Intended for healthcare professionals


Are surgeons still all privileged white men?

BMJ 2016; 355 doi: (Published 24 October 2016) Cite this as: BMJ 2016;355:i5513
  1. Theodore Pezas, specialist registrar in plastic surgery
  1. Oxford Learning Institute, University of Oxford
  1. theodorepezas{at}


Despite efforts to increase diversity, more needs to be done, says Theodore Pezas

Despite attempts to tackle the lack of diversity in core surgical training (CST),1 the perception of surgeons as privileged white men persists.2 According to recent Health and Social Care Information Centre data there are currently 1549 full time trainees in core surgical trainee programmes: 36% (553) of whom are female,3 42% (633) who class themselves as black or minority ethnic (BME),4 and 36% (542) who are over the age of 29.5 While this may be an improvement on earlier figures, they contrast with the medical profession as a whole, the majority (51.3%) of which is female.

It has been suggested that there may be limits to increasing inclusivity in CST among certain groups, such as women, despite initiatives.6 To complicate matters further, stereotypes relating to machismo are difficult for some to overcome.78 So what is hampering the surgical profession from diversifying?9

Devil in the detail

Some seemingly small details also hold some trainees back.

At the start of their CST programme, trainees attend an induction where, despite not having been asked to do so in advance, they are expected to have registered with the Intercollegiate Surgical Curriculum Programme. This can make trainees—especially those with limited IT skills or those still lacking internet access after moving to the region—feel that they are starting their training on the back foot.

In addition, the selection of educational and clinical supervisor may be left to the trainee to arrange—despite not all trainees feeling comfortable approaching prospective supervisors without having worked with them or having introduced themselves first.

While there has been progress in both practice and policy aimed at increasing inclusivity, this has been gradual. The use of simulation has been shown to increase the availability of learning prospects10 as it is recognised that not all trainees are given equal opportunities during placements. Crucial training courses, such as anatomical dissection and laparoscopy, are not available free of charge in all regions.

Many trainees make the most of free access to online journals, courses, and other resources at work. However, many are still unaware of how much study leave they are entitled to; or how much reimbursement they can claim; or that they have to research and arrange this themselves.

Flexibility and support

Out-of-hours training—introduced after the implementation of the European Working Time Directive in 2009—offers the majority of trainees additional learning opportunities that might otherwise be missed during normal working hours. Debriefing procedures mean that all members of a team are included in handover, team planning, and scenario management—this also contributes to the overall learning experienced by trainees. Flexibility of training has allowed many trainees to continue to fulfil familial or religious obligations. Provided deadlines are met, trainees are offered an increasing amount of autonomy.

Inter-regional transfers are available for trainees who have a change in circumstance (such as disability, familial obligations, marriage) that requires they be relocated to a specific region.

Deaneries’ professional support units help trainees with issues—such as disability or mental health problems—which may affect training. Medical school competence standards are now screened in an attempt to avoid discrimination,11 particularly in surgical training where early career guidance is thought to be a potential solution to preventing discrimination.

Multi-faith prayer rooms and etiquette policy reviews have increased awareness of a need for religious considerations in surgical practice.12

Equality monitoring must continue to factor in trainee feedback, potential discrepancies in both subscription and pass rates, and progress yet to be achieved in ensuring diversity and equality of surgical training. While these initiatives are present in many surgical training environments throughout the UK, there is still more work to be done. To improve upon and maintain inclusivity in CST, training programmes must consider each trainee’s individual circumstance and background.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.