The new surgical training curriculum will be introduced by the Royal College of Surgeons in 2007. Pilots will start across England and Wales next summer.
Instead of the current ‘time-based’ system of training, the new curriculum will be based on the acquisition of agreed competencies – competencies which will be tested and recorded. There will be specific standards relating to clinical judgement and to technical knowledge and skills for the early, middle and later stages of training in each specialty as well as generic standards in communications, team-working, management, research/scholarship and ethical practice.
On graduation from medical school, the trainee will in future undertake a two-year foundation programme after which he or she will enter specialist training. A Certificate of Completion of Training will be awarded at the conclusion of the training.
In the current training scheme, the trainee spends one year as a house officer and then a minimum of two years as a senior house officer (SHO). In practice, however, the average SHO takes 5.5 years to reach the next stage in the surgical career - a specialist registrar job – and only 50% of applicants are successful.
At the current time, because of changes in the delivery of surgical services and, most significantly, restrictions in working hours as a consequence of the European Working Time Directive, surgical training is being seriously compromised. Many surgeons are finding that there is no understanding from managers of the importance of training requirements, and little recognition that a failure to invest in tomorrow’s doctors will seriously damage patient care.
‘The aim of training is, and will continue to be, to produce individuals with knowledge and skills to allow them to practice within a defined clinical framework, working as a member of a consultant team,’ says Mr Hugh Phillips, President of The Royal College of Surgeons. ‘I am concerned that there are too many talented surgeons-in-training stuck at the SHO grade. Not only is this wasteful of human resources, but it makes for an insecure and difficult time at a crucial stage in the surgeon’s career.
‘The new scheme will recognise excellence rather than reward time-serving. It will provide a framework to produce a trained surgeon capable of carrying out the surgical care that the public needs. Not every surgeon needs to be trained to be a super-specialist doing the most complex surgery in their chosen field. But they do need to be trained to nationally agreed standards – agreed across the nine surgical specialties* - and capable of carrying out elective and emergency surgery with sub-specialty expertise.’
Mr Phillips sounded a note of caution about the new plans: ‘The College can define standards, set the curriculum, develop outstanding educational packages and assessment tools, but it cannot produce competent surgeons unless trainers and trainees are given sufficient time in the workplace to teach and to learn. The resources required to allow on-the-job training must be recognised by the Department of Health and Trust executives. We do not underestimate what an enormous challenge this is. There is still a serious shortfall in the number of consultant surgeons in the UK and yet we need these hard-pressed consultants to train their future colleagues and successors. They must be adequately supported to do this.’
The new training programme will be regionally delivered and locally managed within a quality assurance framework, set by the Royal College of Surgeons and adhering to the principles set by the Postgraduate Medical Education Training Board (PMETB).
* The nine surgical specialties are: general surgery; cardiothoracic surgery; neurosurgery; otolaryngology; paediatric surgery; plastic surgery; trauma and orthopaedic surgery; urology; and oral and maxillofacial surgery.