NextGen
Perspectives on surgical training:
STANDING ON THE SHOULDERS OF GIANTS By Omar Breik Royal Derby Hospital. Derby (UK)
O
ne of the advantages of training in Oral and Maxillofacial Surgery being so long when you do both medicine and dentistry is that you see different ways of teaching and training within a variety of settings. Even within the time of my own training in the Australian Oral and Maxillofacial training program, there was significant change. Being a member of IAOMS also means that we meet and interact with many OMF surgeons from many different countries, all with different programs. The evolving nature of our training system gives us a unique opportunity to explore how we can improve the quality and nature of training for the coming generations. The structure of surgical training now is a by-product of the work by William Halsted MD, a famous American surgeon credited with developing the first formal surgical training programmes at John Hopkins Hospital. He believed that surgical training should be accomplished in a set period of time, have a progressive increase in responsibility and operative experience, and have a final period of independent activity. In the early system, surgical trainees worked very long hours, learning to operate ‘on the job’ with variable levels of supervision. Generally, people got accepted into the program if they were liked by the head of unit, and progression through the training system was strongly associated with the practice, beliefs, attitudes and perspectives of the consultant who leads the team. The environment in which we train now is very different. In some ways, it is now better, with more stringent criteria on getting accepted into training, formalised feedback 34 iaoms.org
on trainee performance throughout their training, work hour restrictions and rotation through multiple centres throughout training all leading to a broader experience. However, there is merit in holding on to some of the aspects of the ‘old way’ which I feel at times made better surgeons. I will reflect on some of those from my own experience, and then give some advice to trainees and trainers for the future. When I first started training, the system in Australia involved getting accepted into the training program usually 2 years after completing dental school. Once you were accepted, as a ‘Basic Surgical Trainee’, you performed a year (or two) as an OMF registrar/ resident, and then commenced medical school. This was a great introduction into the training program. Firstly, as a trainee you get a taste for what the program and the job is like, clarifying your decision to go ahead with training. Secondly, it allowed for me to begin to foster relationships with my peers and consultants early, allowing me to continue to assist on major surgical cases, stay on the on call rota, and further my education in OMF while I was a medical student. The training program has changed in Australia and New Zealand since then, now a prospective applicant needs to complete both degrees before applying. From my perspective, this means they miss out on years of exposure, December 2018