Preparing for when things go wrongBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4627 (Published 25 August 2016) Cite this as: BMJ 2016;354:i4627
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I have always told my junior colleagues that surgery is all about preparation and a bit involving skill.
While you can teach a robot or a monkey to perform an operation, there is a limit in their ability to manage when things does not go according to plan. The aim of any surgical training is to focus on teaching skills early in the program and then later to learn to plan for unexpected events (as well as learning when NOT to operate).
Most of the time the trainees are very good at picking up skills but can run into trouble when they are out of their comfort zone. While most of us do not set out to let patients have peri-operative complications, in my experience, trainees learn far more when they learn to deal with complications than just learning to do an operation in a "normal" way. The most difficult aspect is to hold trainees back from operating unnecessarily when they are keen to show off their skills and their "look at what I can do" mentality.
I believe that a good surgeon should walk into an operating theatre to "perform" a procedure she/he has already done a hundred time mentally specifically for this patients, with clear plan A to Z if and when things go wrong. Unlike other non-surgical specialities there are few opportunities when a surgeon can stop the operation, walk away, sleep on it, and then come back to finish the operation.
As they say, if you fail to prepare, you should be prepared to fail,
Competing interests: No competing interests