Paediatric surgery should be performed by specialist surgeonsBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7247.1423 (Published 27 May 2000) Cite this as: BMJ 2000;320:1423
Surgery in children should be classified as a subspecialty and carried out by designated surgeons who have undergone appropriate training, recommends a report from the Royal College of Surgeons in England published last week.
The report is calling for major changes in the training and workload of surgeons carrying out paediatric surgery. It also recommends organisational changes so that inpatient surgery for children would be undertaken only by hospitals with comprehensive paediatric facilities.
Every district general hospital is being asked to develop a multidisciplinary group responsible for overseeing, improving, and integrating services for children. Most surgeons in England and Wales currently operate on both adults and children, with only 2% specialising exclusively in paediatric surgery.
The report recommends that surgery in children should be carried out mainly by designated surgeons specifically trained in the paediatric aspects of their specialty.
“It should only be carried out by surgeons whose paediatric workload is of adequate volume to maintain a high level of surgical competence—typically, a minimum of one paediatric operating session per fortnight,” the report suggested.
An even higher regular workload is proposed for cardiac surgery in children, with the suggestion that it should be carried out only by surgeons with a major subspecialty interest reflected in a minimum commitment of two operating sessions a week for patients with congenital heart disease. “There is no scope for occasional practice in paediatric cardiac surgery,” the report warned.
The report was developed by the Paediatric Forum of the Royal College of Surgeons in response to changes in the training of surgeons in England, with a move from an apprenticeship approach to a more structured programme.
“In some specialities, notably general surgery, the quality and duration of paediatric training is very variable,” warned the report. “Those of us in paediatric surgery were concerned about this, and we decided to develop proposals on how to provide an optimum service to children,” explained Ms Leela Kapila, consultant paediatric surgeon at the Queen's Medical Centre in Nottingham, and chairwoman of the forum. “We want surgeons who are going to look after children to be trained properly,” she added.
Work on the report began in 1994, before the Bristol case—in which a high death rate in babies undergoing cardiac surgery led to a major inquiry. Initially, health trusts are being asked to identify consultant posts—surgical and anaesthetic—that involve a commitment to the care of children.
Where new or replacement consultant surgical appointments include this commitment, it should be clearly specified in the job description. Surgeons appointed to such posts should be required to have undergone appropriate training in paediatric aspects.
Children's Surgery A First Class Service is available from the Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PN (www.rcseng.ac.uk).