Every surgeon I know wants to be the best and deliver the best outcomes for their patients. One of the questions that I'm often asked as a ex-surgical trainee and Co-Founder of Touch Surgery is "Why do you need to change surgical training?". Many surgeons I meet ask me "If the current system worked for me, why shouldn't it continue to work for everyone else?"
These are very valid questions, and something that I have found myself thinking about a great deal over the past few years. There are a number of ways that I have found myself answering this - from addressing the global scale of the problems of surgical disease, to the advantages and efficiencies of new technologies, as well as the numerous challenges that are forcing change in the training system. However, I find the most fruitful conversations to start around the question "how do you think that surgeons should be trained?".
Let me start by clearing up some commonly held misconceptions. Surgeons do not learn how to operate in medical school. We do not learn how to operate on animals. We do not learn how to operate on dead bodies. We learn how to operate on real people - our patients. The first time I learned how to take out an appendix was on a real 12 year old boy. And I had never been formally taught, assessed, or even been able to rehearse or practice the procedure before that point. Does this sound like a good idea to you?
This is how I learned the majority of operations during my training. As a surgical trainee I learned by doing, in the same way that an apprentice would learn their craft from a master carpenter. This is the same way that surgeons all around the world are taught, tens of thousands of times a day in hospitals around the world.
To illustrate my point, I often try to draw a comparison with other professions that require high levels of physical performance. For example, you would never find an athlete who practices by performing in the Olympics. Athletes spend a huge amount of time in deliberate practice, honing their skills to perform when the occasion demanded it. It is sometimes easy for the surgical apprentice to forget that at the centre of the operating room is the patient, who is far more interested in your performance, rather than your training.
Sports provide an excellent example of how complex performances can be broken down into parts, with deliberate practice of each part. These techniques have been developed specifically to improve ultimate performance when things really matter. As a student hurdler, I used to spend hours just practicing movements of my left leg, then my right leg, then my torso. I spent hours in mental rehearsal, thinking about the number of strides between each hurdle, and how to connect the different parts of my performance together to provide maximal efficiency and speed. Only in this way was I able to maximise my performances in my admittedly average athletic career.
I believe that surgery has a lot to learn from the basics of sports training like this. We see now hospitals investing more resources into technical labs, trying to teach surgeons how to perform intricate skills like placing stitches laparoscopically. We have platforms such as ours at Touch Surgery, which allows surgeons to cognitively prepare for and rehearse surgical procedures. Surgeons today have to take more ownership of their training pathway than in times past, and understand that in the absence of surgical experience, deliberate practice will be a crucial element of success and great outcomes for your patient.