Many otherwise capable surgeons are challenged by seriously injured patients. Surgeons responding to the London bombings of 7 July 2005 had to contend with many cases of blast trauma and associated injury, but only a handful had experience of similar casualties. The management of severely injured patients is demanding because trauma does not respect the boundaries of anatomy or the surgical specialty.1 Yet the UK lacks both training opportunities for trauma surgery and a service infrastructure, problems that other countries have recognised and started to remedy.

The presence of a general surgeon in the multidisciplinary trauma team remains important: death from occult cavity haemorrhage is ranked second only to major head injury as a cause of death after trauma and is often preventable.2 Techniques such as resuscitative thoracotomy, damage control laparotomy, and rapid control of vascular injury are life saving, yet general surgeons working in the UK have few opportunities to develop expertise.3 More importantly, no formal training pathway exists for those wishing to achieve competence in trauma. In an era when higher surgical specialist training is subject to stringent accreditation this lack of …