Reforms introduced in 1993 by Sir Kenneth Calman together with The European Working Time Directive have reduced training from 30,000 hours to an estimated 8,000 hours, and the Chief Medical Officer is proposing to reduce this even further to 6,000 hours.

To become a competent surgeon in one fifth of the time once needed either requires genius, intensive practice, or lower standards, write the authors.

The largest ever survey of senior house officers in orthopaedic surgery showed that a third of these trainees were not taught in theatre or clinic. As a result many junior trainees arrive at posts without any real competence in operative skills as basic as suturing.

"We cannot rely on highly able and motivated trainees and trainers to struggle on like this. Surgical training must be recognised as a priority," say the authors.

Most current trainees are supposed to become the new "generalist" surgeons who will carry out common procedures, referring more complex patients on to "specialist" consultant colleagues.

"We are left in the worrying situation where 6,000 hours of surgical training in its current state may not be enough to produce these new generalists, let alone provide consultants that can go on to become the kind of specialist consultant surgeon that we take for granted today," they conclude.

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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
19-Feb-2004