: the burly Irishman (physically tough) or the petite Vietnamese trainee from New Zealand (mentally tough) – both so different with dissimilar training needs. Admiration for how people will jump into the unknown and leave their country to improve their job prospects. Learning about different healthcare systems reminds us that the good old NHS isn’t so bad after all.
I think I can honestly say that one of the most rewarding experiences I’ve had when it comes to training a variety of trainees, is the reward for the effort of tailoring my timetable to suit LTFT (less than full time) trainees who have worked with me and for them to be able to squeeze as much out of training with me as they possibly could.
There is nothing better than encouraging a medical student to ‘scrub in’ for their first operation, then giving them things to hold and cut so they are a part of the team from start to finish. The reward, a young person with a massive grin on their face telling you ‘that was awesome’. It reminds you that the job is ‘fun’ and actually the instruments are indeed pretty ‘cool’.
Where to next
Often after spending time with a trainee, you feel invested in their future and wonder where they will ‘end up’. How nice it is to bump into them at conferences years later and find they have succeeded, and are happy in job and life.
Even though having previous trainees come back to work alongside you as a consultant makes you feel about 300 years old, there is a palpable feeling of pride I get, knowing that I contributed in some small part in making this colleague as excellent as they are. (A very small part sometimes…)
How to make a ‘leap of faith’
Training a colleague in the art of surgery takes something of a ‘leap of faith’. Occasionally, the situation arises that the case being undertaken has a step that absolutely must be done with precision. Otherwise, like a house of cards, the rest of the case will fall around the imprecision. As senior surgeons, we have been through the process and at some stage, our trainers must have had the faith in us that they had let us undertake that step. It is not always obvious to us as consultants that they did this, but they must have done and so there have been times where I have found myself giving the specialty trainee the space and time to complete such a step.
I’d never appreciated how difficult that trust can be to have, but it can be. Different trainers take a different approach to this and in my career, I have seen trainers take a variety of approaches – all the way from not being in the theatre complex while this step is being taken, to standing over the surgeon’s shoulder, ready with advice (whether it’s wanted or not).
As a trainer, I am very appreciative of these moments. I always ask the trainees after the case how they felt taking that step. Some realise how key it was, others not. My approach is usually one of making sure the trainee is comfortable with what I’m asking them to do and then pacing the theatre corridor like an expectant father, eager for some feedback from the theatre.
A drive to ‘stay relevant’
One of the great joys of surgery is the variety of ways there are to approach the same problem. Five minutes in any trauma meeting will tell you that not only is this intellectual clash of heads alive and well, but is absolutely necessary. Research thrives on giving us a view as to why one treatment is better than another and a contrary position can almost always be justified by another paper.
Similarly, one of the great joys of training colleagues is that they often come to you with ideas and approaches to treatment that have been formed – not just by reading current literature, but by having witnessed treatment by colleagues with similar interests, in not just in the local area, but sometimes from around the globe.
This spread of ideas is wonderful and often leads to the question “Why do you do that like that? I’ve seen it done like this before…” The discussion that follows is one of the true benefits of training junior colleagues. Not only does it mean that you have to be able to convey your approach to the problem in a way that’s logical and compelling, but it also fuels a drive in the trainer to ensure that the approach we’re taking tallies with current thinking and research. It also reassures us that there is still ‘more than one way to skin a cat’.
The crock of gold at the end of the training experience rainbow
It doesn’t happen often. I can only think of a few instances where I’ve experienced it, but when it happens, it’s a thing of beauty…
The process of filling in workplace-based assessments (WBAs) is an onerous one to both trainees and trainers. There are numbers to fulfil on their side and it’s another slice of paperwork to add to the ever- growing mountain on the trainer’s side.
WBAs should not be like that and when they are used correctly, they enhance training immeasurably. The trouble is that to get the most out of the experience, time is required and that’s hard to come by. Occasionally, when a trauma list is light or a case gets cancelled, that magical block of time appears and although it’s tempting to use it for one of the other thousand things that demand the modern clinician’s time, using it to pre-discuss and plan the case, talk through the principles, perform the surgery and then de-brief afterwards is an experience that I value very highly indeed.
One of my favourite ever training experiences was a combination of a very light afternoon session in trauma, a volar shear fracture of the distal radius, a very receptive and inquisitive trainee and a long debrief post-surgery. The time we took that afternoon to discuss the case beforehand, talk through the biomechanical principles of what we were about to do, apply the principles in theatre and then get the trainee to explain them again and talk about how their experience of the case is an experience that I suspect I won’t have again for a few years, but one which really reminds me of what a privilege training surgeons is.
A sense of belonging
Training is a real pleasure and I suspect most trainers share my view on this. One of the great things about training is that between trainee and trainer, there is a common goal to improve what we do. Trainees strive to become more proficient surgeons and although most trainers have this too, the time and effort we spend discussing and planning how we can get better – and more efficient at helping our junior colleagues to improve as they would like to do, is a something that makes us a mass of highly trained professionals, all striving in the same direction.
It always strikes me that that this sense of common purpose is a very powerful force and one that is easy to overlook. We should cherish that sense of ‘belonging’ that trainees and trainers share.
You can’t be what you can’t see…
Many years ago at the Middlesex Hospital, a registrar told me as a medical student that “we need more women in orthopaedics, they brighten the place up a bit…” How true. Looking around the BOA Congress in 2022, gone were the navy blue, grey and black suits – replaced by colourful outfits and a feeling that our association is attracting an envious selection of varied medical students and trainees. All with their own ideas and thoughts to challenge us.
Junior doctors we salute you! Thanks for passing through and teaching us.