Are we doing enough to encourage future surgeons?

Historically, a career in surgery has a notorious reputation, with anecdotes of long hours, difficult bosses and competitive hurdles. Yet there is still much appeal; perhaps due to the desire to master those surgical skills and the optimism of becoming a surgical consultant – especially one just as inspiring as the person who hooked you into the profession in the first place.

In the past decade there have been many changes to what it means to be a doctor. These, seemingly, have cumulated in ‘tick-box’ exercises, shift work and the strikes over the contract for junior doctors. Burnout and/or despondency is increasingly talked about. Mr O’Brien, President-Elect for BAUS (British Association of Urological Surgeons), recently presented at the Royal Society of Medicine his ‘Future of British Urology’; he spoke of many challenges ahead, but opportunities aplenty. He also suggested that anyone can be a urologist due to the breadth of skills required within the specialty; therefore, it is imperative to showcase surgical specialities and engage at grass roots level.

At a local and national level, we need to do more to ensure that bright, enthusiastic, able students and trainees who want to do surgery are encouraged and retained. Exposure to surgery, especially urology, is often limited at medical schools, and foundation year placements are becoming increasingly community based.

One way of inspiring and exposing junior colleagues to surgery and its specialties is to encourage attendance at the ASiT Conference, Birmingham 2020; and for urology, to attend the BSoT Conference, Leeds 2020. These national trainee groups: ASiT (Association of Surgeons in Training) and BSoT (BAUS Section of Trainees) are run by trainees, for trainees. They support best training and promote surgery as a career. They are a great introduction to surgery and urology as a future career and are a potentially less intimidating, more welcoming affair than their ‘grown up’ equivalents. Additional events run throughout the year and there are regional representatives for both ASiT and BSoT. There are other surgical trainee groups that relate to other specialties.

Attendance at conferences and surgical meetings are an amazing opportunity to engage in the scientific and social programmes, to meet other like-minded people and see the vast possibilities of the specialty. Furthermore, conferences offer the opportunity to present academic work, audit and quality improvement projects. The abstract deadlines for these trainee conferences are fast approaching. Helping a trainee prepare an abstract to submit, is invaluable; it could springboard their potential for success at interview and result in a boost of their self-belief.  

So, let us encourage surgery as a future career and show students and junior colleagues the best (and worst) of surgery and surgical training. Conferences are one option, but we can also all talk about surgical careers and be that positive role model: spark that enthusiasm. Urology taster weeks and careers days are other examples. Let’s congratulate successes and offer support during the difficult times.

What do you do to encourage the juniors around you? Please let us know in the comments below.

Disclaimer: The author is a current urology trainee and holds committee positions on both ASiT and BSoT groups. Her only conflict in writing this blog is to encourage others to engage and collaborate with these trainee-led groups and attend the upcoming conferences.

Comments (7) Add yours ↓
  1. Hannah Warren Urology Registrar

    While obviously trying to be welcoming, encouraging and enthusiastic in the day-to-day job so juniors have a positive experience in my speciality, there are also a number of formal initiatives I would recommend aimed at supporting those that have already declared an interest. Explore what your medical student societies already have up and running. KCL Surgical Society has a mentoring scheme where a medical student is paired with a surgical trainee with a view to gain exposure and get tips on improving their CV. I’ve really enjoyed getting to know a number of enthusiastic medicals student over the last 3 years, tucking them under my wing and helping them grow into budding surgeons. There are student urology societies who put on regular events who would be delighted to receive offers of help (KCL and Bart’s are just two that I have volunteered for – find them on twitter). And even earlier than that – getting the right talent into medical school in the first place. The social mobility foundation help young people from less privileged backgrounds access higher education by pairing them with volunteer mentors from their desired profession – they have 4 times as many students interested in medicine than there are medics to mentor them. With just a handful of video call sessions a year it is very straight forward to make a big difference

    November 29, 2019 Reply
  2. Tom Stonier Urology ST3

    I completely agree medical students/Foundation doctors are often told about ‘getting involved’ in audits and research etc. Yet how to actually approach this can seem daunting. One of the reasons I ended up as a Urology trainee is because of the enthusiasm of a trainer (Mr Paras Singh) to not only get me involved in surgery but also guide me through my first audit. As a trainer though this must not stop here, we need to be mindful of ensuring the student/junior gets what they need out of it – typically this will be presenting it as a poster or orally at one of these conferences. Often, unless they are guided towards BSOT/ASIT/RSM they may not know where to start and the opportunity will be lost.

    Finally a plug for the RSM who are hosting a Career in Urology day for Medical students and Foundation Years. A great opportunity to hear about a career in Urology and there is poster prize competition.

    November 30, 2019 Reply
  3. Tarik Amer

    This is very a well written article full of valid points. Every August, it’s exciting to see so many motivated new young trainees and fellows eager to pursue a career in surgery. However, too often, a number of these bright, engaged future Consultants leave surgery just as their careers are getting going. Reasons cited are the hours, sacrifice, frustration at perceived lack of progress, exams, difficult personalities etc. Having just started as a Consultant, I feel I’ve seen too many great prospects leave the profession since I started my training.

    In essence, to answer the question “Are we doing enough to encourage future surgeons?” my answer is no. That’s not to say that trainers and organizations across the country are not working hard to promote surgery to our juniors and students, we are just not doing it enough of the time.

    I think attending meetings such as those mentioned are so invaluable. I personally am indebted to the mentorship received from Consultants I’ve met at the Royal Society of Medicine (RSM) Urology and Safety Sections over the years. The ability to see cutting edge research presentations whilst also receiving informal advice over a coffee is quite unique to the RSM. As important, has been seeing the good work and progress by my peers and friends made there and in other courses outside of work.. Such friends became FRCS revision buddies and research collaborators. More importantly, they’ve been confidantes when I wanted to discuss challenges. Such a network is a great source of encouragement.

    At a grassroots level, in our own workplaces, we should strive to make surgery seem an attractive career choice by ensuring we manage our own stress and contribute to a positive culture/vibe on a daily basis. We should structure job plans/rotas for our juniors that strike a generous balance between training and service and make time to train them on a daily basis. This includes filling in all the ISCP forms that we all love. If confident, we should help our juniors write their first papers and posters, even if we’re not that confident about it ourselves!

    Hopefully, by doing all this and by encouraging healthy behaviours and lifestyles in and outside of work rather than the ongoing rhetoric about ‘resilience’, we can promote a culture in which young surgeons can flourish and feel valued and become the Consultant surgeons of the future.

    December 2, 2019 Reply
  4. Matthew Perry Consultant Urological Surgeon

    The first two sentences of the above article are telling! The sterotypes of surgical life are therefore still circulated and as such I don’t think we are doing enough to support and encourage junior docs into the field of surgery. The surgeons of today will find their lives change dramatically over the next decade as we inherit the advances in technology with image guidance, focused treatments and ever further minimisation of surgical instruments and techniques. The future is incredible.
    On a recent trip to Amsterdam with a travelling surgical society, we met and had lectures from some Dutch surgical trainees. Most of the women worked 60% rotas and men 80%. These young professionals taking the “slow road” to their final destination of a surgical consultant but managing family life and responsibilities along with their continued learning. They knew that they would be in the profession for decades to come, why the rush and why the risk of burnout? This was a challenging concept for most of us visitors but hugely refreshing in many ways including the challenge to gender bias in the family vs career argument. Once again we can learn from the progressive Dutch.

    December 5, 2019 Reply
  5. Hamid Abboudi

    Sophie, yourself and the ASIT and BSOT committees should be commended on your excellent work to develop interest in surgical careers.

    It is well recognised that undergraduate surgery, and in particular urology, exposure is limited. Short urology attachments often revolve around seminars and tutorials, with all too little time in clinic or theatre – this time on the ‘shop floor’ needs to be optimised. Interest in surgery typically sparks in the operating, rather than the lecture, theatre. My interest in surgery was ignited when asked to scrub for an open cholecystectomy as a 3rd year medical student. Sometimes it only takes a small effort to make a big difference in a developing students mind set. The window for impact is very narrow. Every contact is an opportunity to inspire the next generation of dedicated surgical trainees.

    The annual Royal Society of Medicine careers workshop – usually held in November – is a must for all medical students. All specialties host a stand, providing a friendly, engaging environment to explore career options, often providing a springboard for involvement in projects and CV building opportunities. My first project came off the back of this workshop, meeting a young Kamran Ahmed – now consultant Urologist at Kings College – on the urology stand circa 2009.

    To echo Tom’s message, on the 11th January 2020 the RSM is hosting the biennial Medical Student and Foundation Doctor Urology Careers Day. The morning session includes short, sharp lectures from sub-specialty consultants. In the afternoon delegates rotate between hands on workshop stations including cystoscopy, suturing, catheterisation, laparoscopy and stent insertion.

    December 10, 2019 Reply
  6. Bill Dunsmuir Consultant

    Sophie asks the question “Are we doing enough to encourage future (urological) surgeons?”
    Her well-written article touches on two broad themes: First, what are we doing to frame the urological specialty as being a unique work-life experience for the next generation of urologists? Second, she reminds us of the vast and diverse opportunities that abound for those who choose urology as a career. She does a clever job at both focusing on and, providing some answers to both these discussion points. As a Training Programme Director for the last ten years, I have been very much involved in both these issues. Let me deal with each in turn.
    [1]. Grabbing the ‘best’ at grass roots
    Sophie Rintoul-Hoad has spoken of the terrific value of ASiT and BSoT, and, Hannah Warren and Tom Stonier have highlighted the extraordinary value of mentor-ship programmes and the identification of true mentors-of-worth. Their remarks are, of course, central to the future of successful urological recruitment. Indeed, Dominic Hodgson, the current BAUS Education Lead, has recently scripted a ‘pull’ aimed at our ‘best’ medical students. Dominic is a classic example of what a surgeon is not perceived to be. He is a historian, provincial surgeon, clever and funny, and the sincerity of his message is always embedded in the light-hearted stories he tells. I had the privilege of animating his ‘grab’ for the medical students, in a project that awaits approval for the BAUS website. If you want to see a draft his perspective, you can watch it here:
    In this short animation, Dominic explains why a career in urology is uniquely fulfilling. Perhaps worthy of note, is the strong suggestion that the specialty is inherently attractive for female clinicians. His script is so disarmingly neutral, that my own daughter wanted to ‘be a urologist’ after viewing his film. However, if we focus on the gender challenges that under-pin recruitment, I rapidly draw your attention to Matthew Perry’s response to this very same blog. Despite the misogynistic relics who may still hold court in British Urology, the data from Holland clearly shows near-parity in the workforce contribution of both sexes. Why this might be, is expanded further in Sophie’s second theme: that of abounding opportunities in British Urology.
    [2]. Abounding opportunities in a urological career
    Sophie’s blog astutely summarises Tim O’Brien’s forward view of British Urology (RSM 13/011/2019). Put simply, Tim stated that urology is now such a broad discipline that, in describing its breadth, he presented a PowerPoint® show with – at-the-very-least – 18 broad professional category headings. That left me wondering ‘… what is 21st Century urology?’. Well, I’ll posit a perspective for this blog.
    I recently cycled across Costa Rica with The Urology Foundation (TUF). This extraordinary experience brought me together with colleagues, patients and advocates who have focused on a cause of true worth. Robotic urological surgery was single-handedly brought into British urological practice by Professor Roger Kirby. But Roger went one step further. Given the challenges within the NHS, he forged a charity (TUF) to embrace the sound training of future robotic surgeons in the United Kingdom. That has been achieved with aplomb. However, the triumphant sentiments in Costa Rica were that this was a cause now well-serviced; a project well done. But let’s now consider the bigger picture. Of 16,000 urological operations performed in the United Kingdom every week, about 26 are undertaken with a robot. That is 26 great cases (perhaps the ‘low-hanging fruit’), but what of the rest? Should we, as a profession, now take on the difficult?
    In 1963, when John F. Kennedy made his presidential address, he said that he sought to ‘put a man on the moon and bring him home safely – not because this was to be easy, but because it was hard’. So, when Tim O’Brien embarks on his ‘moon-shot’ will he include a focus on any of the ‘unfashionable’ sub-specialty areas of British urology? How far down his list of 18 sub-specialty categories will he get during his presidential challenge? How will the gulf between high-end heroic surgical practice and the urological problems in secondary care be bridged? Will problems such as Community Urology receive address? I think it will. Tim has a track record of taking on the Cinderella services. Many years ago, as Clinical Lead at Guy’s Hospital, he revolutionised his local outpatient-services. The ‘New Guy’s model’ became the then gold-standard for out-patient services in the United Kingdom.
    But even this is now being surpassed by a new generation of Urologists. There is no doubt that in our aging population, the greater volume of challenges for urologists relates to continence, catheters and the miseries that abound with old-age. In response, British Urology is moving rapidly to service this space. Philip James, Rebecca Dale and Nimulan Arumainyagum are three young Consultants who are taking this challenge head on. Together, they are forging a new concept of ‘borderless’ urological care delivery. By combining an educational tool with a secondary-care based community urological service (hub-and-spoke), they have crafted a nascent and rewarding new sub-specialty of Community Urology. The educational tool is based on the National Catheter Education Programme (supported by Health Education England). This is a dynamic consensus-constructed learning programme created for a multi-professional healthcare audience whereby practice is standardised and learning principles universalised. The programme underpins a Consultant-led service that takes full responsibility for any catheterised patient, wherever they may be. In hospital or the community, the Urology team have overall responsibility for the placement, care and removal of every catheter. Of course, a person having a catheter is a ‘barometer’ for sickness and frailty, and most of these patients are under the care of many other clinical teams. The Community Urologist is now serving to prise open these silos of clinical care. They are welcome knights with endoscopic armour, bringing sound decision making to the often neglected back-waters of human misery.
    And the programme works. This Community Urology project is enthusiastically supported by the commissioners who are rapidly re-directing budgets to Urology departments who are prepared to offer such services. The business models are well-worked and, for those interested, a review of the over-arching concept can be watched here:
    So, to conclude. Whereas a few future Urologists will drive robots and undertake complex and challenging surgery, most will not. Yet that should not deter from an exciting career in urology. The inception of Community Urology is receiving such an enthusiastic response from commissioners, that a whole new branch of urology is being availed to the next generation of clinicians. The opportunities to provide an ever-widening spectrum of urological care are making urology one of the richest and most rewarding branches of modern clinical care.

    December 15, 2019 Reply
  7. Tim obrien Con urologist

    Sorry to join this fabulous discussion late but I’d ‘gone Dutch’ and decided not to do work related stuff when on holiday !😃 btw Miami Beach in December is fun & warm …

    So many ideas flowing forth.

    Surgery is still a fabulous career. This needs to be shouted from the rooftops. Hugely challenging & at times dispiriting and exhausting, but fabulous nonetheless. The friendships and camaraderie that Sophie alludes to remain a big part of that and something that we need to cherish. As my friends in finance tell me, not all jobs provide it. I also love the connection with the great surgeons of the past , a sense of being part of a continuum, and having the chance to develop the next generation just as I was shaped by the surgeons who taught me. I still apply those lessons every day – “Cut at it, cut at it” “ Tim, never force it, the patient has to want it” “ when all else fails take a history”

    Every generation of embryonic surgeons faces new challenges. In the 70’s and early 80’s there were few consultant jobs & disgruntled 42 year old senior registrars became understandably bitter; in the 80’s and 90’s the requirement for a research degree to progress your career was so daunting, especially when that mandatory step was unfunded; in the noughties truncated training left no one sure whether being a urologist would still mean you were a surgeon; and today’s registrars face their set of challenges.

    As Billy alludes to, I do think Urology has a huge opportunity in providing an answer to one of the challenges young doctors face from run through training, viz, “how do I know this career is right for me when I have to date so little exposure to it ?” A choice for Urology doesn’t fence anyone in. There are so many ways to find fulfilment in our specialty; robotics, BPH, fertility, caval surgery, prostate diagnostics, continence, paeds, transplant, nmibc, stones, ED, management and so on. This also allows far more opportunity for the portfolio career that Matt Perry talks of. Maybe robotics for 10 years, diagnostics for 5 and something yet to be thought of for the final 10 …

    Ditching worn-out stereotypes is also important. It’s frustrating to see clips of Sir Lancelot Spratt still shown in leadership presentations as if they represent the present. They don’t. The movies were made in the 50’s and one wonders if it would be acceptable to stereotype any other group with clips from films made 65 years ago. Surgery and surgeons are different.

    So yes, do go to ASIT go to BSoT, go to BAUS , swap stories, share lessons, encourage each other and enjoy shaping the future of our specialty. In short relish the challenges…

    December 28, 2019 Reply

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