Coffee room culture wars
Each generation faces their own challenges. If the modern trainee
were to be transported back in time by several decades, the
lack of guidelines, limited access to diagnostic testing, and what
would seem to be ludicrously primitive monitoring equipment
would be totally disorientating, and likely terrifying. If we were
taken back less far, perhaps to witness the training many of
our current consultant colleagues underwent, we might well
be shocked at the long hours worked with more limited senior
support and also impressed by the resilience displayed in the
face of such attrition and responsibility.
“The world is passing through
troublous times. The young
people of today think of
nothing but themselves.
They have no reverence for
parents or old age. They are
impatient of all restraint. They
talk as if they knew everything,
and what passes for wisdom
with us is foolishness with them."
Peter the Hermit, 1274 AD
But what if we were to imagine a trainee from twenty or thirty years
ago moved in the opposite direction to the present day? I don’t
believe it’s a great stretch to say that they’d be astounded at how
frequently concern over the possibility of something going wrong,
with the potential for legal action is
mentioned in the workplace. The
lack of respect sometimes shown
to rotational trainees by other
members of the healthcare team, to a
doctor from a more hierarchical age,
might well be downright shocking
to them. Even a more recent trainee
of the ‘see one, do one, teach one’
generation might be astounded
by the burden of assessments,
logbooks, and associated admin
their modern peers must laboriously
grind through if taken directly from
then to now.
This is not to say that in many respects
modern trainees do not enjoy a
considerable number of benefits as
compared with their predecessors. I
am sure that reduced working hours
have improved our quality of life.
Modern standards for supervision
mean we are less likely to be placed
in a position where we feel out of
our depth and concerned that despite doing our best we may
not be providing an optimal standard of care for our patients. But
there are two sides to every story. When members of the older
generation of anaesthetists describe how they managed backto-back laparotomies alone as a first-year trainee overnight, the
(typically unspoken) question is ‘but would you want your relative
to receive that care?’ (and NELA evidence would suggest not [1]).
Having said that, in certain circumstances today trainees might
want to take on greater responsibility, but there is perhaps a
higher level of concern than in the past that bad outcomes may
not only be devastating for the patient but could be professionally
disastrous. This leads to, I suspect, greater fear amongst trainees
of making a mistake, and to consultants giving less autonomy to
trainees under their supervision, sometimes micromanaging every
case. It’s a far cry from a broader medical culture in which ‘we all
kill a few as we learn’ [2] was the prevailing attitude, as the doctor
turned scriptwriter Jed Mercurio once claimed. This is clearly a
good thing, but in a perverse way might lead to modern trainees
ruminating on potential or actual errors to a greater degree than
their forbears.
In all areas of life and culture, it’s not unusual to encounter a
certain intergenerational tension. This is as true in the workplace
as it is outside of it. A certain amount of ‘back in my day’
proselytising from the generation above is to be expected, and
sometimes there’s insight and
amusement to be gained from this.
But I worry that over the past couple
of years, especially in the wake
of COVID and with the endless
widening of cracks in the NHS
and its ability to provide effective
services, this sort of rhetoric has
become increasingly pernicious.
Rather than a bit of semi-serious
lamenting of the ills of the modern
youth, there seems to be an
embittered attitude wrapped up
in complaints about ‘wokeness’
(whatever that indeed may be),
references to the supposed fragility
of young adulthood revealed in
references to snowflakes, and the
apparent belief that this time we
really are witnessing the terminal
decline of western civilisation/
the last days of Rome (delete as
appropriate). The regularity with
which one overhears conversations
where the central theme is of the
inadequacies of young adulthood, sitting adjacent to discussions
around the failings of modern training (and by clear implication,
the modern trainee), is wearing, and after a while biting your
tongue gets a bit sore. Disconcertingly, there often seems to
be an unspoken association drawn between the ills of modern
society and the ills of modern practice and training, or at the
very least, an implication that the sensitivity and lack of resilience
amongst the younger generation more broadly is reflected in the
modern trainee. As a peer once put it, it seems that in the past
‘everything was somehow more demanding, more difficult, and yet better in every way,’ which would seem, I think is fair to say, an
unlikely proposition.
Of course, the inevitable response of many reading this would
be to point out that I am exemplifying the precise attitude
for which the younger generation are criticised. ‘Woe is me,
exposure to such subtle, perceived cruelty is simply unbearable!’
(don’t worry, I can handle it). But this would be to misunderstand
my point. As the words opening this piece demonstrate, it has
been the case for as long as there have been humans living
together that there have been tensions between generations and
that the younger generation are perceived to be insufficiently
respectful, or lacking in character, by the older generation. If you
were to take the central theme of any criticism levelled at trainees
today, or of that directed in tabloid columns at ‘woke millennials,’
you’d find it replicated a generation ago, and before that, ad
infinitum. What I am asking for is simply what youth is historically
accused of lacking: respect, which should also be given in
kind. I respect the difficult conditions faced by my current
consultants when they trained. I respect the personal sacrifices
they may have made to complete training. And I respect the
fact that society changes, and if you’ve grown up in a certain
social environment, and that environment and its norms change,
that can be unsettling, and at times may even seem silly. I am
incredibly grateful that my experience as a trainee is certainly
better overall than that experienced by previous generations, in
no small part due to the battles fought on my behalf by some of
their members. But the difficulties of being a trainee, or indeed
just a younger adult trying to find their way through life, don’t
just completely disappear, they too change. Each cohort of
anaesthetic trainees must navigate the complexities of evolving
clinical environments, and we must all traverse a collective
social space together, even if we’re stumbling around a bit
confused much of the time. Given the turbulent period we live in
(aren’t they always) and the challenges the NHS faces, wouldn’t
it be better to do so with a sense of mutual respect, and an
understanding that the experiences of one generation and the
next may differ, but they are both equally valid. We could then
perhaps begin to recognise that our contrasting experiences
should be a source of interest, and something to learn from,
rather than derided.
Nicholas Hobbs
ACCS CT4 (Anaesthetics)
Barnsley Hospital NHS Foundation
Trust, Barnsley, South Yorkshire
References:
NELA Project Team. Fourth Patient Report of the NationalEmergency Laparotomy Audit. London: RCoA, 2018.Mercurio, J. 'We all kill a few patients as we learn.’ The Guardian:Health and fitness. 2004 May 18 [cited 2023 Oct 29].