Mastery comes from the consistent attention to basics
BBASS - the story
The passage highlights a critical gap in surgical training: many consultants learned surgical skills through volume and repetition rather than structured instruction. Key aspects such as setup, posture, instrument handling, and ergonomics are often tacit knowledge – understood intuitively by experts but rarely explicitly taught to trainees.
Surgery, being a motor skill, should be taught using principles similar to those in sports and martial arts, where movement fundamentals and ergonomics are well studied and applied through deliberate practice. Teaching methods like those in the PAR Excellence and PAR Aorta courses have demonstrated success by deconstructing these motor skills and making the tacit knowledge explicit.
A key insight is the concept of “systole” (needle pass) and “diastole” (setup for the next pass). While both expert surgeons and trainees may take the same time for a single stitch, the expert’s ability to minimize diastolic time reflects mastery of ergonomics and efficient movement. Trainees often struggle due to “negative-passive behaviours” – failures to do what should be done, which are typically overlooked in training.
Workshops often reinforce poor habits by having trainees practice seated at fixed tables, ignoring the standing ergonomics of actual surgery. A framework that includes deconstruction of movements, deliberate practice, and proper ergonomic training – akin to sports coaching or martial arts – is needed to accelerate skill acquisition and embed motor memory, ultimately improving surgical performance.
Surgery, being a motor skill, should be taught using principles similar to those in sports and martial arts, where movement fundamentals and ergonomics are well studied and applied through deliberate practice. Teaching methods like those in the PAR Excellence and PAR Aorta courses have demonstrated success by deconstructing these motor skills and making the tacit knowledge explicit.
A key insight is the concept of “systole” (needle pass) and “diastole” (setup for the next pass). While both expert surgeons and trainees may take the same time for a single stitch, the expert’s ability to minimize diastolic time reflects mastery of ergonomics and efficient movement. Trainees often struggle due to “negative-passive behaviours” – failures to do what should be done, which are typically overlooked in training.
Workshops often reinforce poor habits by having trainees practice seated at fixed tables, ignoring the standing ergonomics of actual surgery. A framework that includes deconstruction of movements, deliberate practice, and proper ergonomic training – akin to sports coaching or martial arts – is needed to accelerate skill acquisition and embed motor memory, ultimately improving surgical performance.
Balance, skills and precision make up the fundamentals of BBASS. BBASS (Black
Belt Academy Surgical Skills) was the brainchild of David O’Regan who saw the
necessity to instill a proper training belief in surgical skills.
Under his guidance, the program flourished, integrating martial arts principles with surgical training to enhance dexterity, focus, and discipline among budding surgeons. Each session of BBASS involves rigorous drills that mirror the meticulous nature of surgery, fostering an environment where every participant can refine their technique and build confidence. Participants are encouraged to embrace the philosophy of continuous improvement, reminiscent of the Black Belt journey in martial arts. They learn to approach each task with a clear mind and steady hand, understanding that mastery comes from persistent practice and a dedication to excellence.
Testimonials from past participants highlight the transformative impact of BBASS. Many have praised the innovative approach, noting significant improvements in their surgical performance and a newfound appreciation for the precision required in their field. The program not only hones technical skills but also cultivates a mindset of resilience and adaptability, essential traits for any successful surgeon.
David O’Regan’s vision has undoubtedly set a new standard in surgical education, one that blends ancient wisdom with modern medical practices, creating a legacy that will benefit countless future surgeons.
Under his guidance, the program flourished, integrating martial arts principles with surgical training to enhance dexterity, focus, and discipline among budding surgeons. Each session of BBASS involves rigorous drills that mirror the meticulous nature of surgery, fostering an environment where every participant can refine their technique and build confidence. Participants are encouraged to embrace the philosophy of continuous improvement, reminiscent of the Black Belt journey in martial arts. They learn to approach each task with a clear mind and steady hand, understanding that mastery comes from persistent practice and a dedication to excellence.
Testimonials from past participants highlight the transformative impact of BBASS. Many have praised the innovative approach, noting significant improvements in their surgical performance and a newfound appreciation for the precision required in their field. The program not only hones technical skills but also cultivates a mindset of resilience and adaptability, essential traits for any successful surgeon.
David O’Regan’s vision has undoubtedly set a new standard in surgical education, one that blends ancient wisdom with modern medical practices, creating a legacy that will benefit countless future surgeons.
What People Are Saying
About David
David graduated from Southampton University in 1985. I embarked upon a surgical career as an SHO in
Bath. David became a fellow of the Royal College of Surgeons in Edinburgh (RCSEd) in 1990. I started my
out training as a general surgeon on the numbered training program in Oxford. Encouraged to do Cardiac
Surgery by Professor Stephen Westaby and Mr Ravi Pillai. After eighteen months David was appointed to
the Royal Brompton Hospital rotation. I have had the privilege of working for Professor Sir Magdi Yacoub.
I passed the intercollegiate exam in 1999. I have been a practicing Consultant Cardiac Surgeon since
2001 and have now done over three thousand adult cardiac cases.
David has always taken a keen interest in training. He was President of the Association of Surgeon Training in 1996/ 2000. He instigated the Silver Scalpel Award to identify the best surgical trainer in the UK across all surgical disciplines. He has run this prestigious award for the last sixteen years and has embraced many of the skills demonstrated by these outstanding surgeons. He is now a recognised as a good trainer himself with a national reputation. He firmly believes that good training and good service goes hand in hand. This is evidenced in his approach to the whole of his clinical practice.
David was appointed a Regional Surgical Advisor to the Royal College of Surgeons of Edinburgh (RCSEd) in 2013 and the Specialty Education Lead for the Cardiothorasic Surgery for the college in 2015. He has was appointed the Deputy Director of the Faculty of Surgical trainers of RCSEd in November 2016.
David has always taken a keen interest in training. He was President of the Association of Surgeon Training in 1996/ 2000. He instigated the Silver Scalpel Award to identify the best surgical trainer in the UK across all surgical disciplines. He has run this prestigious award for the last sixteen years and has embraced many of the skills demonstrated by these outstanding surgeons. He is now a recognised as a good trainer himself with a national reputation. He firmly believes that good training and good service goes hand in hand. This is evidenced in his approach to the whole of his clinical practice.
David was appointed a Regional Surgical Advisor to the Royal College of Surgeons of Edinburgh (RCSEd) in 2013 and the Specialty Education Lead for the Cardiothorasic Surgery for the college in 2015. He has was appointed the Deputy Director of the Faculty of Surgical trainers of RCSEd in November 2016.
The first time I attended a BBASS session, it was a talk about the main ideas behind how the organisation teaches, and honestly, it just clicked for me. Their approach made so much sense, and it immediately felt like something I could connect with. As a medical student, I had been looking for ways to get more practical knowledge-things I could actually use in real situations-and BBASS offered exactly that. Now, after more than two years of following their sessions regularly and learning from David, I can confidently say it’s been one of the best learning experiences I’ve had. What I found really special about BBASS is how they break down everything in such a clear, organised way. In medical school, we often get bits and pieces of information, but it’s hard to see the full picture of how it all works together. Especially with surgical techniques-there’s so much to learn, and it’s easy to get lost in the details.
Gabriele Marija Baltrusyte