Training stages

Human development, in virtually every domain, occurs in stages, marked by certain milestones. Neurosurgery residency can also be viewed in this light.

The challenges encountered in residency, are unique for every stage of development and training. That is, junior residents, encounter different challenges and achieve different virtues than intermediates and seniors.

Arrested development, expressed in a surgical context as either resident attrition or failure to progress can often be traced to difficulties at particular developmental stages. - Successful training can be understood in the context of guided navigation through the same stages.

When each stage-specific challenge is successfully overcome, it brings with it the realization of a specific virtue that carries the resident forward in their training. Failure to overcome a stage, results in failure of virtue acquisition, leading to stagnation (“fixation”) and a failure to progress. Depending on the stage, residents may either not finish their training (i.e. leave training or be asked to leave) or finish their training with developmental ‘deficits’ which will subsequently influence their future practice and careers.

The first and most basic challenge involves developing a budding sense of trust in their supervisors, their own clinical skills, and in the program as a whole. Trust is the foundation of any good residency program as residents realize that their own best interests and those of the program, are aligned. Once trust is established, service-to-education ratios become less important, as residents realize that when they are participating in “scut-work”, for example, it is a means to an end, rather than an end in itself. Successfully navigating this first stage leads to the acquisition of hope as a virtue; hope that maturing clinical and surgical skills will lead to confident decision-making, and on a more visceral level, hope that things actually will improve (the proverbial light at the end of the tunnel). Failure to achieve this virtue leads to despair, hopelessness, increasing isolation, and regret, culminating in the sense that one has made the wrong career decision, and/or that things will only get worse.