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Chapter V.  Embracing the Modern Age






            Tweaks to Training

                                                                                                                                                             A Typical Day


            Surgical training is rigorous, whatever
            era it is conducted in. In the past, interns
            were thrown into the deep end and mainly                                                                                                         Surgical  trainees  today  work  in less  starting work at 5.30 in the morning. I’m
            learned by watching and doing. In more                                                                                                           difficult physical conditions than their  on call that day so I won’t be able to sleep
            recent times, the Department and the                                                                                                             seniors did, but they still put in the hours  and then I work through Thursday the
            College of Surgeons of Hong Kong have                                                                                                            and effort to become skilled at their craft.  whole day and leave at 8pm that night,
            implemented more structured training to                                                                                                          Several recent trainees recounted their  without a single minute of sleep. That was
            ensure all surgeons in Hong Kong achieve                                                                                                         experiences.                                 my junior years. But it meant that when I
            consistent standards.
                                                                                                                                                                                                          became a higher surgical trainee, life was
                                                                                                                                                             Professor Matrix Fung, now Chief of  easier compared to trainees from other
            All the Department’s surgical trainees
            are required to take mandatory courses,                                                                                                          Division of Endocrine Surgery, did his  hospitals. Some of them transferred out.”
            including ATLS for trauma, a critical care                                                                                                       surgical training in the 2010s. “My typical
            course and research training, and to rotate                                                                                                      day as a trainee was ultra busy. There was  Things are a little more reasonable now
            to other centres besides Queen Mary                                                                                                              not much sleep because after work, you’re  with the post-call half day, according to

            Hospital. Trainees do not perform most  Surgical skills training at Surgical Skills Centre.                                                      doing research, writing papers, preparing  surgical trainee Dr Joshua Hui. “I think
            procedures until they reach higher levels                                                                                                        for presentations. I worked maybe 85-90  going into surgery, you are going to spend
            of training, something that is probably  “mandatory” means junior staff cannot be                                                                hours in the hospital, excluding time I  more time in the hospital than some
            better for patients. Basic surgical training  pressured to forgo their break). An effort                                                         worked on these other things at home  other specialities because it’s a physical
            lasts a minimum of two years, at the end of  has also been made to boost camaraderie                                                             on my computer. It’s quite tough in the  craft and you need to do a lot of hours
            which is a three-part membership exam –  and bonding among junior staff through                                                                  trainee days but I’d say it’s good training.  to train. Usually, my hours are 7am to
            two written and an Observed Structured  social and training events, echoing back                                                                 It equipped me with an academic mindset  5.30 or 6pm. Twice a day we do the ward
            Clinical Examination of their skills –  to the days when the Department was                                                                      that all surgeons in our unit have. This  round. During the day, I’m sometimes
            followed by another four or five years  very small and everyone knew each other,                                                                 is one of the core values of Queen Mary  in the clinic or in the operating theatre
            of specialty training. The Department  but without the expectation that their                                                                    Hospital that is unique.”                    assisting the consultant surgeon. I’m on
            supports trainees by conducting seminars  whole lives belong in the Department.
            and mock examinations.                                                                                                                                                                        call four or five times a month. I knew it
                                                         “It should not be a question of whether                                                             Dr Alvin Siu, who also did his training in  was going to be busy. I expected it. And
            Even with the HA’s stated 65-hour limit,  one should sacrifice life for work, or vice                                                            the 2010s, also remembers very long hours,  I know we are less busy now than, say,
            the hours can extend upwards. Junior  versa. It should be about ensuring that                                                                    which he said was good preparation. “In  the generation before was. My seniors at
            doctors are on call four or five times a  trainees acquire the appropriate level                                                                 my trainee years it was very demanding.  consultants’ level say they were already
            month and while this is less than their  of skills and knowledge by adopting a                                                                   The intake was not very high – there were  working on appendices and doing some
            predecessors (some were on call twice a  competency-based approach to surgical                                                                   fewer than 10 of us so we had eight or 10  operations themselves, which I won’t start
            week or more), until very recently they  training. These days, the ’time-based’                                                                  on-call days a month. Now, the intake is  to learn until I’m at a higher training
            could end up working 36-hour shifts  or ‘case-volume-based’ approaches of                                                                        almost double. But it was just like army  level, so the learning process is a little
            without a break when their regular duties  old do not suffice.”                                                                                  training. I still remember when I was in  slower than before.”
            were added in. This was a major factor              - Professor Gilberto Leung,                                                                  the hepatobiliary team, on a Wednesday
            in lower recruitment levels. In response,        Clinical Professor and Past-President
            the Department introduced a mandatory               of the Hong Kong Academy
            post-call half-day, which entitles staff to           of Medicine (2020-24) -
            a half-day off after being on call (and







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