Learning in the surgical workplace: necessity not luxury

Surgical teaching and training has a long tradition of apprenticeship-style mentoring, which has been widely revered and respected. The teaching style and learning was feared by some, but appreciated by all. The basis of this teaching was a strong relationship between teacher and trainee that was formed over many years of close working. However, modern legislation in the form of the European Working Time Directive (EWTD) has made this relationship difficult to achieve. Shifting working patterns have broken the continuity. We need to find new ways to learn the art of surgery and to maximise the limited time that is available on the 'shop floor'.

The surgical standard working day is analysed in this article to highlight opportunities for learning, and how to exploit them. Every clinical encounter can be used for educational purposes.

Novel approaches to ward rounds are discussed, together with modifications to intraoperative training. These make teaching an active process, with the learner taking control and self-directing the process.

The EWTD need not be a disaster for surgical training. We need to rationalise and re-think our approaches, but surgical training should not be seriously detrimented by the reduction in hours. Two hours of focused surgical training is worth more than 8 hours of chaotic, random educational encounters, characteristic of previous systems.