Abstract
The article from the groups in London and Philadelphia [1] seeks to highlight differences in surgical training between the UK and US healthcare systems. This report is timely for those working in the UK, where the recent publication of the Shape of Training report by Professor David Greenaway [2] has proposed a new model for future postgraduate medical training. The rather disappointing response rate in the study and the use of self-reported data undermine the quality of the study that, nonetheless, allows broad comparison of surgical training in two continents. It might have been more valuable to have seen a like-for-like comparison with surgical training records or logbooks at equivalent stages of training. The duration of UK surgical training may come as a shock to some, particularly since past reforms were aimed at aligning more closely the UK-based programmes to those in the USA. However, these changes came at the same time as the working week became subject to European working time restrictions, and the length of training has not changed significantly. Although the concept of competency-based training has been introduced with more emphasis on work place-based assessments (WPBAs), there remains a time-based indicative length of training that means the UK graduate will typically undertake a minimum of 10 years of postgraduate training before practicing independently. It is an interesting observation that although the US trainees spend more time in the operating room, there was no significant difference in the number of elective cases undertaken, and the UK trainees performed significantly more emergency cases. The drivers for this pattern of training may have been as much service driven as trainee focused due to the requirements of the 48-hour working week legislation in the UK, with more experience being gained in London in the emergency setting. Concerns have been raised previously regarding the lack of supervision in the emergency setting in UK practice, and while some autonomy may provide the senior trainee with valuable insight as they move towards independent practice, this study does not provide data on the appropriateness of the level of supervision or any information around patient safety issues. There are indeed considerable discrepancies between the transatlantic training experiences with a greater emphasis on endoscopy experience in London but more simulated training and elective surgery in Philadelphia. The question arises as to what sort of surgeon is required to deliver service needs in the respective countries. The increasing tendency to sub-specialization may have appeal to the trainee but may not sit well with the requirement of the health service in the UK. Health service management require generalists to manage the pressures imposed by increasing emergency admissions. The Shape of Training report in the UK envisages a shorter, broader, and more generalist training in surgery, with a move towards credentialing to deliver and maintain subspecialty training. Making the transition to independent practice from a supportive training environment has always been a challenge. This study presents us with more questions than answers but provides useful insight into current training practice. O. J. Garden (&) R. W. Parks Royal Infirmary, University of Edinburgh, Edinburgh EH16 4SA, UK e-mail: ojgarden@ed.ac.uk
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