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How To Become A Good Surgeon

Discussion in 'General Surgery' started by Dr.Scorpiowoman, Nov 28, 2017.

  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

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    The minimum aim of a trainee is to fulfil all the criteria for appointment to a specialist post. This is via a six year higher specialty training programme

    Various bodies have set out their required minimal competences for a surgeon.

    These define the specifications of an adequate surgeon; to define a good surgeon is a more difficult matter. We believe a good surgeon has two vital attributes—firstly, integrity, secondly, the ability to make good decisions.

    These two attributes are continually required in three aspects of day to day life as a surgeon. The first is as a team player. Surgeons need to have good communications skills, be courteous, confident, and able to compromise when necessary. The second is with patients. Surgeons need to be caring and able to communicate. The third area is in managing themselves. Surgeons need to keep up to date with the theory and practice of surgery. They need to know how to do it, when to do it, and when not to do it.

    Five steps to producing the good surgeon

    To produce good surgeons, we believe these steps need to be taken.

    The correct doctors have to be selected to train as surgeons
    Selection procedures for surgeons are not often evidence based. In the United Kingdom candidates must undergo a process of shortlisting, for which a good CV is necessary, and interview, where good interview skills are necessary. This process is used because it is cheap, needs little time, and is done by surgeons who have to train the selected surgeons. Doctors in basic surgical training who are about to apply to a training scheme need to use their time efficiently to fulfil the criteria used to select trainees. These are set out in the application forms used for specialist registrar selection.

    The surgeon needs to be properly trained
    From a technical point of view, a good trainee surgeon must strive for skilled performance; this is accomplished by devoting attention to practised skills in order to concentrate on achieving the desired result. The minimum aim of a trainee is to fulfil all the criteria for appointment to a specialist post. This is via a six year higher specialty training programme. Expected progress during these six years can be summarised as:

    • Year 1. This is similar to beginning a new school. Everyone starts their surgical career in this way. It helps to be nice (no matter how stressed you are) and to turn up on time. For the next six years, however, the trainees' time is precious and must not be wasted by them or others.

      It is important to develop an efficient structured approach to learning. Junior surgeons tend to be easily distracted by complex operations using complex equipment. It is more important to learn the general basics. Courses help in this aim. The year one trainee must progress in all fields. These can be summarised as management, audit, research, clinical skills (basic and specialty), educating oneself, and teaching others (MARCET).

    • Year 2. Surgeons continue to acquire practical skills. Their contribution to service commitments and research begins to be valued. They should begin to grow in confidence.

    • Year 3. The intercollegiate exam (for example, FRCSOrth) begins to loom. Trainees show evidence of increasing maturity and the ability to do the work of a surgeon. From now on each trainee should aim to have one good research idea a year. With careful planning this can be turned into a paper, a presentation and an abstract. Sharing research with other likeminded trainees can dramatically improve the chances of getting your name on the paper.

      Good fellowships are booked up two years in advance. The junior surgeon, even at this early stage, needs to give thought to subspecialisation and booking a fellowship after the FRCSOrth exam. Do not try and specialise in a basic skill that everyone is expected to have (i.e. primary hip replacement and knee arthroscopy).

    • Year 4. This year requires intensive preparation to acquire the knowledge base and practical skills required to pass the FRCSOrth. This allows little time for one's family, research, and other activity.

    • Year 5. Ideally the FRCSOrth is passed at the first attempt early in the year, followed by a fellowship. Failing to pass the exam can make the year very difficult. A good fellowship is a good finishing school and boosts one's surgical skills and research output.

    • Year 6. Six years of hard work and planning should result in a well rounded surgeon with no deficiencies. It is important to be present at as many meetings as possible. It is a chance for advertising your hard won skills and attracting interest from people who are looking for skilled consultants in the near future.

      Many trainees find it difficult to produce research. Research output consists of posters, presentations, letters to learned journals, abstracts, case reports, reviews, papers, and contributions to books. Trainees should try to obtain publications by doing projects that are quick and easy. It is very difficult to complete outstanding research once the rotation has moved you to a distant hospital. Always start a project with a literature search, a clearly stated aim, and a timetable. Work in progress meetings supervised by experienced researchers help to maintain momentum. It also helps to pick the appropriate journal at an early stage and to join successful researchers.


    Surgeons must be technically able; make sensible, logical decisions; communicate well; and know when (and when not) to operate



    For original research the fields of basic science, management, and audit repay attention. Any underused database is a goldmine for evidence based research. Be wary of large long term projects and never review your consultant's “last 100 hips.”

    Career advice

    During their training and beyond, surgeons need advice from a senior figure or mentor. One can also learn skills by observation of role models, both positive (“I want to be like that”) and negative (“I definitely won't do it that way”).

    Get the right consultant job

    As the end of training approaches the prospective consultant must seek out the right job. A wide range of jobs exist, from the teaching hospital to the far flung district general hospital.

    The job advert will likely contain the job specification and the minimum person specification. Shortlisting for jobs is on the basis of submitted CVs. Candidates will need to tailor their CV to each job applied for. A good CV is clear and easy to read. It demonstrates skills in all areas (MARCET) with no deficiencies. Shortlisted candidates are invited for interview. Good interview skills are again necessary.

    Good surgeons may find themselves in the wrong consultant job. The first step in avoidingmismatch is for the individual to identify the right type of consultant post for them. In the past, senior registrars were guided to the right job by a system of apprenticeship and patronage—this has been swept away. The basic points of compatibility are easily overlooked or forgotten in the quest to avoid unemployment: teaching versus district hospital; specialist versus generalist; location; colleagues; junior staff; and does your family want to live there? These and many other factors (specific to the individual and [sub]specialty) should be taken into account to decide if this is the right job for you.

    Settling into the consultant role: the early years

    Surrounding staff will assess you by the AAA criteria: available, affable, averagely competent. It becomes easier to display these characteristics if you are in the right job.

    There is a spectrum of consultant jobs, varying from the now old fashioned district general hospital generalist to the teaching hospital superspecialist:

    • The surgeon in a district general hospital—an adaptable generalist, with a firm grounding in the pillars of good surgical practice. If, in a particular surgical department, the individual surgeons each excel in one or two (different) areas this should result in a functional, well balanced unit. A new consultant will often evolve to fill whatever niche is available in that department

    • The superspecialist—often strong personalities who enjoy large teaching hospital practice. These surgeons have particular expertise and are good at sorting out our problems. They usually receive many tertiary referrals. Many trainees use these surgeons as role models, few become one. Either type of surgeon may have star qualities: and in reality good surgical consultants fall somewhere between the ends of the spectrum. The ones that patients and colleagues like tend to be genial, approachable, and non-judgmental.
    Conclusion

    Surgeons must be technically able; make sensible, logical decisions; communicate well; and know when (and when not) to operate. The necessary steps to producing good surgeons may be summarised as appropriate candidate selection; good training; good advice; appropriate job selection; and settling into the job. The worst type of surgeon is one who is distanced from his colleagues; this surgeon practises alone and denies ever having complications.

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