Case study

General surgical registrar — Rachael Clifford

Rachael describes how training in general surgery suits her practical hands-on approach. Her skills and experience are developing as she progresses through the training

How did you get your job as a trainee surgeon?

Once I had completed my two-year Foundation Training programme and made the decision to go into surgery, I had two stages of national selection interviews to complete. The first, at the end of my Foundation Training, was to access the senior house officer (SHO) level core training, and the second, following the completion of that training, to become a registrar.

What's a typical working day like?

A typical day in a surgical speciality always starts at 8am. The first hour involves doing a ward round of my inpatients with the rest of the team to identify any problems that need sorting out early on. On the day of a theatre list, the pre-operative patients are also seen first thing to check their consent and that everything is in order. The rest of the day is either spent in theatre, outpatient clinic or a session relevant to my specialty (such as endoscopy or interventional radiology).

What do you enjoy most about being a trainee surgeon?

I'm exposed to a wide variety of medical specialties. Right from early on, the main feature of a surgical rotation that I enjoyed was the emphasis on team working. From training in theatre to post-take ward rounds everything is approached very much as a team, which brings with it a great support network.

I prefer taking a practical hands-on approach to work, so witnessing instant treatment outcomes and seeing the benefits in my patients is always hugely rewarding. Although demanding and requiring a great deal of commitment, there is no other job that I would prefer to be doing.

What are the challenges?

Technically we're able to perform most operations on most patients, but the challenging side of surgery is making the decision that surgery isn't in a patient's best interests. Explaining to a patient and their family in the acute setting that an operation would not be the best thing for them, and there is no other alternative treatment, can be challenging on both a communication and emotional level.

The on-call shift patterns and length of 'normal' days can also be challenging when trying to achieve a good work-life balance.

In what way is your degree relevant?

My degree in medicine was essential in becoming a surgeon. It gave me crucial medical knowledge and a platform to go forward and experience job rotations to discover where I wanted to take my career.

How has your role developed? What are your career ambitions?

As my training progresses and my seniority increases, my level of responsibility and exposure in theatre does also. Assistance with cases is replaced by becoming the primary surgeon, and alongside operating independently you then take on the next role of training younger surgeons.

Although it's daunting at first, our attitude towards teamwork means that there's always a support network in place to enable this to happen in a transitional way. As my knowledge and experience has progressed I've adopted a more prominent decision-making role in terms of running a theatre list, reviewing patients in clinic and leading on-call ward rounds.

My aim is to become a resection colorectal cancer surgeon. As consultant job interviews are competitive, we're advised to complete a period of research (MD or PhD) and fellowship period in our area of interest at the end of training to prepare for the final interview stage.

What are your top tips for someone wanting to become a surgeon?

  • Have confidence in yourself. Throughout each stage of interviews and job applications there's always competition and it's easy to feel stressed. However, your interviewers aren't trying to catch you out and are just looking for enthusiastic doctors who are serious about being trained.
  • Even if you're not certain about a surgical career early on, try to make your CV impressive so you don’t rule it out as an option for yourself. I didn't decide that I definitely wanted to be a surgeon until the end of my first year of Foundation Training (which is late by most people's standards), but by throwing myself into audit and teaching, I didn't struggle to get a core training job first time round.
  • Show your consultants and registrars that you're enthusiastic to experience time in theatre. Exposure to the job and getting hands-on is the only way to truly experience whether the career is right for you. Even as a foundation year doctor, I was encouraged to learn and progress my basic skills in theatre.

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