Foundation doctors (F1 and F2)
All newly qualified doctors spend two years in training as foundation doctors. At least three months must be spent in surgery and three months in general medicine. Foundation doctors will typically spend four months on a placement. Once they have completed their first year of training they are eligible for full registration with the General Medical Council (GMC). On surgical teams, foundation trainees are mainly concerned with preparing patients and observing procedures conducted by the surgical trainees. Foundation trainees with a keen interest in surgery may be given opportunities to assist in minor elements of surgery under close supervision.
Core Training Doctor (CT1 and CT2)
These posts are core surgical training appointments where the surgeon gains experience at performing different surgical procedures. Core training programmes will last up to 2 years (CT1 and CT2) depending on the grade and specialty. Doctors in these posts were formerly called 'Junior Surgical Trainees'.
Specialty Surgical registrar (StR)
Doctors at this grade will usually spend six to eight years at this level building up experience. After the two years (sometimes less) of core surgical training across different areas of surgery, doctors can sit the MRCS (Member of The Royal College of Surgeons) exams. This, along with other assessments, enables them to continue their training, and they then revert to the title ‘Mr’, ‘Mrs’, ‘Miss’ or ‘Ms’, instead of ‘Dr’. This is due to tradition; in the past surgeons did not have to complete full medical training and so were not allowed to be called. After a further four to six years of training and passing further exams they can become Fellows of the Royal College of Surgeons. On successful completion of this training period, surgical StRs are awarded the Certificate of Completion of Training (CCT), thus gaining entry to the specialist register and can apply for positions as consultants. In teaching hospitals a StR may be called a research registrar.
Specialist Surgical registrar (SpR)
Before 2007, surgeons who wished to build up their surgical experience would apply for these posts, which typically lasted for six years. As a result, there remain a few of these surgical SpRs in post. As with StRs, they have to pass further exams, after which they become Fellows of the Royal College of Surgeons. After their training and examinations are successfully completed they can be awarded the CCT and, as per the above, become eligible to apply for positions as consultants. In teaching hospitals, a SpR may be called a research registrar.
Specialty/ Staff grade/Career grade surgeons
These surgeons will have had some experience as a registrar (see above) and have completed at least two years of surgical training after their foundation years (except Specialty surgeons, who could be just out of core training). They may perform a range of operations and outpatient consultations under the supervision of a consultant. Depending on experience career grade doctors tend to focus on a few specific routine operations. They will often run their own clinics, have their own personal waiting lists and operate independently. Some Career grade doctors will also have teaching responsibility.
Associate Specialist Surgeons
These surgeons carry out a wide range of surgical care, dependant on the extent of their training on the ward, in the outpatient clinic and in the operating theatre. This might include complex surgery at which they have become expert. They work under the supervision of a consultant. They too will often run their own clinics, have their own personal waiting lists and operate independently.
The consultant is responsible for managing your care and is assisted by a team of doctors and other professionals. While you may see your consultant at hospital appointments and on the ward, he/she may not perform your operation. The consultant has overall responsibility for the standards of care given to all patients by doctors in their team. Consultants usually specialise and may become highly skilled in one or two specific areas of surgery, but they are also responsible for a wide range of emergencies admitted under their care. In order to become consultants in the NHS, their names must be on the specialist register of the GMC. In teaching hospitals, consultants may be called professors, readers or senior lecturers. Consultant surgeons employed by a University who have a contract with a hospital may be called honorary consultants.
Non-medically qualified practitioners
Podiatric surgeons have not completed a medical degree, but have instead trained exclusively in the surgical and non-surgical treatment of the foot. Training will typically take five years. After this period they can apply for posts as Consultant podiatric surgeons.
Surgical assistant/ Surgical care practitioner
Training for this consists of a two year part-time clinically based course at a Higher Education Institution. These are non-medical practitioners who have extended the scope of this training to work as members of surgical teams. They can perform surgical intervention, and pre-operative and post-operative care under the supervision and direction of a consultant.