Editor—Four points strike me on reading the editorial by Chikwe et al and the responses on bmj.com.1,2
Firstly, there was no golden age of surgical training. We spent more time as “junior doctors.” Some staggeringly bad surgeons were appointed under the old system, as well as highly experienced and motivated ones.
Secondly, having observed and trained registrars for 20 years, I have not seen any deterioration in quality. Training in emergency surgery may even improve with designation of an on-call consultant “surgeon of the week” to take trainees through emergency cases during the day. Under the new contract at least one list a week must be a teaching list for senior house officers. Despite the shift system, enough training lists should be possible to teach all senior house officers in rotation.
Thirdly, we must not be confused by the terms specialist and generalist. It has always been quicker to train a specialist than a true general surgeon. Perhaps we need a new term for the undifferentiated “basic” surgeon, produced by a shortened, competency based training programme.
Fourthly, politics and medicine are developing so rapidly that the staffing and training needs of only a few years from now are difficult to predict. I take comfort from the fact that the NHS has been in existence for over 50 years and has never got close to sorting out appropriate staffing levels or training. There is no chance of it getting it right any time soon.
Competing interests: DTR trained under the old, haphazard, and prolonged system.
References
- 1.Chikwe J, de Souza AC, Pepper JR. No time to train the surgeons. BMJ 2004;328: 418-9. (21 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Electronic responses. No time to train the surgeons. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7437/418 (accessed 28 Apr 2004).