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Views And Reviews

Should medical training be something we “survive”?

BMJ 2020; 371 doi: (Published 07 December 2020) Cite this as: BMJ 2020;371:m4738
  1. Greta McLachlan, general surgical trainee1,
  2. Simon Fleming, trainee orthopaedic surgeon2
  1. 1Cleveland Clinic London, UK
  2. 2Barts and the London School of Medicine and Dentistry, UK
  1. greta.mclachlan{at}
    Follow Greta McLachlan on Twitter @geemclachlan and Simon Fleming @orthopodreg

The change precipitated by covid-19 has shown us that just because it’s “always been done this way” doesn’t mean it should be, or has to be

During the second world war, planes would return home with bullet holes in their metalwork. The US military thought, logically, that the way to protect these planes during their next flights was to reinforce the areas that had been hit. Abraham Wald pointed out, however, that these planes had survived enemy fire and made it home. Therefore, the areas of direct harm were survivable. The areas that hadn’t been hit likely represented where other planes had been hit and not made it home. So those were the areas that should be reinforced. Welcome to the concept of survivorship bias.

All of us have a survivorship bias when it comes to how we were trained, or are being trained, in medicine. We made it through our training (at least, thus …

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