A training culture in surgery

摘要

The coincidence of the Caiman reforms on the training of junior doctors with the reduction in their hours means that the quality and quantity of training must be improved. "Train the trainer" courses are one obvious way of enhancing consultants' teaching skills. An improved capacity to train does not, however, always lead to changed practices. Trained consultants have more confidence about training, but colleagues lacking this preparation may be sceptical of, feel threatened by, or become resistant to new ideas or practices. So trained consultants may keep newly acquired skills to themselves or even revert to former attitudes and practices. Junior doctors value on the job training very highly. Yet research has shown that their experience of training is often bleak, and the relation between training and service delivery is seen as unsatisfactory.1 By contrast, in the cardiothoracic surgical unit at Papworth Hospital there is a training culture, in which consultants actively coach juniors through on. the job training. This culture is now well established, is resistant to change, and will probably endure. The lesson may be that improving training is as much a matter of changing culture as of training individuals to be better teachers.