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Ramez Kirollos, a consultantneurosurgeon from Cambridge, hastaken the title of surgical trainer ofthe year as he picks up the SilverScalpel award for 2010. Now in itstenth year, the Silver Scalpel isorganised, funded and awarded bythe Association of Surgeons inTraining (ASiT) to recogniseexcellence in surgical training. It isawarded annually to inspirationaltrainers who have scored highlyacross five categories: leadership,resourcefulness, training anddevelopment, professionalism, andcommunication. In March this year,Mr Kirollos was presented with theaward.

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‘Fantastic,’ replies Mr Kirollos, when askedhow he feels about being presented withthe title. The consultant at Addenbrooke’sHospital, Cambridge, adds quickly that theaward came as a complete surprise andthat he feels he has not done anythingmore than his trainers did for him.

This modest reaction reflects MrKirollos’s general philosophy on asuccessful trainer–trainee relationship.According to the consultant, successfulsurgical training is based on treating yourtrainees as your friends and futurecolleagues and ultimately on recognising

that trainees are the future of surgery. Heexplains: ‘It was the standard set when I wastraining and it works. I have a few traineeswho have been appointed consultants whoare better than me and it’s something I’mproud of. As long as one of your aims as atrainer is making the new generation betterthan you are then a successful relationship iseasy.’

Mr Kirollos is responsible forapproximately 13 trainees within theneurosurgery department atAddenbrooke’s, looking after a mix ofregistrars and clinical researchers. One ofthese trainees, Adel Helmy, currently aCollege/Medical Research Council clinicalresearch training fellow within thedepartment, nominated Mr Kirollos forthe Silver Scalpel in November 2009.

Mr Helmy explains that part of hismotivation to nominate Mr Kirollos washis gratitude for the consultant’swillingness to go ‘above and beyond’ whata trainer is required to do. Mr Kirollosexplains that taking time to build a good,trusting relationship with each individualbenefits both trainer and trainee. ‘Youlearn how your trainee learns and knowingthem also helps to predict where a problemmay arise,’ he says.

TimeWith the introduction of the EuropeanTime Working Regulations (EWTR) and

other service demands, the squeeze ontraining time has prompted somesurgeons to call for protected trainingtime to be added into trainees’ contracts.However, when asked about protectingtraining time, Mr Kirollos is not drawninto the discussion. He says: ‘Time is not aproblem when you like something; you alwaysfind time for it.’ According to theconsultant, the introduction of the EWTRis not the major challenge for a trainee;he feels instead that the pressure of the‘tick-box culture’ within the trainingstructure often causes more problems.

‘In my opinion EWTR is not the biggestobstacle,’ he says. ‘It is the paperwork thetrainees have to complete alongside theiroperative training. When I was a trainee wewere trusted to get on with things but these

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SURGICAL TRAINERSDOI: 10.1308/147363510X514073

Mr Kirollos receiving his award from David O’Regan

CHASING THE PAPERWORK TO PROVETHEY HAVE DONE SOMETHING MAKESTRAINEES FEEL LESS PROFESSIONAL.

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days they are being given paper to counttheir hours on or they are being asked forevidence of training. Chasing the paperwork

to prove they have done something makesthem feel less professional.’

ValuesMr Helmy says that Mr Kirollos stood outfor nomination because of the emphasishe puts on the basic science and anatomybehind neurosurgery. ‘It’s refreshing that thewhole department at Addenbrooke’s valuesanatomy so highly; sometimes within trainingit is neglected in favour of other morefashionable elements such ascommunications skills. Mr Kirollos inparticular gives up a lot of his own time toteach us the anatomy behind the surgicalapproaches,’ he says. ‘In addition to weeklyteaching we benefit from his professionalinterest in developments in neurosurgicalanatomy; for example, Mr Kirollos hascreated a successful international coursecalled Cambridge Lectures inNeurosurgical Anatomy, which has brought3D technology into our department – aunique and valuable resource.’

He also cites Mr Kirollos’s values andapproach to professional conduct asanother reason: ‘Mr Kirollos’s ownprofessional practice encompasses properfollow-up of his patients, includingunderstanding how complications have

affected patients not only post-operatively butsix months or two years down the line. As atrainee, learning this approach gives you a

more rounded view of how a patient hasdone,’ he says. ‘This is important withinneurosurgery as what you feel is a successfuloperation can often give you a skewed ideaof what is a good clinical outcome. Withoutappropriate follow-up you don’t see theimpact that an operation has on a patientover time.’

CareThe Silver Scalpel award also recognisesthat good trainers provide an element ofpastoral care alongside operative training.Mr Kirollos explains that this is where agood trainer–trainee relationship isessential. ‘A trainee being stressed orovertired doesn’t come as a surprise whenyou know your trainees well. You can predictit,’ he says. However, he adds that thehardest part of caring about your traineeis when something goes wrong and apatient is involved. ‘This is a very difficultsituation because patient safety is paramountin all training; however, if a trainee is facingdifficulties it is vital that trainers intervene ina way that does not destroy his or herconfidence forever.’

Mr Helmy concludes that all good surgicaltrainers, including Mr Kirollos, leave alasting impression. ‘All trainees are a

product of their trainers, that’s the key thingabout surgical training,’ he says. ‘You pickand choose the best ways to do things fromeach of them and their input moulds you intothe surgeon you become.’

Previous winners2009 David Khoo2008 Ajith Siriwardena2007 Ian Gunn2006 Fiona MacNeill2005 David Jaffrey2004 Ray Clarke2003 Christopher Curwen2002 Henry Sue-Ling2001 Mike Hershman

Details on how to nominate trainers forthe 2011 Silver Scalpel award will beavailable on the ASiT website(www.asit.org) in the autumn.

Adel Helmy

YOU CHOOSE THE BEST WAYS TO DOTHINGS FROM EACH TRAINER ANDTHEIR INPUT MOULDS YOU INTO THESURGEON YOU BECOME.

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