No time to train the surgeons

Editor—The Royal College of Surgeons of England agrees with Chikwe et al that surgical training must be a priority.¹ The specialty is facing serious challenges both in delivering services and in training because of the reduction in junior doctors' hours of work. However, some of the enforced changes are to be welcomed: no one can truly regret that trainees are no longer expected to work a total of over 30 000 hours, or over 85 hours a week. Furthermore, the impetus for the reform of senior house officer training was the general recognition that training was poor and needed a radical overhaul, especially in surgery.

To compare hours worked in the past with the other figures in the editorial relating to hours of daytime service and training in a 48 hour week can be confusing when we are faced with a 56 hour week. We need to focus on not only the hours worked but also what is done in the time, ensuring that training opportunities are maximised. Delivery of training is not easy, but some examples are working well given commitment from trainers and trainees, good management support, and accurate profiling of hospital activity, particularly at night.

Figure 1.

Credit: HENRIK SORENSEN/PHOTONICA

The colleges and specialist associations are devising new seamless training programmes in surgery in which assessments are based on competence rather than time. This college is working to provide more and better courses to support surgical training, when possible locally. We anticipate a greater use of skills laboratories and simulators, another call on resources. We are pressing for dedicated training lists and clinics, so far without much success. To deliver training and ensure patient safety more consultants are needed, so with current staff shortages existing trainers must be given dedicated time to teach and train, which will inevitably affect their service throughput.

Although creating a better training programme for surgeons with a reduction in working hours requires considerable resources, it is an opportunity to create a new and efficient training system for the surgeons of the future, who will in no way be inferior to the current cohort of young consultants.