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We read the article by Osborn et al with interest. The authors present data concerning the cohort of aspiring surgeons who applied to a Welsh basic surgical training rotation. We would like to make the following points:

1. The Modernising Medical Careers initiative commenced in August 2005 with the new foundation programmes. At present there are approximately 4,500 SHOs in surgery in England¹ and 500 SpR numbers will now be available across the surgical specialties each year (Joint Committee on Higher Surgical Training, personal communication). This has led to the current ‘lost tribe’ of SHOs competing for a small number of SpR jobs.

2. Orthopaedics is a popular specialty; there is even greater competition for SpR than for SHO posts. In 2005 in South West Thames there were 180 applicants for 5 SpR posts. Successful applicants tended to have broad, high quality experience. Lengthy, poor quality experience is associated with a reduced chance of shortlisting.² Early careers advice is therefore vital.

3. Much of the data regarding experience with research gives 0 as the median value with some large outlying values (ie: presentations; median = 0, range = 0–43). This demonstrates that a small number of candidates have marked enthusiasm for producing research at an early stage. Identification and nurturing of such trainees would aid development of their research careers.

References

1. NHS Health and Social Care Information Centre. NHS workforce: Consultants and GPs as at 30th June 2005. London: NHS Health and Social Care Information Centre; 2005.

2. Nielson DM, Ricketts DM. Short-listing for orthopaedic specialist registrar posts – what is important? Ann R Coll Surg Engl 2005; 87: 185–187.

We thank Bismil et al for their comments. The point regarding Modernising Medical Careers would surely result in an increase in the number of applicants for an established basic surgical training (BST) rotation rather than – as we found – a marked reduction, particularly with UK graduates.

We agree that the royal colleges are extremely keen for training in these surgical years to be highly concentrated and efficient. Therefore, we would again suggest an established BST rotation with six-month stints in the specialties. Accident and emergency and general surgery would be efficient and would increase the number of applicants.

We agree with Bismil et al’s comments regarding research. Any additional means of identifying an outstanding candidate, such as their ability to address a clinical problem and answer it by research, would seem a legitimate means of discrimination.