Stop the presses! A conviction I have held deeply for quite a long time has been effectively challenged, thanks to Dr. Sid.
Here is the excerpt (full post here) that got me thinking:
Sick and brutal as it may be, the constant haranguing of trainees -- the endless reminding them that they know nothing, that they're a bunch of screwups, that there's a chain of command they must follow, that if something goes wrong they are responsible -- all that stuff that's unique in its severity in surgical training makes for a deep and abiding sense of limits. More than anything else, that's what keeps patients safe and their doctors out of trouble.Wow. He's right.
Until the moment I read this, I felt strongly that the inhumanity of surgical training was nothing but gratuitous hazing that was unnecessary at best and cruel at its worst. What good could possibly come of brutal head games? What does humiliation and browbeating have to do with acquiring surgical judgement and skills?
I won't go so far as to say, "Now I get it." I will say that I better understand that one of the results of this training is recognition of one's limits. Apparently it works. I still wonder if it's really the only way to inculcate these values, or even, if there are other ways, whether it's the best. How would we know? Generate a "new paradigm" in surgical training, randomly assign trainees to one or the other, then compare how much trouble they get into once they're out in practice? Yeah, sure.
Still, I do believe the harshness of the training would be more palatable if it were made clear from the outset that this treatment was not personal, but that the internalization of limits was the true goal. And for what it's worth, the present system does not appear to work flawlessly. There are still far too many stereotypically arrogant and personally dysfunctional surgeons around who I'm sure were harmed more than they were helped by the abusiveness of their training.
But thanks, Dr. Sid, for the first rational justification for surgical training I have ever heard. You have given me a lot to think about.