“Just finished watching the Four Corners report on harassment and bullying the medical (esp. surgical) community. Although there’s plenty of truth in it, I am concerned that the ways of the bad few will smear the wonderful many teachers that I have had and have. I am concerned that bad trainees will use this to shield their poor practice. I am concerned that the woeful lack of (constructive) criticism will diminish further.
The most distressing part of all of this are the good trainees, who after being bullied, simply get on with the job because they have to. That too often, only those with less to lose can afford to complain. This needs to change. May we, the Fellows of College, be the ones to do it.”
As someone passionate about surgical education, I find this entire process distressing. Although bullying touches on many different fields and areas, I think it is education that binds all of this together. Doctors have always had an obligation to teach those that come after them, just as those before them taught them. In the past, this happened under an apprentice model, where one learnt under one master until they were ready. I found it interesting that this model is still referred to, including on the Four Corners program tonight.
Because, the apprentice model was taken out the back and shot a long time ago. The body is suffering rigor mortis.
Under a master-apprentice model, there was a link between the master and the apprentice. The apprentice had their future linked to the master. But the master had their reputation, their livelihood, their very being linked with the apprentice as well. A master would train an apprentice who they hoped would work with them in the future. Who would be someone that enhances their reputation in the community. In other words, the master had a vested interest in the apprentice.
Under the current model of training, the surgeon has no vested interest in the trainee. The trainee comes for 6 months, a year at most, and then disappears again. There is often no continuing relationship. If anything, the trainee’s only future vocation is as a future competitor. Even if the surgeon thinks highly of the trainee and endeavours trains them well, that surgeon or surgeons cannot be guaranteed the fruit of their labours: that this young, bright trainee will come back as a colleague.
This does not excuse any of the behaviour that was purported to have happened tonight. The model now is of a teacher and a student. There is not the same sharing of life, of goals or vision. There is, however, a trust between student and teacher. The student must learn, the teacher must teach. Only in cooperation can something beautiful be made.
However, I do not believe that education is an innate skill of every surgeon. Certainly, we do not teach how to teach during surgical training. This needs to change. We need to teach surgeons how to teach trainees, residents, medical students, nurses, allied health staff and their colleagues. The Royal Australasian College of Surgeons has brought in many educational activities in this area, including the Masters of Surgical Education which I am currently engaged in. Yet the take up has been relatively low.
What do we need to do? We as surgeons, need to honour those have demonstrated educational excellence. We need to help every surgeon that has contact with junior staff become a competent educator in the same way that they are a competent operator. And we must learn to give and take good critique, that looks to put the current and every future patient’s health as front and centre.
Although the trainees and younger fellows of today start with great intentions, I wonder if the same consultants that we accuse of poor teaching and bullying today also had those same intentions. Without action, will those intentions merely evaporate?