LAUSR

The transition from resident to a new consultant is a remarkable change for the doctor concerned. The purpose of (sub)specialty training is to prepare the trainee for the new post. The main focus of (sub)specialty training is to gain knowledge and expertise regarding the medical content, investigations, treatment options, and surgical skills. Management and leadership courses are increasingly incorporated into training to supplement the soft skills learnt during residency, but is this enough? To start, it is important to understand that transition is not a single moment, but a continuum [1]. Large changes require coping strategies to allow us to face new challenges and opportunities while being able to deal with the stress and emotions that accompany them [2, 3]. This is not commonly addressed during training. Making the jump from resident to consultant can be likened to obtaining your driving license. Everybody is aware that after obtaining Bthe piece of paper^ you are not an experienced driver, which requires time behind the wheel and exposure to roads. Similarly, the completion of training and obtaining Bcompetence^ does not give the breadth of knowledge that experience does. Literature reveals that the training of young drivers could best be focused on the translation of learning to independent driving [4]. Therefore, one should not only focus on the technical skills of driving a car, but teaching safe attitudes and norms, judgment, and self-control at the wheel [4]. A parallel can also be drawn with the military. The Army defines readiness as Bthe capability of its forces to conduct the full range of military operations... readiness is a function of how well units are manned, equipped, trained, and led^ [5]. Soldiers’ training is aimed at getting them Bfit to fight^ and in the best physical shape they can achieve. Resilience, endurance, strength, and hand–eye coordination are optimized during training and this creates self-confidence for the individual. This could be extrapolated to medical training; to get Bready for consultancy^ you need to spend years learning, practicing, adapting, and honing clinical and surgical skills. However, unlike medical training, the military also focuses on mental preparedness for accepting and controlling one’s fear, because no amount of training can fully prepare a soldier for all eventualities of war. A recent survey among 147 Dutch gynecologists who had finished their general obstetrics and gynecology residency within the past 1–5 years revealed that the majority (80%, n = 113) of new consultants were well prepared for their post [6]. The 20% of gynecologists who feel less prepared hamper knowledge about (hospital) management, supervision experience, and sufficient surgical experience [6]. Besides the clinical and surgical skills required to become a consultant urogynecologist, there are a plethora of additional skills that one is suddenly expected to excel at. Whilst juggling your own referrals and theatre schedules, responding to complaints, and preparing business cases, you also have to manage and train junior doctors. To a large extent, trainees are protected from these additional responsibilities during residency. Nonmedical tasks and the delegation of responsibilities are the biggest issues for new consultants [3]. Important components to prepare for transition are experience with decision-making, responsibility, and the ability to prioritize and to copewith stress [7, 8]. Furthermore, burnout among new consultants correlates with lack of preparation in generic competencies, supervision during on-call shifts, (time) management, financial acumen, and (multidisciplinary) collaboration [9]. Yardley et al. have clearly described the most important positive effects on transition in their review paper [1]: