How to be Assertive Without Being a Bully

A Guide for Surgical Trainers

Endorsed by the Faculty of Surgical Trainers


Surgery can be a highly demanding environment, and in pressurised situations we need to prioritise patient safety. Under these circumstances there is a need for clear leadership, but being assertive can sometimes be challenging without coming across as aggressive or intimidating.

Training is also an area in which potential issues could arise. Not every trainee will develop at the required rate, and it is important to be able to address concerns with an individual without fearing being labelled as a bully.

The following recommendations may help with workplace relationships.

  1. Set a goal at the start of the theatre list

  • If time is likely to be a pressure, give clear instructions regarding expectation at the start of the day. E.g. "Case 4 needs to start by 3pm so if we’re running behind then I’ll take over at 2pm." This helps prevent the trainee from feeling undermined if the case is taken from them.
  • Divide parts of the case up specifically eg trainer does the resection, trainee does the anastomosis. This will often be assumed but not communicated.
  1. Suggest someone takes a break

  • If progress is slow, or if a trainee or assistant is making mistakes that could compromise the patient, suggest they go and take a break. This removes them from the situation rather than continuing with the case in front of them. Any further feedback should then be discussed after the case has finished, so that both trainer and trainee can focus on the training aspects without other distractions.
  1. Have a feedback session following the theatre list or clinic

  • Comment on both good and bad aspects of the day, away from the environment.
  • Suggest an action plan for improvement rather than just offering criticism.
  • Apologise if you displayed hostile behaviour, no matter how critical the situation was at the time.
  1. Keep goals level-specific rather than personal

  • Stick to the targets identified at the initial educational meeting in a placement
  • Give feedback based on the attainment of these goals, rather than how a specific trainee compares to other trainees of the same level
  • Sub-optimal performance should be recorded on ISCP as good performance would be – but be open about this and do this with the trainee. Use this as an opportunity to record a baseline from which they can improve.

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