He was afraid of punishment for not knowing how to do his job. Remove the punishment, create a systemic environment of improvement rather than individual blame

He was afraid of punishment for not knowing how to do his job. Remove the punishment, create a systemic environment of improvement rather than individual blame, and he can easily speak up and say he's not prepared for the procedure and get help. Without that, he's afraid of being fired or discovered as "inept," none of which will help him become less inept, which is the only goal that matters. The question is not how we weed out inept doctors, but rather how we create a system that improves doctors systemically so that as few as possible are unqualified for as little time as possible. Thinking about this as an individual problem is unhelpful and inconsequential to any real change.