Sandip Nandhra presents part two of our series on ‘The makings of a modern surgeon,’ first presented at our BJS Academy Workshop in April 2025.

During surgical training, many imagine the most rewarding days to be tied to complex, high-stakes operations. Yet, in my third year as a trainee at Rigshospitalet in Copenhagen, Denmark, the case that left the deepest impression on me was not glamorous—it was about saving a single testicle.

During my on-call shift, I received a call from a peripheral hospital 150 km away. A 3-year-old boy had been admitted there earlier with scrotal pain, diagnosed with a urinary tract infection, and discharged. Seven hours later he returned, inconsolable, with worsening pain. The on-call surgeon strongly suspected testicular torsion and requested an immediate transfer to our center.

By the time the boy arrived, almost twelve hours had passed since the first symptoms. His parents were visibly anxious and had many questions, fearing the worst for their son: Would he lose his testicle, and what implications would that have for his future—socially, sexually, and in terms of fertility? Their worry was amplified by the fact that he was their only child, conceived after five years of fertility treatment, which added extra weight to their fears.

To honour Pancreatic Cancer Awareness Month, we are highlighting some of the most important research published this year in BJS Journals, BJS and BJS Open, on pancreatic cancer. Advancing research in this field is essential to improving patient outcomes and offering hope. Together, we can make a difference.

I still remember that evening vividly. It wasn’t just another day in theatre—it was the day I truly found my voice.

Back then, I was working as a trust-grade SHO in the UK. It was my first surgical job, and as an international medical graduate, everything felt new and daunting. The language, the culture, the humour—even the way we communicated in theatre—was different. For someone like me, an introvert from an ethnic minority background, speaking up wasn’t easy. But in surgery, silence can be dangerous.

That day, I was assisting in what was supposed to be a straightforward laparoscopic cholecystectomy. Morgan, one of my SHO colleagues, was eager to start the procedure. Our registrar, Robert, was guiding him through the initial steps, while I stood as second assistant. The consultant was in the room but unscrubbed, watching from the sidelines.

Surgeons come from different cultures, have different religious beliefs, work in varying health systems and resources and are ultimately guided by legal requirements of the country they work in. We link all of these factors by describing the science behind decisions, heuristics, cognitive processing and human factors. We discuss how surgeons interpret the risk of surgery to the patient but have to be conscious that they are also balancing the risk to themselves. The latter being an increasing consideration as surgical outcomes are reported according to key quality performance indices, such as anastomotic leak. The personality of the surgeon is explored finding not a ‘bad’ trait but traits that may respond suboptimally in certain circumstances. To overcome this, achieving ‘personality awareness’ is proposed.

Most surgeons would say that they learnt decision-making through experience in their day-to-day job, with few having had formal training within their surgical training programmes. Residents also describe indirect training and alongside a medical student, give us insights into the progression of decision-making from student to independent surgeon.

When things do not go as planned, we question our decisions and although often not wrong, we can have a strong and negative emotional response. We describe the difference between adverse events and errors and how both can lead to burnout. Human factors can cause both as a result of a longer term stress with the delicate interplay of the surgeon, hospital and job discussed. Mentoring or support programmes could play an important role.

Correspondence to: Wenjiang Wu (email: 1053660645@qq.com)

Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine

Shenzhen