Time for a professional approach

Surgeons in Britain have long taken pride in their plentiful practical experience, on which their clinical skills are based. Much of this experience was gained through emergency operations performed without any supervision during the night. One survey reports that 76% of surgeons had performed operations for the first time without supervision (J Wilson, personal communication). One trainee described his training as merely “an opportunity to have access to patients.” But experience without training increases confidence not competence.1 This version of self directed learning is no longer appropriate, if it ever was. Changes in the patterns of working and in patients' expectations dictate a more formalised and professional approach to the training of surgeons.

Between them, the New Deal2 and the Calman report3 are reducing the time available to train a surgeon from 13 years at over 100 hours a week to eight years at 56 hours a week—a reduction by nearly two thirds. The resulting increase in the conflict between service provision, experience, and training is well illustrated by the Oxford trauma service. The service is now delivered by consultants, and junior doctors' hours …