Trauma and orthopaedic training in the United Kingdom.

Abstract

The United Kingdom has a free health-care system, the National Health Service, which was started in 1947 by Clement Attlee, the Prime Minister at the time. Many changes have occurred since then: the population has increased from around forty-six million to almost sixty million (according to government figures), and medicine has evolved dramatically so that many more conditions can now be prevented, diagnosed, investigated, and treated both medically and surgically. These developments have been paralleled by an increase in people’s expectations. As the population has increased, so has the number of doctors. Although the United Kingdom has increased its doctor-to-population ratio over the last ten years, the increase is less than that in mainland Europe and North America. Currently, there are 1453 consultant trauma and orthopaedic surgeons and 700 orthopaedic trainees in the United Kingdom. Following graduation from medical school, all doctors complete two six-month preregistration house jobs: one in surgery (occasionally within a broad surgical specialty, such as orthopaedics and trauma or cardiothoracic surgery) and one in medicine. These jobs are the broad equivalent of internships in the United States. The trainee will then apply for a basic surgical training rotation, which involves several six-month posts in different surgical specialties, such as general surgery, trauma and orthopaedic surgery, urology, cardiothoracic surgery, neurosurgery, etc. Most often, basic surgical training lasts between two and three years, during which time the trainee is expected to gain Membership in one of the Royal Colleges of Surgeons (MRCS). The MRCS examination, which has replaced the old fellowship examinations (FRCS), comprises multiple-choice questions, essays, oral examinations, and clinical examinations in aspects of surgery in general. Following successful completion of basic surgical training, the trainee can then apply for a specialist surgical training post. Specialist surgical training has become more structured over the past eight years. …