David J. O’Regan1, ASiT Council2
The ASiT Silver Scalpel Award was founded in 1999 and is recognised nationally as a mark of training excellence. The nominations for the ASiT Silver Scalpel awards are always humbling examples of exceptional surgical trainers that inspire all those involved in surgical training. These sentiments are echoed by the past and present Medical Directors of the NHS who have the honour of reviewing the top nominations each year; all the nominees truly deserve an award. The following is a reflection on the 2021 nominations to highlight some real positives in a challenging year for everyone. The winner will be announced at the ASIT annual conference on 6th March 2021.
Not surprisingly, many of the citations this year refer to the pandemic. A key recurring theme is that the trainer has still been able to train despite COVID-19. This emphasises that delivering good training requires a philosophy of commitment in a challenging environment. Excellent trainers have adapted to the challenge of COVID-19 to continue to nurture the next generation of surgeons. This year more than ever, perhaps, the mentorly approach and support of good trainers has been needed by trainees and the ASiT Silver Scalpel nominations emphasise that. Trainers have run towards the challenges and delivered. We salute these surgical trainers.
During the pandemic, surgeons have gone above and beyond to care for their patients in exceptional circumstances. There has been transformational change in surgical care delivery with the advent of virtual clinics and MDTs and different ways of delivering care. The following nominations show, however, that the core of what makes a good doctor has not changed. Above all, excellent surgical trainers are kind hearted, caring human beings who do their very best for their patients, their colleagues and their trainees. Supporting these trainers and acknowledging the work they do is essential, as they are nurturing the next generation who will carry the torch.
The distribution of the nominations is across all specialities. Nominations were received from teaching hospitals and district general hospitals and reflect both secondary and tertiary care. The themes are the same and profound. These are some inspiring quotes from the nominations linked together to form a narrative. We could not have written this any better than the trainees who wrote these words about their trainers. With permission, we have left their words verbatim in bold and in italics. The result makes for powerful reading for reflection.
These trainers consistently going above & beyond what is required of them to contribute towards the surgeons of tomorrow, whilst continually promoting the highest standard of surgical care for patients. They lead by example, and always takes a meticulous approach to care of the surgical patient, driven by a clear passion for delivering excellent care with the expectation that junior colleagues practise with the same. They naturally command respect, yet combine authority with the ability to listen, engage and coach, thereby empowering trainees to utilise and make the best of training opportunities. Trainees describe their leadership style as patient, calm and consistent. They can remain calm and compassionate in the face of difficult patients and situations. They provide the highest standards of care to patients with compassion and empathy. Their communication skills are exemplary. They listen to patient’s needs and provide them with the time they need to ensure they are happy with the treatment provided. With patients, they are thorough and dedicated. This is reflected in the fact that patients very often ask for them by name (and are very disappointed to see anyone else in clinic or on the ward!).
The service they deliver is patient focused and demonstrates integrity and probity. They are strong advocates for patients, and take a holistic approach to their care, considering and dealing with not only their surgical problem, but wider issues such as their nutrition and mental health. Their respect for the patient is communicated clearly and fairly and inspires juniors to strive to do their best for the patient. They inspire trainees to always put the patient at the centre of our care despite competing personal, professional, and organisational demands. They always make sure that every patient fully understands what is explain(ed) to them and go out of their way when patients still have questions following their consultation to give them a call to discuss this with them and make sure they are happy with their understanding.
They are regarded by trainees as “motivational”, “highly encouraging” and “extremely thorough in assessment and feedback”. Despite national commitments they always find time to sit with individuals and discuss training and progress. These trainers identify areas where development is required and actively ensuring that these are addressed. They meet with each new trainee individually to understand and discuss their career aims and training needs. In this manner they are able to develop individualised training pathways, introducing fluidity into a regimented system to allow trainees to excel, by utilising their uncanny knowledge of the nuances of every post.
Despite the recent pressures on the service, they have continued to identify and maximise learning opportunities for trainees on the ward, in clinics and in theatre, and has used these to improve the quality of patient care and patient safety. When in theatre, they plan ahead, outlining roles and identifying and agreeing learning opportunities with each trainee beforehand. And ensure that all team members are able to gain something from the experience and to feel that they have contributed to the patient's care.
During operations, they show calmness and patience through their willingness and ability to take a "hands-off" approach when appropriate; demonstrating new skills before stepping back and allowing trainees to complete the case with support and encouragement. They are instrumental in the development and delivery of training beyond the immediate surgical workplace. They have of their own volition, organised small group skill training sessions, and made themselves available in their own time to deliver weekly remotely supervised skills sessions
They are open-minded and encourage and value contributions from all members of the team, regardless of their experience or seniority. They are passionate about collaborative working and through their open, energetic, credible, and likeable nature manage to forge strong links with our allied specialties. This is beneficial to all trainees as it has resulted in the trainee getting wider exposure to varied pathology and surgical skills.
They create opportunities to experience multidisciplinary team working, and to improve trainee confidence at presenting in front of an audience. They also motivate trainees to participate in audit and clinical research projects.
They care and make a point of looking out for the wellbeing of all staff in the department; this was particularly noticeable at the start of the COVID-19 pandemic. They take great personal pride in encouraging trainees to excel at everything they do and takes pride in their triumphs. They have a devotion to sharing knowledge and encouragement. They work hard to involve the wider surgical team in teaching and training and provide opportunities for all staff members to further their continuing professional development.
It would not be an overstatement to say that they epitomise professionalism and effective communication. They are consummate professionals, treating those encountered with respect and dignity, and without prejudice. They work hard to flatten the traditional hierarchies in the department - for example by equalising roles between staff nurses and dental nurses, and foundation year doctors and dental core trainees. Furthermore, some consistently go above and beyond the norm by challenging inappropriate behaviour in trainers and actively protect time to train.
This is the standard set by a consultant who did the same for me back in the day and I always said I would repay the favour for future trainees. Perhaps this is the beginning of a good basis for surgical training. It will be interesting to examine the legacy of all the nominated Silver Scalpel Award nominees over the last twenty-one years. I am sure we will see that there is a strong element of paying it forward.
Training perhaps could be thought of as is a philosophy and a positive mindset that rubs off on the whole team to the benefit of our first priority – our patients.
ASiT is grateful to Swann-Morton for their long-standing support of this award. ASiT is grateful to all ASiT members who nominated trainers; to the members of ASiT Council who conducted in depth semi-structured interviews of the top nominations; to the doctors and nurses at the sites of the Consultant trainers nominated who gave their time to be interviewed; to David O’Regan, Past-President of ASiT, for his ongoing enthusiasm, energy and support; to the Surgical Royal College Presidents and the NHS medical directors who help select the final winner. Most of all, ASiT is grateful to the exceptional consultant trainers across the UK who deliver excellent training day in and day out despite the challenges- you inspire us.