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The shape of surgical training – more distortion to come?

eoSurgical is run by surgeons, for surgeons. Its founders have worked their way through various UK training programs during the last decade, initially within the tail-end of the Calman system and then into the Modernising Medical Careers (MMC) era. The latest ‘Shape of Training’ review, now over 5 years old, demands yet more change.

The aspiration of these reports is reasonable: building a medical workforce in the UK that is suited to the needs of delivering contemporary healthcare in the widest sense. Surgery, even in its most generalist form, remains a boutique strand of care that cannot expect to dominate over-arching training philosophies. However, there is ample scope to serve its needs in parallel with other specialities.

We know that general practise, mental health care, and emergency medicine are woefully understaffed. There are additional challenges facing other types of hospital medicine and, fundamentally, there are insufficient doctors in the UK to deliver the quality of care that its growing, ageing and increasingly comorbid inhabitants desire and demand.

However, as with many top-down re-organisations, there is a temptation to impose a one-size-fits-all system. MMC was meant, in part, to streamline postgraduate medical training and prevent the existence of a ‘lost tribe’ of junior doctors. It has been entirely unsurprising, as a current junior doctor, to see the growing numbers of post-Foundation doctors disengage with enforced MMC training programs. Many now leave for the Antipodes or leave medicine altogether, and ‘FY3’ is now firmly established in the hospital lexicon. This reflects the fact that many doctors need time to consider their options. The old system learned to accommodate this and now the new system is adapting.

The system is the aberration, not its users.

The next aberration, in the form of the Shape of Training review, suggests awarding a certificate of speciality training after just 4-6 years of theme-based training (e.g. child health or mental health or surgery). This is fundamentally at odds with the needs of surgical training. Time working in a firm and time in the operating theatre is crucial and has already been undermined. Acquiring specialist skills in 4-6 years is quite simply unrealistic in the current training environment. As such, the proposals from the Shape of Training review are unfit for surgical purpose. At present, a robust list of requirements must be demonstrated in order to complete training in a given surgical speciality. Upholding these requirements may be the only way to maintain standards and prevent a top-down watering down of surgical training and care.

Mark Hughes

Director, eoSurgical

Skull-base neurosurgery fellow, Leeds General Infirmary


Email: mark.hughes@eosurgical.com

Twitter: @eosurgical