The BMJ Today: Torture, training, and role models

Unsettlingly recent media coverage seems to be full of articles and images of torture which raises the questions for our profession of “What is the role of doctors when faced with victims of torture?” and “Where should their loyalties lie?” Torture as described in a recent editorial is “a complex, politically driven phenomenon that is used to terrify, punish, and intimidate.” The authors outline challenges faced by health professionals who they say “can play a vital role in preventing torture and holding those who torture to account.” Better support networks and standardisation of training internationally are identified as possible ways to help to prepare clinicians who find themselves in these settings.

The authors highlight the role of medical schools and universities as places where good and “ethical” training practices around managing victims of torture can become embedded early on. The ultimate aim is to help these doctors exercise “independent clinical judgement.” And so whilst there is no expectation on them to solve this complex and widespread problem, they are encouraged to continue to act as “witnesses, documenters, reporters and healers to prevent violation of people’s fundamental human right to health.”

Trainees and the quality of training are high up on the agenda for Clare Marx, the first female president of the Royal College of Surgeons of England in a recent interview. She identifies “finding good role models” as one of the things that has been helpful in her career. She highlights studies however that show that trainees are unhappy with the training they are getting in their early years as “they are not being looked after—just doing service work.” She further states that it may be possible to be trained in a 48 hour week but probably only if you are just doing training. With this in mind she is keen to work with Health Education England on a curriculum and training pilot to allow trainees to focus on training instead of service work. However Miss Marx does make the point that “those who really want to do surgery will make the time” in the same way that you cannot tell a professional violinist to stop practising.

And she says that research shows that women “just don’t think they fit in surgery.” She says that there may be a perception that there are not enough female surgeons at the top who are “normal rather than superwomen.” When asked if she thinks that collaboration and shared decision making are “traditional surgical attributes” in relation to the college’s recent report Good Surgical Practice 2014, she says “They will be in the future.”

And finally this week’s UK poll asks “Is the NHS your top UK election issue?” Join the debate here.

Cath Brizzell is head of education, The BMJ.

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