Redefining the Professional Identity of the Surgeon by Reflecting on Critical Incidents in London, United Kingdom

Abstract

INTRODUCTION: Critical incidents are increasingly prevalent documented events in National Health Service (NHS) hospitals in the United Kingdom. Claims are made against the NHS in cases of medical negligence, with Obstetrics and Gynaecology accounting for 15% of the total claims, the second highest among all specialties.  OBJECTIVE: To understand the impact of critical incidents on the developing surgical identity of Obstetric and Gynaecological trainees in London, United Kingdom. METHODS: A Qualitative study using semi-structured styled interviews. The interviews were audio-recorded and subsequently transcribed. The data was then analysed. Six trainees, of specialist trainee level three to seven were interviewed separately. This consisted of five female and one male doctors. This is within the current gender ratio difference in London. RESULTS: Undergoing a critical incident was felt to be a traumatic experience for all trainees involved. The incident itself and its management by the department, hospital or deanery had a significant impact on the psycho-social well-being of the doctor involved. Critical incidents can negatively affect the professional development of the surgeon. Surgical identity is an area that appears to be in the hidden curriculum, however many trainees struggled to define what their surgical identity was and how it may have been affected. CONCLUSION: Critical incidents cause significant psycho-social distress for the developing surgeon. Surgical identity should be implicitly understood within medical education. This study highlights the urgent need for those writing medical curricula; both undergraduate and postgraduate to make the implicit explicit. Surgical identity discourse must be a priority for the new curriculum. Professionalism and an ability to endure the psychological stress caused by undergoing critical incidents is likely to be enhanced, by creating a strong sense of belonging within the surgical profession. The loss of the traditional apprenticeship model and its mentors must be considered within the new design.