The Consultant They See Coming

There comes a point in surgical training when people stop looking at you as a trainee and start looking at you as a future colleague.

Nobody announces it. There is no examination to mark the moment, no certificate, no letter. But you feel it. The questions put to you change. The conversations become more interesting. The expectations shift, almost imperceptibly, from whether you can do something to how you would do it.

And occasionally, the relationships become more complicated.

For years you have been the one learning from everyone else. You have asked the questions, followed the instructions, sought the advice, and tried, day after day, to become good enough to operate on your own. Then, somewhere towards the end, people begin to realise you are nearly there. You are no longer simply the registrar.

You are the consultant they can see coming.

I have often wondered whether that is the moment some trainers find hardest. Because the question is no longer whether you will pass your examinations or complete your training. The question, unspoken, becomes something else entirely.

What happens when you no longer need them?

Surgical training is an unusual relationship. For years, one person holds something another person wants: knowledge, experience, technical ability, credibility and, perhaps most importantly, access to opportunity. The trainee wants to acquire those things. The trainer is meant to help.

In theory it is simple. The better the trainee becomes, the more successful the trainer has been.

At the beginning, the hierarchy is obvious and nobody questions it. The consultant knows more. The consultant decides; the trainee learns how decisions are made. The consultant operates; the trainee assists. Then, gradually, the trainee begins to operate, first under close supervision and later with growing independence.

Towards the end, something interesting happens. The distance between the two begins to narrow.

The trainee may have developed a particular interest. They may have spent time in specialist units, learned techniques their trainer does not routinely perform, built research and networks in areas beyond their trainer's world. And quietly, the relationship stops being entirely one-directional. The trainee still has a great deal to learn. But the trainer may now have something to learn from the trainee.

That is when you discover who has really been teaching you.

I have come to believe there are broadly two ways a trainer responds when a trainee approaches independence.

The first sees an achievement. They look at the person in front of them and recognise the years of work that brought them there. They are pleased, and they show it. They introduce you to colleagues. They point you towards opportunities. They let you operate. They start treating you as the consultant you are about to become. Occasionally they tell you that you are better at something than they are, and they mean it.

The second response is harder to describe, because it rarely announces itself.

The trainee's growing independence seems to create a kind of friction. Criticism sharpens. Opportunities become harder to come by. Things that were acceptable last month are suddenly questioned. You are reminded, in various ways, that you are not quite ready. Not quite experienced enough. Not quite mature enough. Not quite the finished article.

Sometimes, of course, that is entirely fair. Surgical training is not a popularity contest, and no patient should be exposed to risk because a trainee is impatient to progress.

But there is a difference between identifying a genuine limitation and repeatedly moving the point at which someone is considered ready.

Most experienced trainees eventually learn to feel that difference long before they can prove it.