There is an interesting document I have come across recently, it is from those rather clever and switched on people in the West Midlands (wherever that is) who seem to come up with lots of good ideas. The link is here.
They propose a really quite revolutionary idea that trainees should feedback to trainers what they think of them via a handover diary that they pass on the next fellow in a fellowship post, I think it was plastic surgeons but the lessons are transferrable to us in general surgery too.
The endless and one way process that goes on between trainer and trainee is good when it works well, obviously I have to say it works well as I am a ticking clock heading towards independent practice.
They tell us how to do things, they tell us what they like and don’t like. Some train like they were born to teach, these are the only ones who get feedback as they are rewarded by us telling them they are amazing, nominating them for silver scalpels (lots and lots of male winners, just the one female so far I think…), fighting amongst ourselves to go theatre with these golden gods of training.
Everybody else (99%) is either ok or shit. They have highs and lows and good days and bad days but they receive no feedback on how they are as a trainer. Do they erroneously assume that they are good at it? How do they improve? How will I be the trainer I want to be?
West Midlands plastic surgeons possibly have the answer in the form of this diary.
All of us should keep a book of how to do operations and what individual bosses teach you. I know as many different set ups for how to do an anterior resection as I do things to do with my hair.
Informally I have done the oral version of this trainer diary in the form of a chat with the incoming registrar to the job I was leaving. “He hates it when you use cutting diathermy, or the heel of the hook, he “doesn’t believe” in drains, he likes antibiotics to be iv for all things, he doesn’t like lateral sphincterotomies/ he loves lateral sphincterotomies, he hates Prof Bigshot/he is Prof Bigshots biggest fan”. The difference is we don’t tell them any of this. Only one person I have ever worked for has asked me what I think of him as a trainer and wanted feedback, it’s no coincidence that he is also the best trainer I have ever had. And I’ve been at this surgery malarkey for 15 years.
How brave a trainer would you have to be to ask your trainers for honest and frank feedback about you as a trainer in written form to hand on to your next trainee? You would have to be thick skinned and able to cope with criticism, be willing to change your way of teaching to suit different individuals learning modes and needs (which almost none of them are able to do), willing to try new things and change and evolve. These are not easy tasks and are not very typical skills of consultant surgeons.
Bighospital has been shaken recently by a lack of trainees and people talking about not everyone getting registrars if they don’t train. So far this is just chat and noise and there are no real plans to make it the case. It is conceivable though in the future that only those who can teach get the privilege of training the ever dwindling number of trainees, chances are we will have to be good at it.
Will I be a brave enough brand new consultant to purchase a little notebook and ask my registrars for feedback? Yes. Will I cry under my desk when they write “KBW is a terrible trainer and has a short temper and a foul mouth”? Probably.
Can you imagine how good they’d be at teaching if they thought we would write a report that was personal rather than the anonymous and vague GMC Survey?