A training culture in surgery

BMJ 1996; 313 doi: (Published 21 December 1996) Cite this as: BMJ 1996;313:1635
  1. David H Hargreaves, professor of educationa
  1. a Training of Doctors in Hospitals Project, University of Cambridge, Cambridge CB2 1QA

    The coincidence of the Calman 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.

    Cultures: origins, maintenance, and change

    Culture is usually defined in anthropological terms as the values, knowledge, customs, practices, and language of a group of people. As medical students doctors are socialised by this shared professional culture, into which are inserted specific cultural elements relating to particular specialties and to the idiosyncrasies of a department or hospital.

    The origins of a culture and its members' associated social identities are usually obscure, but once acquired they are taken for granted and not easily changed. A culture defines reality for members and provides ways of thinking and behaving—the recipe solutions to routine problems. A strong culture may be reproduced over generations. …

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