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Improving Surgical Training – A Trainee’s Perspective – What does it mean for us?

08 Nov 2017

Dr Hannah Lewis

Those of us intending to apply for core surgical training this year have a new training programme for general surgery to consider – Improving Surgical Training (IST). When I first heard about the pilot from a mentor, I thought it sounded too good to be true. However, after getting involved in an IST Q&A session at an ASiT event last month, I’m hopeful that the IST pilot could be the beginning of a new and improved training pathway for surgical trainees. In this blog, I’ll summarise, mythbust and inform you about IST from my own perspective – that of a trainee with an application to consider.

So where has this come from? The pilot is the first step in an alternative and improved approach to postgraduate surgical training. It has been developed to implement many of the changes recommended in the RCS’ Improving Surgical Training (IST) report, which was produced in response to the independent Shape of Training review. Its aim is to provide more streamlined, focused and competency-based surgical training, which is in the best interests for us as trainees, for our patients and for service needs. It also aims to encourage and support trainees, with the aspiration that our trainers will be in a better position to train, and that trainees are better supported and available to learn. Can you see why I thought it sounded too good to be true?

I’m currently an “F3” and I purposefully did not apply for surgical training last year. As an aspiring breast surgeon, I currently have two options for training:

  1. General surgical training for eight years followed by a oncoplastic/breast fellowship – a long training programme with minimal breast surgery experience until much later in training, and having to attain competence in emergency general surgical skills that I would later not use for my patients.

  2. Plastic surgery training, also eight years of training with some focused breast training as part of a rigorous training pathway.

Both options excited but daunted me – which was the best training path for me as a clinician, and what would provide me with the best training for my patients? I remained unsure. In many areas of special interest, most notably in breast surgery, trainees face the reality of training to complete general and emergency surgical cases for logbooks and passing CCT, rather than completing and being merited for realistic clinical competence that they will use for the remainder of their practice.

I first heard about IST from a mentor who was aware of my dilemma, and as a general surgery ST3 recruiter was aware of this new training initiative. Though I was immediately interested, with any new progression or change it raised a lot of uncertainty and questions.

Some of my concerns, such as how my consultant will have enough time to train me, and how IST trainees will fit in with other CSTs, were addressed by the IST panel at ASiT’s recent ‘Preparing for a Career in Surgery’ event, held in Edinburgh last month. 

Personally, I’m very interested and hopeful that this new training pilot – although teething problems are inevitable – is the start to a new and improved pathway for surgical trainees. I’m sure that anyone who has worked with or knows a surgical trainee would agree that they wished the education and support of surgical training was improved.

Understandably, proposing a new approach to how we learn and train as surgeons is bound to be met with questions and some rejection, but there can only be developments and improvements on the IST programme once the change has started. With the pilot commencing in 2018, perhaps now we finally have the chance to start making that change, for the benefit of ourselves as future surgeons and of our patients. 

You can read a consultant's view of the pilots here

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