Few careers demand as much technical mastery, resilience, and emotional fortitude as surgery. The road to becoming a consultant surgeon is long and arduous, paved with lengthy hours, high-pressure decision-making, and the constant pursuit of excellence. However, one factor often determines whether a trainee thrives or merely survives: mentorship.
Having walked the path of an ophthalmic surgical trainee and having previously navigated the world of high-performance sport, I have been fortunate to experience mentorship in its various guises. As a former semi-professional rugby player representing Ireland, the Irish Universities, and the USA at underage level, I have benefited from the structured guidance of coaches, captains, and senior teammates. Likewise, in my surgical training I have been shaped by exceptional trainers whose influence extends far beyond the operating room.
Mentorship in surgery is often framed in technical terms – teaching the latest techniques, refining a trainee’s surgical hands, and guiding them through complex cases. While these are all crucial components, I believe that true mentorship is much broader in scope. The best mentors instill confidence, provide emotional support, and foster an environment where learning can flourish. This holistic approach mirrors the most effective leadership in sport – it is not just about skill development, but also about cultivating resilience, decision-making, and self-belief in mentees.
The 4 A’s: pillars of excellence in ophthalmic practice
One of my most valued mentors, a highly respected ophthalmic surgeon, often speaks about the “4 A’s” as the key pillars of being a great doctor and surgeon: Availability, Affability, Affordability, and Ability. This simple yet profound framework encapsulates what defines excellence in clinical practice.
Availability. A great doctor must be present, both physically and emotionally, for their patients and colleagues. The best surgeons are not just available in emergencies, but foster a sense of accessibility for those who need their expertise and guidance.
Affability. Being a skilled surgeon is not enough; a doctor must also be approachable and compassionate. Patients facing vision-threatening conditions need reassurance and empathy, just as colleagues and trainees benefit from an environment where open communication is encouraged.
Affordability. While traditionally this refers to financial accessibility, in practice it also extends to the generosity of time, knowledge, and effort. The best ophthalmologists recognise their role in a broader healthcare ecosystem, ensuring that high-quality care is available to all, regardless of socioeconomic status.
Ability. Technical skill and clinical acumen remain the bedrock of an outstanding surgeon. However, true ability is not just about dexterity in the operating room; it includes sound decision-making, lifelong learning, and the capacity to adapt to evolving medical advancements.
Beyond technical skills: the hidden curriculum of surgical mentorship
Mentorship in surgery is often described in terms of technical skill transfer, but the most profound lessons occur within the so-called “hidden curriculum.” This encompasses the unwritten rules of surgical culture, career progression, and professional identity formation.
One of the most significant aspects of mentorship is role modeling. Trainees subconsciously absorb the behaviors, attitudes, and ethical standards of their mentors. Whether it is how a surgeon speaks to patients, handles stress in the operating room, or balances career and personal life, these lessons help shape the next generation.
The hidden curriculum also includes guidance on career strategy. As an aspiring surgeon, knowing which subspecialty to pursue, how to navigate fellowship applications, and how to position oneself for leadership roles can be daunting. A mentor provides clarity, helping a trainee make informed choices rather than relying on guesswork.
Lessons from sport: mentorship as a culture, not an event
In elite rugby, mentorship is embedded into the team culture. Younger players are expected to learn from their senior counterparts, and more experienced athletes naturally take on a guiding role. This inherent culture of mentorship is not reliant on formal structures – it is a shared responsibility across the team.
I believe surgical training could benefit from a similar model. While formal mentorship programs exist, they often lack the dynamism of natural, embedded mentorships. Encouraging a culture where mentorship is organic – where senior trainees mentor juniors, and consultants actively cultivate the next generation – would lead to a more supportive and effective training environment.
Moreover, the best rugby coaches do not just focus on performance; they consider the person behind the player. They recognize that a player going through a tough period off the field will struggle to perform on it. The same is true in surgery – trainees juggling exams, personal challenges, relationships, and professional pressures need mentorship that extends beyond the technical domain.
Modern challenges in surgical mentorship
Despite its importance, mentorship in surgical training faces several challenges. Increasing service pressures mean that senior surgeons have less time to devote to teaching. The move toward competency-based training models, while beneficial in some respects, risks reducing mentorship to a checklist exercise rather than a dynamic relationship. Additionally, the rise of portfolio careers means that trainees may rotate frequently, limiting long-term mentor-mentee relationships.
To counteract this, we need to prioritise mentorship at all levels. Hospitals should create protected time for mentoring, recognising that this is an investment in the future workforce. Trainees should also be encouraged to seek multiple mentors – no single individual can provide every aspect of guidance needed.
Mentorship in surgical training is often informal and lacks a standardized framework. This is particularly true in ophthalmology, where the structure of mentorship programs varies widely across institutions, if it even exists at all. In a scoping review I recently published, my co-authors and I analysed the literature on mentorship in surgical training, identifying five key domains where mentorship has the most significant impact:
Burnout. Effective mentorship can act as a buffer against stress and fatigue, which are common in high-stakes surgical training.
Surgical skill and performance. Mentees with structured mentorship demonstrate improved surgical outcomes and confidence in the operating room.
Career paths and professional development. Strong mentorship facilitates career progression, subspecialty choice, and research engagement.
Diversity promotion. Mentorship is a powerful tool in fostering diversity and inclusion in surgical training.
Work-life balance. Good mentors help trainees navigate the demands of surgery without sacrificing their personal well-being.
Through this review, we proposed a conceptual framework tailored to ophthalmology trainees, offering a structured approach to mentorship that could be adopted at an institutional level. The review highlights mentorship not as a luxury, but as an essential pillar of modern surgical education.
Lasting impact
Reflecting on my own journey, I can see the fingerprints of great mentors at every stage. From the rugby coaches who instilled discipline and teamwork to the ophthalmic surgeons who honed my clinical and surgical acumen, mentorship has shaped me not just as a professional but as a person.
For those in training, my advice is simple: seek out mentors who embody the 4 A’s. Absorb their lessons, not just in technique but in how they navigate their careers and support others. And when the time comes, pay it forward. The best way to honour great mentorship is to become a great mentor yourself. Because in the end, mentorship is not just about skill transfer – it is about legacy. And that is as true in surgery as it is in sport.
