Intended for healthcare professionals

Rapid response to:

Analysis

How long does it take to train a surgeon?

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4260 (Published 05 November 2009) Cite this as: BMJ 2009;339:b4260

Rapid Response:

Learning to cut through a new swiss cheese

Purcell Jackson and Tarpley have analysed the effect of reduced
working hours on surgical training and as a junior trainee, it is the
cutting opportunities that are the worst affected. Waiting list targets,
the publication of surgeon-specific results, the threat of litigation and
the appointment of surgeons’ assistants all contribute further to the
squeeze on training.

The analogy of holes lining up in swiss cheese has been used to
describe the coincidences leading to a critical incident and training
cases can sometimes seem equally unlikely. Factors related to the case,
the trainer, the list and theatre resources can all impact. A single such
case, with proper feedback, can provide invaluable experience but
opportunities vary greatly between jobs. Increasing such opportunities
nationally would require a frank investment in earmarked training lists
with trusts remunerated through ring-fenced budgets and trainers’ efforts
recognised in excellence awards.

Learning through observation will always be crucial to the surgical
apprenticeship but with reduced working hours, structured operative
training should be more than a rare coincidence.

Competing interests:
None declared

Competing interests: No competing interests

17 November 2009
Rhys Jones
CT2, General Surgery
University Hospital of North Tees, Stockton, TS19 8PE