Trends in applications for higher surgical training

Abstract

Introduction: Over the past 5 years, there have been radical changes in working hours and selection processes throughout UK for the surgical specialties. A survey by the British Medical Association in 2004 revealed increasing unemployment (even among UK trainees) following a number of changes. This study investigates the effect of these changes on applications for the All-Wales Higher Surgical Training (HST) programme. Methods: A total of 107 applications werereceived for HST jobs in Wales advertised in 2004, 144 in 2006, and 202 in 2008. A comparison was made between the three cohorts by analysing nationality, qualifications, clinical experience, and academic activities. Results: There has been a 25% (n=8) and 120% (n=35) increase in the number of UK nationals applying for the HST programme in the years 2006 and 2008 respectively, compared with 2004 (32 in 2004; 40 in 2006; 67 in 2008). There has been a corresponding increase in the number of Indian applicants by 50% (n=22) and two-fold (n=45) in the same time period (40 in 2004; 62 in 2006; 85 in 2008). The number of female applicants almost tripled in 2006 (n=7), and ultimately increased nine-fold (n=33) over the same time period (4 in 2004; 11 in 2006; 37 in 2008). The proportion of applicants possessing an additional higher degree rose in 2006 by approximately 9%, reflected by a similar rise in those undertaking formal research. In 2008, this rate had fallen by 12% and 16% respectively. The duration of surgical training at middle-grade level dramatically reduced from 2 years to 5 months in 2008. The median numbers of audit remain unchanged in all three cohorts. The median number of presentations by the applicants rose in 2006, while courses fell in the same year. These trends reversed back to original figures in 2008. The median number of published works improved from one to two in 2008. Discussion: The total number of applicants to the HST programme has steadily increased by more than 30% over the two years from 2004 to 2006, and has nearly doubled over the 4-year period. The most significant changes have been the increase in the number of female applicants, and the numbers of UK graduates, with a steady increase in graduates from the subcontinent, suggesting that neither the European Working Time Directive nor the Medical Training Application Service has deterred the applicants towards general surgical training.