An audit of clinical training exposure amongst junior doctors working in Trauma & Orthopaedic Surgery in 101 hospitals in the United Kingdom

Mustafa S. Rashid

doi:10.1186/s12909-017-1038-5

Abstract

BackgroundThere are concerns regarding early years’ training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery.MethodsWe recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, “not in work” (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure.ResultsOverall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty.ConclusionsJunior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.

Highlights

There are concerns regarding early years’ training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom
Given the introduction of work-hours regulations, and a perceived reduction in training opportunities within Trauma & Orthopaedic surgery in the United Kingdom, we aimed to evaluate the clinical exposure of junior doctors working in T&O departments in the National Health Service (NHS)
Core surgical trainees made up 21.6% of the cohort (n = 200) with a mean of 1.9 Core Surgical Training programme (CST) per T&O department

Summary

Introduction

There are concerns regarding early years’ training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. One or two of these posts may be in a surgical specialty, including Trauma & Orthopaedic (T&O) surgery During their Foundation Year 2 (FY2), doctors will apply to a Core Surgical Training programme (CST). Core Surgical Training programmes vary in the number and duration of surgical posts They will either be “generic”, including 3 or 4 specialties or “themed”, providing trainees with up to 18 months of training in a particular surgical discipline, e.g. Trauma & Orthopaedic surgery, out of 24 months. Posts are typically 4 or 6 months in duration, depending on the programme During this 2 year training programme, junior surgeons follow a surgical curriculum, and are required to fulfil core competencies, as well as successfully undertake an examination, conducted by the Royal College of Surgeons. The attainment of all competencies, including successfully passing a specialty exit examination, undertaken in ST7 or ST8, leads to an award of Certificate of Completion of Training (CCT)

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