Do you have what it takes?

April 30, 2014 By: Bjorn Rembacken

Do you have what it takes?

Every year we are hosting a one year’s Endoscopy Fellowship in Leeds. The aim is to provide one of our senior Gastroenterology Trainees with a grounding in advanced therapeutic endoscopy.

Unfortunately, it has become apparent that not every trainee is comfortable with advanced therapeutic endoscopy.  They have a problem with the unpredictability of neoplasia and therapeutics.  Sometimes the resection goes to plan but at other times there is pain, immediate bleeding, delayed bleeding or even perforations.  Unpredictability is an inherent part of endoscopic therapeutics.  In fact, it is one of the reasons that I love it.  Not two cases are the same!

However, some of our trainees find this new role deeply unsettling.  Up to this point in their careers, they have never found themselves to be the reason why their patient ends up on the ITU or admitted for live saving emergency surgery or readmitted with a haemoglobin level of 40.  

A few years ago the Christmas edition of the BMJ published a tongue-in-cheek piece of research which clearly identified the "Therapeuticians” from the “Diagnosticians” (those who dare from those who duck).  A plucky researcher hid in the car park of a large hospital and secretly timed how long it took for surgeons to park their cars compared to the medics.  There was a clear divide, whereby surgeons would park their cars 20% faster than their medical counterparts.  The reason was not that the medics were driving larger cars but because they were far more cautious.  They would pull up to a free slot but bail out because it looked a little tight, or was close to a bend or required reversing into the slot etc.  The surgeons had more confidence in their abilities and were less concerned about what could go wrong (scratched paintwork). 

I now try to dissuade the trainees from applying who are the least likely to be comfortable in a life of therapeutic endoscopy.  It is easy to identify them. They will not miss an opportunity to phone you for advice, craving reassurance that they are doing the right thing. They feel uncomfortable making decisions, particularly if it has to be based on a “best guess” rather than a treatment protocol.   Paradoxically, I regard our ability to assess large amounts of partially contradictive and confusing information and provide a sensible and educated guess, is what separates us from nurses.  This is what we are trained for! 

I do ask trainees if they think that they would be happy in a professional life of removing large and scary lesions.  Unfortunately, most trainees have little insight into their own comfort zones.   Perhaps I should change my approach and simply time how long they take to park their cars. 

About the author

Bjorn Rembacken is at Leeds Teaching Hospitals NHS Trust, Leeds, UK. He was born in Sweden and qualified from Leicester University in 1987. He undertook his postgraduate education in Leicester and in Leeds. His MD was dedicated to inflammatory bowel disease. Dr Rembacken was appointed Consultant Gastroenterologist, Honorary Lecturer at Leeds University and Endoscopy Training Lead in 2005. Follow Bjorn on Twitter @Bjorn_Rembacken

 

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