Sherida Kelda M O, Quinton Naomi D
The Leeds Institute of Medical Education, School of Medicine, University of Leeds, United Kingdom of Great Britain and Northern Ireland.
Surg Open Sci. 2024 Oct 11;22:3-12. doi: 10.1016/j.sopen.2024.10.002. eCollection 2024 Dec.
The General Surgery (GS) educational community of practice faces crisis. Recruitment is challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility (UK Shape of Training Steering Group, 2017; Kennedy, 2021) [1,45]. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum (Brown et al., 2019) [26]. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose.
Qualitative methodology within a constructivist research paradigm was utilised. Recruitment included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. Individual semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. 'Data sets' were transformed to a thematic map and key themes identified.
Foundation, specialty doctors, core and higher surgical trainees were included (60 % men, 40 % women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency.
The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.
普通外科（GS）教育实践社区面临危机。招募工作受到推迟基础培训文化规范的挑战；而留住人才则面临着精英主义、歧视和僵化观念的影响（英国培训模式指导小组，2017年；肯尼迪，2021年）[1,45]。外科教学法已通过技能习得进行了研究，但隐藏课程呢（布朗等人，2019年）[26]。提出了三个研究目标：普通外科医生是什么样的人，从事这一职业的促成因素或障碍有哪些，以及我们目前的英国培训体系是否符合目的。
采用建构主义研究范式中的定性方法。招募对象包括初级医生的代表性样本，包括男性、女性和来自不同种族背景的医生。个人半结构化访谈探讨了参与者对培训、招募和工作与生活平衡的看法。数据进行了转录、熟悉、解构和生成。潜在数据分析、编码和发展过程中保持了反思性。“数据集”被转化为主题图并确定了关键主题。
纳入了基础医生、专科医生、核心和高级外科住院医师（60%为男性，40%为女性）。确定了支持、态度和牺牲等基本主题，它们相互作用影响教育叙事。支持包括个人、机构、学术和文化形式。精英主义态度、隐性和显性的性别偏见、微侵犯以及作为外科传统隐藏起来的公然歧视。注意到一个总体的牺牲概念：个人、职业、财务和情感方面的，即所谓的外科代价。
该研究探讨了普通外科领域的表现型、动机、智力和理念。突出了围绕消极态度、文化和行为的系统问题，教育是一种强大的工具，可用于挑战观念并改善培训。
