Lessons, leadership, legacy: an evening on postgraduate surgical education with Professor Jon Lund

Professor Jon Lund calls me from the car. He’s just stepped out of an on-call shift and asks if the interview is still going ahead. He can hear background noise: children, screaming, the sizzling of burnt food in a pan. I tell him I’m mid-dinner – splitting bread and fish to feed the many – and he laughs. “Shall we try post-bedtime?” We agree to speak at 9pm. True to his word, he calls bang on time, now walking his dog. Professor Lund laughs when I warn there’ll be hard-hitting questions. “I’m ready,” he says.

How did you get involved in surgical education, and what keeps you committed today?

“It’s been a career-long enthusiasm,” he begins. He recalls standout teachers from his own student days: Mike Nicholson in Cambridge, Steve Leveson in York. “They were incredible educators – inspiring, hands-on, deeply invested in people. I saw early on how education wasn’t just about learning but about creating the environment for safe and joyful patient care.”

Professor Lund’s rise through education leadership was rapid: College Tutor during MMC reforms, Core Surgical TPD, General Surgery TPD, Head of School, SAC Chair. He designed entire rotation structures in the East Midlands. “It was a blank sheet of paper – literally. I had to build the whole thing. I was able to design the whole core training rotation, much of which is still in place today,” he says.

He found joy in seeing others succeed. “When someone does their first procedure and crosses that threshold into believing they can – that’s addictive.” A self-confessed geek, Professor Lund also launched ilovecolorectalsurgery.com (now defunct) and created the School of Surgery podcast. “Every Friday I’d check the downloads. It was exciting knowing we were reaching thousands of people across the world every week, many more than we could ever teach in person.”

In an overstretched NHS, is structured surgical education a necessity or a luxury?

“If you think education is expensive, consider the cost of not educating,” he replies sharply. “It’s what it says in the hashtag, no training today, no surgeons tomorrow. You weren’t born a surgeon. I wasn’t born a surgeon. We got here because someone gave us time, support and belief.” He warns that cutting training budgets is a false economy. “You can’t have a functioning service in five years if you don’t train people today.”

Professor Lund is clear: training requires shared ownership. Deaneries provide structure. Hospitals must protect time. And trainees must show up, prepared and engaged. “You need people to assess how good you are, help you improve, give proper feedback. That takes time, money and support.”

He continues: “This focus on waiting lists and service is so short term. If people don’t like training, maybe they need to think about why – as a doctor, as a surgeon and as a person. Ask yourself what it is you don’t like and do something about it. Try a bit of self-improvement. Be a better person. Be kind to the people who are us, just a few years ago. We owe our very livelihoods to the people who trained us – let’s pass on that investment to the next generation.”

Then, with a smile in his voice: “I used to be you. You’re going to be me. It’s the circle of life in surgery – slightly different versions each time, but the same old story. We start knowing nothing, we end up knowing a bit more, and we pass it back down.”

Should trainees take greater ownership of their training?

“Absolutely. We treat adult trainees like children – it’s deeply hierarchical. But progression isn’t automatic. You earn it.” He continues: “One of the problems with medicine as a career structure is that we don’t recognise adulthood properly. No matter how much we try to flatten hierarchies, they still exist. We don’t always allow people to be grown-ups and take charge of their own development. Progression isn’t automatic. You have to meet the benchmark to move forward.”

Do numerical benchmarks in training work?

“They’re an imperfect proxy – but they serve a purpose,” Professor Lund explains. Numbers aren’t minimums, just indicators of breadth. “They tell us you’ve seen enough variation: big, small, high BMI, thin, easy, bleeding. They’re there to stop someone qualifying with just 12 resections.”

He shares a pivotal moment: “We had a candidate at SAC who applied for CCT with fewer than 12 anterior resections. We realised we had no formal rule saying they couldn’t. That’s when we introduced indicative numbers – set by looking at real logbooks and taking the 25th percentile.”

Still, he’s clear-eyed: “Benchmarks are convenient, not ideal. What we need are high-quality workplace assessments that genuinely tell us whether someone is ready to be a day-one consultant.” He praises the Multiple Consultant Report as a step forward but says it must be done well: “Feedback should be supportive, developmental – not threatening.”

Should training be more flexible and how do we protect standards?

“Everyone has different needs. Flexibility is vital. But standards must be non-negotiable.” Professor Lund is pragmatic about burnout and rota gaps: “People want flexibility because work isn’t nice. So let’s fix the environment. As Richard Branson says: ‘Train people well enough so they can leave, treat them well enough so they don’t want to.’”

How can trainees make themselves a priority for trainer time?

“Preparation and communication,” he says. “Know your cases. Review the imaging. Be at the briefing. Say what you want from the list.” He advocates turning briefings into education huddles for the whole team, not just surgical trainees. “The anaesthetist might be trying a new block. The student nurse might be learning to scrub. Everyone’s training – not just the surgeon.”

Professor Lund advises being specific: “Say, ‘I’m fine with hernias. Can I focus on the left colon today?’ That sets the tone. And if the list’s busy, you adjust. One hernia, not two. Mobilise, not resect. You box and cox.” Feedback, he insists, must be routine. “Not at the end of the list, after each case. A few words. A tip or two. That’s how people grow.”

What developments in RCSEd education should trainees be excited about?

“We’re moving into RCSEd-ucation – see what we did there?” he jokes. Simulation, AI, 3D printing, perfused cadavers, all are under way. But the delivery is what excites Professor Lund most. “Short-form content. Micro-teaching on your phone. The stuff people actually use.”

He’s emphatic: “Technology must augment, not replace, people. Humans are best. But AI can help make faculty time more impactful.”

What excites you most personally?

“That people still care. Despite everything – strikes, burnout – people still want to pass it on.” And, of course, the tech. “Metrics, video feedback, new platforms – I love it all. But only if it helps people get better.”

With more than 548 academic citations, what’s the next big research question in surgical education?

“I’ve already asked it,” he grins. “How do we use AI to improve delivery and assessment?” His current fellow, Abby Burrows, is completing a PhD on the topic as part of a partnership between Nottingham Trent and Edinburgh Universities.

If you could change one thing about surgical education overnight, what would it be?

“Professionalise it properly. Hypothecate the funding. Make sure it reaches the trainers. Attach a tariff to training cases,” he says. Each trainee brings £14,000 a year in education funding but, he says, little of that reaches the trainers. “Training takes time – 10 to 20% longer per case. That’s fine, but it needs recognising. Especially as more work goes to independent providers.” He believes attaching a tariff to trainee-led operations would incentivise trusts to support education, not see it as a loss. “If the government’s serious about recovery, it needs to invest in tomorrow’s workforce.”

What are your three words for your one-year plan as Dean?

He laughs: “Social. Media. Expansion.” Then, more seriously: “We’ll rationalise courses, improve simulation and grow podcast-based education for surgery and dentistry. The College needs a global reach to maintain its position as a world leader, to democratise education and to address challenges in educational equity.” 

As we finish, Professor Lund says it’s been a pleasure – “even the hard questions”. Then he adds: “You’d make a great podcaster, you know.” Silver- tongued and silver-haired, Professor Lund has a dangerous way with words.