The College has hosted a joint meeting with the presidents of the specialty associations and Chairmen of the surgical specialty groups to discuss major issues faced by the profession
Held on 10 June, the meeting aimed to deliver agreement on the major issues facing surgery, and the agenda included training in 48 hours, surgical simulation, and the promotion of excellence in training through new specialist training opportunities. Also up for discussion were joint educational initiatives and the role of mentoring.
Training and WTR
The meeting supported the principle of compliance with Working Time Regulations, but with certain conditions including exploring the option of continued educational activity (e.g. surgical simulation) outwith contracted working time.
It is expected that modular training will be an important feature, with more senior trainees requiring increased flexibility in working time compliance. The increasing complexity of a trainee’s operative exposure (including increasing volumes of emergency surgery) should be accompanied by a more flexible approach to working time, and curriculum should be realigned to reflect this.
In the event that competencies are not mature at the time of acquisition of a CCT, delegates agreed that a period of proctoring may be required for those who have newly acquired a CCT, utilising training fellowships and team working, with the availability of experienced mentors for younger colleagues. But the option for independent practitioner status prior to, or as an alternative to, consultancy (specialist surgeon) requires more consideration because some practitioners may not want to be involved in complex or high volume emergency surgery.
This spectrum of specialist activity would fill a gap within service provision in different types of hospitals, from rural to district general hospital, and also specialist and academic units. The meeting warned that the present training structure provides only a single standard of graduate which does not meet the needs of the diversity of hospital types and roles. It delivers neither a generalist nor a specialist, but a surgeon with potential for either, and points to an increasing need for applied training around the CCT period.
Surgical simulation
There was consensus on the need for a national strategy for simulation, but not necessarily with a single simulation centre. The meeting also recognised the importance of protecting long-term funding, but with the proviso that a simulation curriculum is also needed for early, as well as for advanced, training in each specialty.
Joint education initiatives
Delegates agreed that the perspective on surgical education should be widened beyond the current focus on acquisition of skills within training grades. There was support for the view that skill retention and, indeed, skill degradation needs more research.
Delegates were enthusiastic about exploring the possibility of a Faculty of Surgical Educators, to restore and enhance the status of those involved in surgical education, and to recognise that not all future consultants will be trainers and educators.
It was noted that there are differing perspectives on, and different potential roles for, mentoring. These range from an optional process of reflection on professional activities that is available to everyone, to a supervisory role for more experienced surgeons to provide guidance for those who are less experienced.
Specialist training opportunities
Another initiative welcomed at the meeting is the development of bespoke Advanced Training Medical Fellowships (ATMFs) that promote excellence in training. But it was agreed that they must have structured training and learning agreements. The College is to explore its role in facilitating and supporting these new opportunities, which will contain a significant service element, allowing holders to gain further experience in a learning environment.
Professor George Youngson CBE, Vice President for Professional Affairs
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