Letters Surgeon specialisation and operative mortality

Surgical training must ensure continued production of specialist surgeons

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4702 (Published 06 September 2016) Cite this as: BMJ 2016;354:i4702
  1. Helen Mohan, vice president1,
  2. Rhiannon Harries, immediate past president1,
  3. Adam Williams, president1
  1. 1Association of Surgeons in Training (ASiT), 35-43 Lincoln’s Inn Fields, London WC2A 3PE, UK
  1. president{at}asit.org

In their recent paper, Sahni and colleagues demonstrate the importance of surgeon specialisation and volume in achieving lower mortality rates.1 The Association of Surgeons in Training (ASiT) is a firm advocate for excellence in surgical training and supports training to the highest degree of specialisation.2 ASiT is concerned by proposals to change surgical training to a more generalist and less specialised curriculum after the publication of the Shape of Training report.2 3

Sahni and colleagues add weight to the argument that a shift towards generalism would not be in a surgical patient’s best interests. The outcome measure used in this paper is 30 day mortality, and the differences in relative risk are significant.1 It is imperative that such evidence is considered when redesigning surgical services and training. Training to the highest level and operating within a specialist sphere of knowledge equip surgeons to achieve the best possible outcomes for their patients.

We think that it is imperative to train surgical trainees to the highest possible standards in their specialty and subspecialty. A shift towards generalism in surgery raises significant patient safety issues. Rather than training surgical generalists, we should develop high quality specialist surgeons. Clear evidence shows that specialists achieve better outcomes, as confirmed by this paper from Sahni and colleagues.1 These findings must be considered when redesigning the surgical curriculum.



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