Taking charge of your training 

I think there should be a mirror in our registrar room, (this mirror would be handy anyway as a regular mirror for me to check my face in) but it should have a sign above it reading “The person responsible for your training”.

The apprentice/trainer model is dead in most hospitals and training is increasingly squeezed out of the operating theatre due to targets and time constraints. See this recent letter from the RCSEd president which makes this point well.  https://www.rcsed.ac.uk/media/414502/hunt.pdf

Many people, trainees and trainers, sit back and complain and compare today to the training in the good old days. As much fun as this is (I did a one in four, I did 90 hours a week, we operated 72 hours straight with no food…whatever!) it doesn’t help us in the current climate. I’m counting the days until I am done training, but will soon be a trainer. I think I am rather well placed to advise on training in general surgery as I have been training for so very long.

The people who have trained me, were trained in the old system by people who worked 100’s of hours more than I will. They learnt to teach me from how they were taught and most of them are bad at it.

Models of training

1. Apprentice and trainer. This model is the ideal and results in steady progress and a joyful and rewarding relationship over time. This model is dead in most hospitals and is what we all constantly lament the loss of. 

2. We don’t know any other models. 
I don’t really know how to get better at teaching people, I keep trying it and I’ve been reading lots of books on the subject but I cannot quite bring myself to do a certificate or diploma in education because it will cost me some of my hard earned money and probably be boring. 

I know I vehemently dislike most undergraduate teaching; nothing fills me with ennui more than 4 dull faced slack jawed millenials who can’t tell me what a hernia is, what the contents of the inguinal canal are, what bugs cause wound infections and how local anaesthetic works. 

Why should I show these eejits what I am doing and explain what is vas and what is sac when they are patently clueless? Somewhere there are lots of parents going without summer holidays and sirloin steak to put these children through medical school, they are most undeserving of the sacrifice. 
I do like post graduate teaching though, these are motivated learners, panicking about career progression and paying out their own money for exams. 

What I’ve realised over the years of good and bad trainers is that the person responsible for it all is me. Most of the years have been good but I have behaved appallingly at times in the past and let someone not train me, because I was being petulant and it suited me to say that this person doesn’t teach. I stood about huffing and moaning that they don’t let me do anything whilst never asking to do anything. 

ISCP, our internet based reflective continuous assessment website is really good when used regularly and appropriately and sadly it is not used to its full advantage by most trainers and trainees. I have had the benefit of working for one or two amazing trainers, one person in particular who I want to be like and so far I am managing to do what he did when I operate with the juniors. I am desperately trying to use ISCP the way we did but am failing to get my trainers to engage with what my needs are. 

In a relationship if you aren’t having your needs met you have “a talk” with your other half and sit down together and tell them you need more hugs/sex/help with the hoovering. In a training relationship you should do the same but I am struggling to find anyone who wants to listen.

How can we all engage more in training, how do you motivate the people who teach you to train better, how do you get them to change what they are doing without moaning and complaining and offending?  

(Don’t feel sorry for me, this situation is very much all my own fault) 


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