The changing face of surgical training

Surgery has always been able to attract the best medical graduates into the specialty but undoubtedly it has been a difficult time for surgical trainees over recent months and years. The MTAS (Medical Training Application Service) debacle over selection severely undermined confidence and although some of the underlying principles of MMC (Modernising Medical Careers) may have been sound, the implications of its implementation were not adequately thought through. This has led to a situation in which many trainees are confused and demoralized and working in a ‘change environment’ often with no real sense of direction or confidence in the future. This is compounded by uncertainty as to the role of PMETB (Postgraduate Medical Education and Training Board), the implications of the EWTD (European Working Time Directive), the workings of the ISCP (Intercollegiate Surgical Curriculum Project), a lack of confidence in the assessments for progression (ARCP Annual Review for Competency Progression), the inconsistency of the Deaneries across the country and inadequate workforce calculations with regard to surgical subspecialties and reconfiguration. Surgical training, therefore, remains under threat, and all the above issues need to be addressed if we are to continue to attract the best trainees into surgery.

Change is always going to be with us. We live in a society that is rapidly changing and in order to ensure the maintenance of professionalism and that the profession keeps pace with this rate of change we need to be proactive in providing surgical training that is fit for purpose. This requires adequate resources for training with regard to time, personnel and finance and an explicit curriculum and framework in which surgical trainees can feel confident that they are being adequately trained for future clinical practice. Therefore trainees need to be adequately informed, appropriately trained and actively encouraged. The Tooke report sought to address many of the problematic issues surrounding training, but much still remains to be done to ensure that surgical training enjoys the confidence of both trainees and trainers. Surgery remains a craft specialty, and as an apprenticeship model of training is no longer feasible, we need to be more proactive in the delivery of surgical training. Furthermore we are faced with a new MRCS examination in the Autumn of 2008, continuing problems with selection, concern about time allowed for training in consultant job plans and an insecurity about future career prospects. All such elements of change are made worse by an inadequate knowledge of what exactly is going on and what is being proposed.

At the start of a new 3 year cycle of ‘SURGERY’, it was therefore felt appropriate to devote the first issue to dealing with many of the above concerns. The articles in this first issue have, therefore, been chosen in an attempt both to inform and encourage surgical trainees, and to reaffirm the need for a well motivated surgical workforce that will carry the ‘surgical baton’ on for future generations.