In the UK, and probably worldwide, surgeons are not being trained as they were pre-pandemic. The cancellation and resultant backlog of elective surgery has decimated training opportunities across subspecialties. Currently, some patients are being listed for procedures on a waiting list that simply doesn’t move.
Restoring and enhancing surgical training is critical to the future workforce. We are now entering a third year of the pandemic. There are trainees entering middle years of registrar training who have experienced only the slim pickings of restricted elective operating, watered down further by redeployment away from surgery. Trainee logbooks comparing 2019 with 2020 show a 50% reduction in operations with the trainee as the primary surgeon.
Senior trainees, in need of fine tuning and complex procedural experience, are no less impacted. The issue extends beyond technical skills: all trainees are less exposed to patient assessment and decision-making in the outpatient department, on the ward, and within the MDT. Among more senior trainees, 12% of those nearing the end of training were officially recognised as “delayed due to covid-19” in their latest annual review of competency progression.
The impact will be felt at the consultant level sooner than many appreciate. The system relies upon a balance between perpetual revitalisation of personnel from below, in combination with pre-existing seasoned wisdom and experience.
There is a glimmer of hope in that we may be transitioning towards a situation of living with and tolerating covid, enabled by the mitigation strategy of vaccination. The substantial backlog of operations represents a training opportunity that must not be lost (for example by farming out procedures to a private sector devoid of trainees). Individualised trainee trajectories, expanding high quality e-learning, and enhancing simulation are all needed in addition.
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh