No time to train the surgeons

Editor—Chikwe et al mainly blame the Calman reforms and the European Working Time Directive for the crisis in surgical training.¹ Maybe a share of the blame lies with the medical establishment, especially the royal colleges and postgraduate deans, who have an influential role in selecting trainees.

Some trainees have two right hands and are a pleasure to teach; some have two left hands and teaching is torture. Most trainees are in between. Even with reduced hours, it is possible to train; the trick is to identify the right trainee.

One way of ensuring that the outcome of current training programmes is not “dumbed down” consultants is to select experienced trainees. A considerable wealth of talent and skills exists among doctors known as “time expired” senior house officers (who have not obtained a numbered post three years after obtaining the MRCS) and non-consultant career grade surgeons.

Young doctors who have just finished basic surgical training will not have acquired sufficient surgical skills to allow them to complete specialist training to very high standards in the truncated time available in the higher surgical training programmes. They can further their surgical skills in so called non-training posts (trust fellowships or staff grade posts).

A good trainee will seek out good training. Only when they are sufficiently skilled and experienced should they enter the higher surgical training programme. Selection procedures for these programmes must not prefer academic achievements to surgical competencies.