BoSS Podcast Episode 10: Mental Management of Complications, Reputation and the Uneven Politics of Forgiveness

And again, you have very long experience in training people as well.

And David, coming back to you, you have watched a lot of younger Sergius, I'm sure, experience complications for the first time, perhaps.

Can you remember a situation or a specific kind of like trainee perhaps where you saw that they were affected really badly by what happened in theatre and their confidence changed or the way they were thinking about their career changed because of that?

I'm going to come back to that.

I want to just set the scene because it's going to be different across Europe.

But in the UK, we endorse simulation and modular training.

So even if I don't like you, I still have to train you.

And the way we train is we get people to do simulation.

So they practice in simulation and then they perform on patients.

So if you're a first year training with me, you don't have the pressure and panic of the one golden case simulation.

This is your 30 minutes.

Do your worst.

But if you mess it up, that's it for another week.

And that pressure is crippling.

Very, very difficult.

Whereas if you say to the trainee or the resident, you're going to do all the incisions on every case this week.

And once you become competent at that, you'll then start doing the rexus on every case this week.

And then eventually we'll put it together.

Often we do it backwards, as you know, insert the lens, wash out the viscoelastic.

So you build up your competency and there's the four stages where you move from unconsciously incompetent where you don't know how you don't know what to do till you start realizing you're consciously incompetent you realize you don't know what you're doing then you become consciously competent with thought and deliberate action you can do the things and then eventually the experts are unconsciously competent that they just do it naturally but you can fall back down that and I remember a particular trainee who was off on the long term for personal reasons and came back and they'd slip back down that and they had lost confidence but they need a lot of encouragement to get back on the simulator to get back up and running because their surgical numbers were at a stage where they thought they were better than they were And so that person was quite difficult to try to reestablish their baseline and how to improve where they're at.

And so they find surgery extremely stressful.

But I would say at this point, in case I forget to say it later, I would rather have a conscientious resident and trainee who is concerned when things don't go perfectly than one who is blasé towards the end of their training, who thinks themselves, oh, you need a few complications under your belt because I'm going to be a consultant.

You know, that person is much harder to train.

And I don't know if you know about Nike running in Portland, Oregon, but what they do is they take all the runners across the USA, bring them to Portland, Oregon, And the first thing they do is they teach them to walk properly before they teach them to run, before they teach them to be world class.

And some people can't hack it.