Doceo ergo sum: mentoring surgeons

Mentoring is an essential element of a life in surgery. I teach, therefore I am. Programs that promote practice-sharing between ex perienced surgeons transitioning out of practice and new graduates entering surgery would facilitate effective mentoring. Gaspare Tagliacozzi (1545–1599), a great teacher of surgery, is credited with the “modern” introduction of the cross pedicle flap graft to reconstruct the nose. There is creditable evidence that his technique originated in India 1500 or more years earlier. The link may have been through Greco-Roman medicine in southern Italy, but the secret was maintained as proprietary knowledge within families of hereditary surgeons. We remember the teacher rather than earlier practitioners who chose not to share their skill. If any surgeon today is likely to be remembered in 500 years it will be the American Thomas Starzl (1926–2017) who taught surgeons from every country including Canada the physiology of the liver and how to transplant the organ. The Canadian Journal of Surgery (CJS) mourns the recent deaths of 3 surgical masters by celebrating their lives as teachers. Jean Couture (1924–2016) was chairman of the department of surgery at Université Laval, where he mentored generations of surgeons.1 Dr. Couture led and taught nationally through organizations such as the Canadian Association of General Surgeons and the Royal College of Physicians and Surgeons of Canada, which he served in many capacities, including as president of both organizations. In the 1990s, when the future of CJS was uncertain, he intervened to bring in the support, financial and academic, of specialty societies. Don Wilson (1917–2017), chairman of the Department of Surgery at the University of Toronto, was also a president of the Royal College. Dr. Wilson was a pioneer of bioethics in Canada, campaigning for its integration into every aspect of specialty training. Tom McLarty (1925–2017) was neither chairman of a department nor president of a national organization, but he inspired love and gratitude among generations of surgeons in southwestern Ontario. His gentle “let me show you how to do that” approach fostered technical excellence and an open mind to innovation among his devoted followers. When the time came to sum up the lives of these wonderful surgeons, their contributions as mentors predominated. Though it is popular to consider an image of the surgeon as the lonely pioneer overcoming barriers to new treatments for patients with illness previously considered hopeless, the reality is one of a leader who inspires the team to success. Schools and surgical organ izations are keen to formalize programs for mentoring. Virtually all of these programs are destined to fail, because it is difficult to maintain enforced enthusiasm. Indeed, none of the classic mentors were ever trained in the art or participated in a mentoring program. Their success as mentors appears to be due to a combination of character, circumstance and reputational reward. Many of the classic mentors were so successful that their influence continued long after their retirement and even their death. An example is the surgical society named for the founding editor of CJS, Robert Janes (1894–1966), that continued to meet almost 50 years after his death.2 A desire that seems to be common among mentors is to leave the field in a stronger, better position for those who follow. We are entering a period where this wish will be difficult to fulfill. New surgeons in Canada have been forced to accept temporary or locum positions. In addition to the uncertainty, they are frequently left difficult, hazardous operations by their leave-taking established colleagues — a trial by fire. It has been suggested in CJS that a better route to consider would be practice-sharing in which the departing experienced surgeon collaborates with the new graduate over a 5-year transition period.3 The University of Ottawa has implemented such a program.4 As the Royal College seeks to combine residency training with lifelong learning, it is beginning to put shape on the phases of a surgical career. University and Royal College programs of practice-sharing as a means to facilitate successful transition between these phases will promote mentoring more effectively than nonspecific mentoring programs.