What makes a good surgical trainer: Trainees' perspective


  • WALY


7JJ The Teacher


Faculty of Medicine - Zagazig University
University of Edinburgh


The postgraduate surgical training in the Egyptian medical schools adopts the traditional apprenticeship model, (Hamdorf and Hall, 2000), (Reid et al, 2000) and (Debas et al, 2005). However, the production of proficient surgeons needs the recruitment of adequate numbers of appropriate medical graduates as well as the provision of resources to educate and train them. Among these resources is the good surgical trainer, (Collins and Gough, 2010). Postgraduate surgical trainers are the focus of this research. From surgical trainees' perspective, what makes a good surgical trainer?

Summary of Work

This qualitative exploratory study has employed the constructivist grounded theory methodology for data collection and analysis, (Charmaz, 2011).

Individual semi-structured in-depth interviews were conducted to collect data from the purposively selected sample of trainees, (Patton, 2002).

Constant comparative analysis of data was aided by NVivo 10 computer programme, (2012 QSR International Pty Ltd).

Summary of Results

By analysis of the data presenting the participants' experiences as surgical trainees, as well as their views, thoughts and feelings about what happened and what should happen, during their training, the researcher arrived at the findings summarised in the illustrative model below (Figure 1).



After exploring surgical trainees' experiences with, and expectations of good surgical trainer in a medical school in Egypt, the researcher theorized that a good surgical trainer needs a set of qualifications and motivational values to fulfil his/her roles and provide better training experience.

Take-home Messages

The understanding of the trainees' expectations of the surgical trainer should inform the improvement endeavours of the surgical training programme as well as professional faculty development programmes. The surgical trainers' awareness of the trainees' expectations is hoped to improve the future training experiences.


I would like to thank all those who were my backbone throughout this work. The Co-author Gill AITKEN and the research interviewees as well my supportive family; Mother, husband, daughters and sons. Thank you dear all for your love and support.


Charmaz K (2011): Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage Publications, Los Angeles-London-New Delhi-Singapore-Washington DC.

Collins JP and Gough IR (2010): An academy of surgical educators: sustaining education – enhancing innovation and scholarship. ANZ J Surg 80: 13–17.

Debas H. T., Bass B. L., Brennan M.F., Flynn T. C., Folse J. R., Freischlag J. A., Friedmann P., Greenfield L. J., Jones R. S., Lewis F. R. Jr., Malangoni M. A., Pellegrini C. A., Rose E. A., Sachdeva A. K., Sheldon G. F., Turner P. L., Warshaw A. L., Welling R. E., and Zinner M. J. (2005): American Surgical Association Blue Ribbon Committee Report on Surgical Education: 2004. Annals of Surgery. 241(1): 1-8.

Hamdorf JM, Hall JC. (2000): Acquiring surgical skills. Br J Surg.; 87(1):28–37.

Lingard L, and Kennedy T.J. (2010): Qualitative research methods in medical education. In Understanding Medical Education: Evidence, Theory and Practice. Edited by Swanwick T. ASME, Ch. 22, 323-335.

Patton M.Q. (2002): Qualitative Research and Evaluation Methods. 3rd ed. Sage Publications. Thousand Oaks. London. New Delhi

Reid M., Ker J.S., Dunkley M.P., Williams B. and Steele R.J.C. (2000): Training specialist registrars in general surgery: a qualitative study in Tayside. J.R. Coll. Surg. Edinb.; 45: 304-310.

Weiss R.S. (1995): Learning From Strangers: The Art and Method of Qualitative Interview Study. The Free Press - A division of Simon & Schuster, New York-USA. Ebook downloaded on Samsung Galaxy Tablet from:

http://ifile.it/hfioy0/ebooksclub.org__Learning_from_strangers__the_art_and_method_of_qualitative_interview_studies.epub  retrieved on 30/10/2011

Summary of Work

Purposive sampling

In qualitative research sample selection has an intense effect on research quality. In this work, the researcher needed a sample that represents the population of surgical trainees. They include basic trainees (BTs) and specialty trainees (STs), junior and senior, and male and female trainees. Probability random sample from a population carries the possibility of the unwanted duplication of common cases and missing or improper presentation of less common ones, (Weiss, 1995: 29/248). The researcher preferred to select respondents purposively in order to include all important dissimilar forms in trainees' population. Purposive sampling helped selecting variable informants for in-depth study of what makes a good surgical trainer in trainees' eyes which is the purpose of this research, (Patton, 2002: 46).

Summary of Results

Table 1: Research sample details

Table 2 summarises favourable and unfavourable trainer's behaviours from the trainees points of view, while Table 3 shows lists for desirable and undesirable surgical trainer's impact on surgical trainees'.

Table 2


Favourable behaviours

Unfavourable behaviours

Sharing updated knowledge and skills

Being reluctant to update or share experiences

Accepting feedback

Neglecting feedback

Communicating effectively

Failing to communicate

Fostering learning:

  • Identifying trainees’ learning needs
  • Encouraging interactive learning
  • Welcoming questions
  • Clarifying Decision Making Process
  • Explaining
  • Providing helpful Feedback
  • Conveying knowledge & experience


  • Getting bored of assisting trainees
  • Ignoring questions
  • Obscuring decision making process
  • Providing destructive criticism
  • Operating without explaining
  • Depriving the trainees from operating cases
  • Leaving junior trainees' training entirely for the senior trainees

Role modelling professionalism:

  • Modelling medical ethics
  • Being honest, kind, fair, patient, modest, altruistic, committed and confident
  • Respecting trainees


  • Attending irregularly the ward rounds
  • Being deceiving, cruel, unfair, tense, nervous, impatient, arrogant, selfish and hesitant.
  • Humiliating trainees

Supporting (mentoring) trainees

  • Building trainee's confidence
  • Building rapport
  • Guiding
  • Reassuring trainees
  • Undertaking Responsibility
  • Creating comfortable atmosphere
  • Being available and reachable
  • Motivating trainees
  • Understanding trainees' limited capabilities


  • Destroying trainee's confidence
  • Putting trainees in emotional stress
  • Creating threatening environment
  • Being unreachable when needed
  • Suppressing the trainees
  • Over demanding the trainees
  • Over loading the trainees


Supervising training

  • Assigning tasks
  • Scheduling of rests
  • Clarifying ground rules & work instructions
  • Considering trainee's social life
  • Monitoring schedules implementation


  • Completely delegating the schedule monitoring to the senior trainees
  • Cancelling the trainees off-days or rest hours

Assessing trainees

  • Judging Objectively
  • Standardising assessments
  • Clarifying assessment methods


  • Assessing the trainees subjectively
  • Mystifying the assessment methods

Leading the training

  • Planning and updating training
  • Managing Time and Resources
  • Improving work conditions
  • Negotiating with Flexibility


  • Following traditional training programme me
  • Being authoritative and over controlling

Caring for patients

  • Making timed decisions
  • Keeping patient safety
  • Establishing evidence based patient management protocols


  • Neglecting patients follow up
  • Delegating responsibilities for the trainees that are beyond their capabilities.

Table 3

Desirable impact

Undesirable impact

  • Growing team spirit among residents: Sometimes they supported each other to withstand difficult situations in the absence the trainer.
  • Coping with death of cases: The trainees suffered grief for death of cases early in residency. The trainer’s support helped them overcome this status and learnt to cope with death of cases.
  • Realizing that a manner is an individual matter unrelated to surgery profession.
  • Feeling good about the training experience
  •  Adapting to difficult situations
  •  Becoming persistent
  •  Admiring surgeon's work
  •  Interacting better with people
  •  Expressing themselves better
  •  Managing time for more achievement
  •  Becoming practical
  •  Gaining patients respect
  •  Enjoying work
  •  Retaining applied knowledge
  • Becoming apathetic indifferent: for the trainer shouting and yelling when he is unsatisfied.
  • Seeking other sources for learning which may be not trustworthy: Sometimes the trainees search for learning from any source that can teach them. This threatens their sense of belonging to the university as well as these sources are not usually trustable. 
  • Hiding mistakes and withholding to ask to avoid humiliation
  • Perceiving that surgeons are of bad manners as the trainers modelled unprofessional behaviour.
  • Impaired learning and commiting more mistakes because of exhaustion.
  • Suffering emotional stress
  • Quitting/avoiding surgical residency
  • Forgetting about hobbies
  • Becoming aggressive, impatient, tense
  • Loosing patient trust

Qualifications include surgical proficiency, professional training competencies, effective communication skills and reflection skills.

Motivational values that drive the surgery trainer to utilize his/her qualification in training younger generations include believing in training mission, devotion, intention and faith.

The roles that good surgical trainer should play include fostering learning, role modelling professionalism, supporting trainees, supervising training, assessing trainees, leading training and caring for patients.

Take-home Messages
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