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Surgeons criticise trust’s use of care practitioner to perform laparoscopic cholecystectomies

BMJ 2024; 385 doi: (Published 13 May 2024) Cite this as: BMJ 2024;385:q1075

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Re: Surgeons criticise trust’s use of care practitioner to perform laparoscopic cholecystectomies

Dear Editor

Here, we have a clash of priorities.

On the one hand, we have a highly gifted and highly motivated registered general nurse who has shown considerable aptitude in the acquisition of technical skills, not only in the colorectal specialty, but, also, in the technically demanding context of laparoscopic cholecystectomy[1]. Such an individual is an asset to Walsall Healthcare Trust, and also a good return for their investment in their training, especially given the fact that they are unlikely to emigrate to a country where they will face great competition (from qualified doctors) on the job market. On the other hand, Walsall Healthcare Trust has to honour its obligation to provide full training opportunities to the consultants of tomorrow, who have made great sacrifices to optimise their eligibility for the limited pool of training posts.

Senior consultants might have, in some instances, been complicit in optimising the acquisition of technical skills by physician associates at the expense of the acquisition of the same technical skills by trainee doctors[2]. The rationale, again, is, arguably, the perception that the former strategy will prove to be a good return for their investment, especially if the physician associate proves to be an individual who shows exceptional aptitude for the acquisition and execution of those technical skills.

Diagnostic skills belong to a completely different category. Arguably, a medical qualification is a unique precondition for optimal acquistion and execution of those skills. Accordingly, the dilemma which confronts policy makers is whether to prioritise the training of technically highly skilled clinicians over the training of clinicians who have superior diagnostic skills but not necessarily optimal technical skills.

[1] Wise J. Surgeons criticise trusts's use of care practitioner to perform laparoscopic cholecystectomies. BMJ 2024;385;q1075
[2] Boyle J. Survey unearths catalogue of errors by unregulated medics. Sunday Post January 7 2024

Competing interests: No competing interests

20 May 2024
Oscar M Jolobe
retired geriatrician
British Medical Association