RCSEd Supports Calls for Changes in the Way We Train Surgeons
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The Surgical Forum of Britain and Ireland says change is needed urgently in the training of surgeons in a report launched today, which argues that the centralisation of services and the question mark over future of district general hospitals together with increasing specialisation has created too few surgeons with a commitment to tackle increasing levels of emergency surgery.
Launching the discussion paper that represents the views of surgeons across Great Britain and the Republic of Ireland, John MacFie, Chair of the Surgical Forum, said:
"The conventional training and role of surgeons in some specialities is no longer appropriate to meet the demands of a changing society, where emergency surgery is the most common reason for hospital admission - something that will only increase with our growing ageing population and changing patterns to patient care. Safety and the best possible outcome for our patients are at the heart of all we do. To achieve these, we need a different surgical landscape for the future where in certain specialities we create consultants with a greater focus on providing emergency care."
The Forum argues that increasing specialisation and targets for elective surgery have led to a depletion of support for emergency care. This may compromise the future of the district general hospital (DGH) model of care, and risks not meeting the needs of society.
"If the DGH model of care is to continue, these hospitals must be able to attract good quality surgeons to ensure a high quality service. It is simply unacceptable to have differing standards of care in different hospitals," John MacFie said, explaining: "In recent years increasing specialisation and centralisation mean that we have fewer 'generalist' surgeons to provide emergency surgical cover - the term specialist often regarded as a proxy for 'better'. This has led to emergency surgery to being considered by some as second class and as a result often under-resourced."
The Forum says that standards for emergency surgery are often variable and the outcomes inconsistent, and argues that this is a serious problem because the majority of patients admitted to UK and Irish hospitals every day are emergency admissions.
John MacFie says that society must address the dilemma, and fears the consequences if it does not: "The consequence will be further diminution in standards for emergency care. It also fundamentally challenges the future role of the DGH."
The Forum is calling on employers and the agencies responsible for training surgeons to recognise that we need to train surgeons for future service requirements. This will necessitate:
- ensuring adequate resources for emergency surgery cover
- creating a better work/life balance in the profession to attract the best surgeons
- focusing training to meet the needs of patients and the health service
- reaffirming the importance of a consultant led and delivered emergency surgical service and clearly defining the evolving role of consultants in specialisation and leadership
- awarding CCT once competence is achieved in common procedures to reduce the length of training
- using the expertise of the royal colleges in workforce planning
- deciding as a matter of urgency the future of the district general hospital model, and ensuring the surgical curriculum necessary to practise in DGHs if it remains in place
- important to recognise that the requirements for different surgical specialties vary and a one size fits all approach is not appropriate
Commenting on the Forum's call for change, RCSEd President, Mr Ian Ritchie said:
"I fully support this initiative from the Surgical Forum which represents opinion from all four Surgical Colleges in the British Isles and Ireland, as well as the Specialty Associations. This broad recognition of the need to review the way we train surgeons for the National Health Service is welcome.
"It has always been the view in the Royal College of Surgeons of Edinburgh that surgical training should be directed to the needs of the population at large. In the first instance, this must be to deal with the majority of common conditions and once this has been addressed, there is a need to consider more specialised training for the smaller number of patients who need highly specialised surgical attention."
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