Holding Surgical Educators to a Higher Standard

Education should be about the learners, not the teachers.

When things go wrong in surgical education, the default response involves blaming the learners. However, it is time for surgical educators to step up, look inwards, and realize that when educational interventions fail to meet expectations, we are usually the problem, not the residents.

At every program I’ve been involved in, I’ve seen a variation of the following:

• program has weekly educational session.
• attendance starts to slip at the mandatory session.
• program wonders “why aren’t my residents showing up/they must not be taking their education seriously enough/let’s send them a strictly worded email to remind them that attendance is MANDATORY”
• a notable lack of introspection about “I wonder if the residents actually find the educational conferences useful”

Let’s go back to your average medical student. They are incredibly bright and hardworking, with stellar academic accomplishments. They beat out a whole host of highly accomplished individuals just to get into medical school. Then, in medical school, they continue to push themselves hard to achieve success.

They invest hundreds of dollars on top of the hundreds of thousands of dollars of debt they are accumulating just to attend medical school in external educational resources such as First Aid, Pathoma, SketchyMedical, OnlineMedEd, and UWorld to prepare for the tests that will shape their future and to learn medicine more effectively.

Then, some of these medical students become surgery residents. You take an extremely bright, motivated population, and subselect a group of people with the sort of work ethic and ability to defer immediate gratification for the duration of 5-7 year training programs involving 80 hour work weeks.

Then, you host your educational conference or training session, and they don’t attend.

And the first thought is that these highly tested/proven individuals are now too lazy to invest in their own surgical education??? These residents come to the hospital at 5AM six days a week, stay late, then spend a large amount of their free time at home studying and preparing for clinics or cases the next day. 80+ hour week after 80+ hour week. And they do it because learning surgery is more important to them than almost anything else in their lives. Often more important than sleep, time for self care, time for family…

The problem is not the learners. The problem is us. Surgical learners have worked hard, powered through, and learned to be excellent surgeons often despite our best educational interventions/conferences/simulation, not because of them.

We need to take the focus off of ourselves as surgical educators, off our papers, our careers, our committees, our pet project ideas, and focus back on who really matters in surgical education—the learners.

These learners will walk through walls to learn surgery. Instead of forcing our ideas onto them, we should provide the best resources for learning surgery to them and get out of their way.

We should take a product development view towards any sort of educational intervention or conference or simulation. As surgical educators, we are product developers. We do our best to create a useful product and then give it to our users, the learners. If it is a good product, they will use it. If they don’t, then we built the wrong product and need to go back to the drawing board and get better. We do not need to treat our highly motivated and intelligent learners as children, trying to enforce compliance and wondering why we often get half-hearted buy in.