Surgical training - can we learn from aviation?

Abstract

The following two articles identify similarities between professional air crew and surgeons, both being leaders of multidisciplinary teams and holding ultimate legal responsibility. In the first article, British Airways training captain Guy Hirst illustrates the non-adversarial teamwork inherent in effective crew resource management with confidential reporting of adverse incidents and the care with which flight instructors are selected and nurtured. Denis Wilkins, a senior surgeon, demonstrates in the second article that nobody takes responsibility for the 'signing off' of trainees for any particular surgical procedure. There are, of course, differences in the training environments of the professions. Advance flying training requires a student pilot to put an aircraft into critical situations and to demonstrate the ability to recover. Mostly, this can be performed repetitively either at sufficient altitude or in the safety of a simulator. In surgery, one cannot purposely put a patient 'at risk' to enable trainees to demonstrate their skills at 'recovery' and surgical simulators are in their infancy and do not achieve priority in a cash-strapped NHS. The authors recognise the need for properly selected trainers who are remunerated accordingly. Having been both a flying instructor and a surgical trainer, I can testify that both professions require patience, rapid reactions and the ability to remain calm. These papers are fascinating and timely in the era of introduction of new surgical curricula. Surgical training requires considerable funding at grass-roots level to catch up with the standards of aviation.