AN ORTHOPAEDIC TRAINING PROGRAMME

Abstract

Over the last few years and with increasing momentum and definition, the several specialist associations and the four Surgical Royal Colleges have made a complete reexamination of the British methods of surgical training. The result is likely to be one of the most revolutionary changes yet conceived in this sphere in this country. It is a reformation with a defined purpose; already a clear pattern has emerged and the major principles have been decided. The whole when put together promises to be one of the best balanced and excellent training programmes anywhere. It seems an essentially simple scheme, with many advantages over traditional training, and yet the time spent will be considerably shortened. There are, however, particularly when it comes to detailed policy and practice within our own speciality, reasons why we should now look carefully at the training programme we want and why we want it. Decisions are in the making both by the appropriate British Orthopaedic Association committees, the British Orthopaedic Association at large and by the Colleges of Surgeons. In attempting to clarify the major issues here, evolution of an acceptable training scheme may be accelerated and improved. In contrast to the Continental hierarchical system the British method of surgical training is essentially a clinical apprenticeship to a consultant, who, traditionally independent, taught his younger surgical apprentice with varying effort, but frequently with great enthusiasm, all that he had learnt. Most men look back to the training with their “chief” as the formative and important years of their professional life, often immensely enjoyable years. Why is it that many, although not all, now feel that the method has become inadequate, and why has this conviction become so strong that amending regulations are already drafted which will change the whole structure? The reasons are several but three are outstanding. Training has become too long and men are not reaching consultant responsibility in the more popular specialities until thirty-five to forty years of age, too late for their best years to be fruitful. This is an age when enthusiasm, drive and initiativeare already on the wane, particularly if not nurtured by early, full responsibility; professional and domestic security remain too long uncertain. Much of the blame for this must be borne by the National Health Service, in which prospective planning for staffing needs has been conspicuously unsuccessful, though all of us appreciate that that is not an easy task. The second reason is that few surgeons now cover the full range of even their own speciality. This is particularly true in the bigger, more highly differentiated teaching and training centres in which most will train. There is no longer one master for the apprentice but several, and each has many apprentices often for a very short time. The close personal relationship which bound it together and gave it much of its value has gone. There being at present no criteria as to what constitutes a training centre, any registrar post is acceptable whether teaching occurs or not. This difficulty often arises in those hospitals where the senior men are most overloaded with routine work and experience in, and facilities for, teaching are absent. Promotion up the training ladder is essentially competitive-by and large an advantage. Training in these smaller centres counts little in this competitive selection, but despite this a study of those who come to registrar selection committees shows that many have * Read ata PlenarySessionof theAnglo-American Conference on Postgraduate Orthopaedic Training,