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Return to firm structure could help boost trainee morale, says Royal College of Surgeons

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5353 (Published 17 November 2017) Cite this as: BMJ 2017;359:j5353
  1. Abi Rimmer
  1. The BMJ

A training scheme that will create a modern firm structure could help to improve junior doctors’ morale, the Royal College of Surgeons has said.

Earlier this month the college started recruiting to the Improving Surgical Training (IST) programme. This pilot scheme has been designed to give surgical trainees a better balance between training and service provision and to make the role of the surgical trainer more professional. It will be piloted throughout England, Scotland, and Wales, with 81 posts available.1

One aspect of the pilot scheme will be to create a modern firm structure—where members of the wider surgical care team, including physician associates and surgical care practitioners, will help to support trainees.

Ian Eardley, senior vice president of the college, explained that the modern firm would not be the same as the old system, which was based on doctors working long hours and being on call the whole time.

But he said that the scheme would recreate the best aspects of the old firm model. He said, “The nice things about the old firm were firstly that you had a support structure in place; if you had a problem, whatever hour of the day or night, you always had a person who you knew could help you, who could give you some advice.

“You [also] had a consistent relationship with the people who were your seniors and who could support you in terms of your training and development.”

Eardley said he hoped that the pilot would help to improve trainees’ morale. “People say that a lack of support structures, which a lot of junior doctors experience, was one of the main reasons for their unhappiness,” he explained. “If we can improve that, I would hope they will be happier, hopefully because they have better training as well.”

The pilot will also allow trainees to spend around 60% of their time in elective daytime training roles, to ensure that they spend the right amount of time in training rather than service provision.

“One of the problems for junior doctors at the moment is that in many places their prime role is to be the emergency on-call system, and we would argue they spend too much of their time being on call at nights or weekends,” said Eardley. “That has two consequences: firstly, for a surgeon, it means that they don’t get into theatre often enough to learn their basic surgical skills, they don’t get into the outpatient clinic enough, and they don’t spend enough time doing elective daytime training.”

To allow trainees to work more during the daytime the pilot sites will need at least 10 people on their on-call rota. To fill the rotas, Eardley said, some of the pilot sites were using a mixture of doctors and other members of the surgical care team.

The pilot programme will be open to all trainees applying for core level surgical training posts through the 2017-18 national selection process. It will initially be piloted in general surgery and from August 2019 will be opened to applicants in urology and vascular surgery.

Depending on the outcome of the pilots, Eardley said that aspects of it could be rolled out into all surgical training. He said, “Some of the components—the rota work, the work on service commitment, the work on improving the quality of trainers, the consistency and support for trainees, the work we want to do on simulation—I think ultimately should be on offer to everybody if we can prove that it works.”

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