Letters Nuffield report on emergency general surgery

ASiT’s concerns about views expressed in the Nuffield Trust report on emergency general surgery

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2593 (Published 11 May 2016) Cite this as: BMJ 2016;353:i2593

This article has a correction. Please see:

  1. Elizabeth Elsey, yearbook editor1,
  2. Rhiannon Harries, immediate past president1,
  3. Adam Williams, president1
  1. 1Association of Surgeons in Training, Royal College of Surgeons, London WC2A 3PE, UK
  1. elizabeth.elsey{at}nhs.net

The Association of Surgeons in Training (ASiT) is concerned about views expressed in the Nuffield Trust report on emergency general surgery.

Data quoted in relation to general surgery trainee operative experience at completion of training imply that all trainees expressing a “general surgery” specialist interest meet the Joint Committee for Surgical Training minimum operative numbers, with those declaring a specialist interest (such as colorectal, transplantation) performing fewer general surgery index operations.1 Importantly, the report does not state that only two of the 155 trainees studied had a special interest.2 Additionally, the studied cohort was recommended for a certificate of completion of training (CCT) in the same year that the quoted guidelines were introduced, so were not required to meet these standards.2 All trainees undertaking general surgery training have to meet rigorous and demanding criteria to qualify for a CCT. We therefore do not believe that modern general surgery trainees with special interests are inadequately trained to provide an emergency general surgery service.

Furthermore, although we wholeheartedly agree with changes to training that improve standards and promote excellence, we fundamentally disagree with shortening training to create emergency general surgeons who lack specialist skills. ASiT strongly opposes truncated training pathways with a view to specialisation after CCT.3

Finally, we are worried about the ever-decreasing numbers of doctors in training, from 24 874 in 2004 to 14 106 in 2014.4 While recognising the value of the wider surgical team (eg physician associates), ASiT has concerns about the potential effect on surgical training of the increasing use of non-surgeons in emergency general surgery.3



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