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Improving surgical training

We have worked with the Royal College of Surgeons of England to pilot a new competence-based, run-through training programme in general surgery.

The Improving Surgical Training pilot trialled improvements in the quality of training, a better training-service balance for trainees, professionalising the role of the trainer, and looked at developing other members of the team from other professional backgrounds to work alongside trainees to improve patient care.

The programme was commissioned following a review of surgical training which found high dissatisfaction rates among surgical trainees, that many were spending increasing amounts of their time on service provision, and not enough of their time on training. The General Medical Council’s annual trainee survey also consistently found that surgical trainees are the least satisfied of all the medical specialties with their training.

The pilot provided an opportunity for trusts to develop an alternative workforce model, maximising productive training time and making use of the specialist knowledge and skills of members of the extended surgical team. It also provided the ideal occasion to develop the concept of the modern firm, announced by Rt Hon Jeremy Hunt MP, whilst Health Secretary, involving the multi-disciplinary team within which junior doctors work, and who are best placed to provide the support they require in a positive and collaborative environment.

The pilots were launched in August 2018 in general surgery at over 30 different trusts across England, Scotland and Wales, with 80 surgical trainees taking part. 

Rotas in the IST pilot provided trainees with 60% elective daytime training activity. Each trainee also had a minimum of one hour per week to receive feedback from their trainer and reflect on their work. Enhanced training for IST trainers was developed and delivered by the RCS via dedicated two-day boot camps.

Professor Wendy Reid, Executive Director of Education and Quality and Medical Director, Health Education England, said:

“Improving Surgical Training provides an exciting opportunity to enhance training in general surgery – and, in due course, training in other surgical specialties - to help improve patient care.”

An independent evaluation of the IST pilot across England was conducted with key findings of the evaluation including:

  • Longer placements created better relationships within surgical teams, with one-year placements seen as optimal
  • Run through attracts trainees who are committed to their specialty and may help to build stronger relationships with supervisors and others in clinical teams
  • Bootcamps are popular and valued by surgeons in training and trainers who attended
  • Getting the balance between service and training remains a common issue. Well staffed rotas are seen as important to protect training time, and the EST is a potential solution to help with achieving this.  
  • Access to simulation and an expectation that trainees would use available resources

The full report and evaluation summary are now available and work is now underway to utilising these findings in deciding on future developments in surgical training.

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