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Should surgical training include involvement in a clinical trial?

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2045 (Published 22 April 2015) Cite this as: BMJ 2015;350:h2045
  1. Dion Morton, professor of surgery, Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK ,
  2. Colin D Bicknell, clinical senior lecturer and honorary consultant vascular surgeon, Imperial College London, London, UK
  1. Correpondence to: M Dion dion.morton{at}uhb.nhs.uk, C D Bicknell colin.bicknell{at}imperial.ac.uk

The next generation of surgical consultants will need research experience to advance the specialty, writes Dion Morton, but Colin Bicknell worries about increasing the time trainees spend away from the operating theatre, where they learn their craft

Yes—Dion Morton

Clinical trials in surgery are sometimes perceived as a luxury—difficult to perform, rarely informative, and certainly activities that should be restricted to academia. Despite challenges, the benefits that surgical trials bring can be substantial, enabling safe and controlled evaluation and dissemination of new techniques and technologies.

The rapid proliferation of new technologies is increasing the demand for research, and many clinicians will be needed to run these clinical trials, way more than the number in academic units. Surgical trainees, the next generation of consultants, will have been failed by their trainers if they are not competent and confident clinical researchers. Without specific training, there is little chance that they will be capable or willing to undertake challenging clinical trials as consultants.

Building a surgical evidence base

Without a sound evidence base, surgical practice will evolve in a sporadic and haphazard fashion. Clinical trials seek to consider important patient centred questions. Surgical studies have the additional benefit, beyond that of drug trials, of disseminating best technical practice. For example, in the development of laparoscopic surgery for colorectal cancer, three international trials on two continents1 2 3 showed safety and efficacy, disseminated the technique, and led directly to the funding and development of national training schemes.4 A similar process is now underway in robotic surgery.5 This is what patients expect and what we must therefore deliver by equipping new surgeons with the skills they need.

Surgical care extends well beyond the operating theatre. Surgeons have a key role in selecting patients and care after operations. Advances in perioperative care developed in the past decade, including optimisation …

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