The State of Basic Surgical Training in the UK: Ophthalmology as a Case Example

Concern is being expressed about the state of basic surgical training in the context of growing demands to improve service provision in the National Health Service. Taking ophthalmology as a case example, we sent questionnaires to all 466 senior house officers (SHOs) in recognized surgical training posts in England, Wales, Scotland and Northern Ireland. The main outcome measures were intraocular surgery performed in the previous two weeks and since starting as an SHO in ophthalmology; access to protected teaching time or cases on theatre lists; and supervision during surgery. Phakoemulsification, the most common type of cataract surgery, was used as a generic indicator of intraocular procedures. 314 (67%) of the SHOs responded. Of those working in the hospital in the previous two weeks, 50% had performed at least one component part of a phakoemulsification (phako) operation and 44% had performed at least one full phako operation. The average number of full phako operations done per week was 0.741. 77% reported some protected surgical teaching time over the two weeks and those with protected teaching time reported more full phako operations per week. Of those who had performed at least one surgical procedure in the previous two weeks, 79% had been supervised by a consultant. Of those who had completed two or more years' training as an SHO, only 42% met the Royal College of Ophthalmologists minimum requirement of 50 complete intraocular operations performed under supervision. Women were less likely than men, and SHOs in district general hospitals were less likely than those in teaching hospitals, to have achieved this target. As many as half the SHOs in ophthalmology are not receiving an adequate basic surgical training. If this continues it may prove difficult to train sufficient new surgeons to an acceptable standard to meet the increasing demands of an ageing population. This is not an issue for ophthalmology alone but for all surgical specialties.

Selection matters-a regional survey of UK consultant opinion on selection into postgraduate surgical and medical training

BACKGROUND AND AIMS

Recent changes to postgraduate training in the United Kingdom have led to considerable debate regarding selection processes for specialist training (ST) positions. A survey of the opinion of a group of consultants on the relative importance of selection criteria for entry into the first year of specialist training (ST 1) was conducted.

METHODS

An electronic questionnaire was sent to the e-mail addresses of all consultants at 4 hospitals in London with a request to rank order the importance of specific selection criteria when assessing (1) a candidate's suitability for entry into ST 1, (2) the fairest shortlisting mechanism, and (3) whether an interview should be a necessity for appointment.

RESULTS

Of 657 consultants successfully contacted, 212 (32%) replied. Previous specialty-specific experience gained during foundation (intern-level) training was considered the most important criteria in assessing suitability for entry into ST 1 with additional research degrees second most important. A conventional curriculum vitae (CV) was considered the fairest way of shortlisting candidates, whereas a nationalized final undergraduate examination (Final MB) was least favored. Ninety-five percent of respondents felt that an interview was essential for appointment to ST 1.

CONCLUSIONS

Consultants place the most emphasis on previous specialty-specific experience and additional research degrees when considering selection for ST 1, bringing into question the generic nature of foundation training. Consultants preferred to maintain some subjective controls over purely objective markers in the selection process. Thus, there is little support for a nationalized ranked examination as a shortlisting tool, and an interview is recognized as essential for appointment to ST 1. There is a need to build on these preliminary findings by conducting further investigations before changes to selection methodology are implemented.