Returning to Training

Returning to Training after Absence

Returning to surgical training after an absence from the clinical environment can be a daunting prospect, and planning ahead is the key to reducing stress and paving the way for a successful return to work.

Recognition that this can be a difficult time prompted the Academy of Royal Colleges (AoMRC) to compile its ‘Return to Practice Guidance’ published in April 2012.¹  They reported that breaks of less than three months appeared "less likely to cause significant problems, but may still affect confidence and skills levels." In contrast, the report commented that "an absence of three months or more appears more likely to significantly affect skills and knowledge."

The AoMRC emphasises that while employers should be helping trainees to settle back into work safely after a break, it is the individual trainee’s professional duty to ensure they are safe to return to clinical practice. The individual trainee must ensure that they are up to date, competent and safe to return to practice. A useful way to identify and clarify issues arising from an absence is to arrange a meeting, before your return to work, with your Assigned Educational Supervisor (AES) and with your clinical supervisor. A useful source of information is the BMJ elearning module relating to returning to work after a career break.²

Practical Advice

Here are some suggestions which trainee surgeons have found useful, both in their preparation for return to the workplace and also as they have settled back into surgical practice.

1. If possible, make an appointment with your educational supervisor before your start date, otherwise within the first 2 weeks. Your confidence can be increased by ensuring that your colleagues know you have been away and don’t have unrealistic expectations from you. Do not assume that they will know, as with shift patterns of work they may think you actually have been at work in a different Trust.
2. Don’t volunteer for any additional responsibilities during your first 2 months back at work, and ask your training programme director if it would be possible to place you back in a hospital you have worked at before. Be sure to contact the rota organiser well in advance, and ask not to do ‘out of hours’ emergency duties for the first 2 weeks. Instead, ask to be assigned some daytime emergency duties during the first 2 weeks so you have time to increase your competence and confidence during office hours (when help and support is readily available) and thus prepare you better for out of hours work.
3. Set up an email alert with a journal in your surgical specialty while you are off work. Being up to date will boost your confidence and allow you to take part in clinical discussions with colleagues e.g. at the MDT, when you return. Consider attending a conference, book onto a laparoscopic skills course, or book time in your local simulation skills lab to help you regain confidence prior to starting back at work.
4. Once you have returned to training, do ensure your clinical supervisor knows you have been away from clinical duties and ask for increased supervision for the first few lists, until you regain confidence and competence. Don't apologise when asking for help and supervision when you return; seek out colleagues who are excellent teachers and make use of their expertise.
5. If returning to work is stressful, perhaps mentoring could help? There is an increased awareness of the value of mentoring to help cope with the demands of working in the NHS. Many LETB/Deanery and trainee organisations including ASIT (Association of Surgeons in Training) and WinS (Women in Surgery) offer mentoring advice.
6. If you are returning from maternity leave do make use of ‘Keeping in Touch days’ (KiT days).

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