Surgeons in run-through programmes take longer to complete training

Authors: John Jolly, David Wilkinson, Jon Hossain, Julie Honsberger, Michael Gough 

Publication date:  11 Feb 2016


John Jolly and colleagues found that surgical trainees appointed to run-through programmes take up to three years longer to complete training than doctors following other training routes

Important changes to postgraduate training have taken place in recent years, with the introduction of a two year foundation training programme in 2005, followed by specialty training programmes in 2007.

In 2007 trainees were appointed to run-through specialty training, where they progressed to the next level of training if they achieved the required competencies. Uncoupled training programmes began in 2008, while run-through programmes continued in some other specialties. In uncoupled training two or three years of core training are followed by competitive interview for a higher specialty training post, which allows progression to completion of training.

It is still under debate, especially in surgery, whether run-through training is more effective than uncoupled training. At present, there is a mix of both within surgical specialties.

After being recruited into the surgical specialties by the Yorkshire and South Yorkshire and Trent deaneries (now Health Education Yorkshire and the Humber—HEYH), the 57 top ranked candidates were offered run-through surgical training (eight years), while the lower ranked candidates were offered core surgical training posts (two years).

The two deaneries also recruited another cohort of 60 trainees into higher surgical training (six years) in 2007, beginning their training programme at specialty training year 3.

Comparison methods

We conducted a retrospective review of all surgical trainee data recorded on the HEYH database over eight years. To assess progress of individual trainees, we collected data on outcomes of the annual review of competence progression (ARCP). If trainees had time out of programme, maternity or sick leave, or leave for any other reason, this was recorded. Some trainees worked in academic posts and some worked less than full time.

We analysed data on all 154 surgical trainees appointed in 2007. The 57 run-through trainees were seen towards the end of their second year to determine which higher specialty they wished to pursue. After interviews trainees were ranked and matched to their highest preferences (table 1).

Table 1

Trainees recruited in 2007

Surgical specialty Run-through (n=57) Core surgical (n=37) Higher (n=60)
Core surgical training - 37 -
General surgery 19 - 18
Trauma and orthopaedics 23 - 17
Ear, nose, and throat 8 - 7
Plastics 3 - 10
Urology 1 - 6
Paediatrics 3 - 1
Cardiothoracic - - 1

We examined the progress of surgical trainees by ARCP outcomes and time out of programme. The proportion of run-through trainees receiving an ARCP outcome 1 (satisfactory progress) every year (63%) was similar to that of the higher surgical trainees (62%) (fig 1). The proportions of unsatisfactory outcomes were also similar.

Fig 1 Annual review of ARCP outcomes

Time away from programme

More run-through trainees (47%) than higher trainees (18%) took time out of programme for research, training, or experience. It is likely that many of the higher trainees had some research or training experience before being appointed in 2007.

Few trainees (4/154) left the programme. Two core trainees left after receiving an ARCP outcome 4. One higher surgical trainee left the programme after two years and another resigned after five years (table 2).

Table 2

No of trainees spending time away from programme

Run-through (n=57) Core (n=37) Higher (n=60)
Out of programme: research, training, job experience 28 (47%) - 11 (18%)
Out of programme: career break 2 (4%) - 2 (3%)
Maternity 1 (2%) - 5 (8%)
Sick leave - - 1 (2%)
Interdeanery transfer - - 1 (2%)
Academic posts 8 (14%) - 11 (18%)
Less than full time 1 (2%) - 5 (8%)
Left programme 0 2 (5%) 2 (3%)
Total 40 (70) 2 (5%) 38 (63%)

Completion of training

Most (80%) of the higher trainees had completed their training and were given an ARCP outcome 6 by 2015. The run-through training was expected to take a minimum of seven to eight years from appointment. Almost a third (32%) of run-through trainees had completed their training by July 2015 (table 3).

Table 3

No (%) of trainees at completion of training* or current training grade on HEYH database by July 2015

Run-through (n=57) Core (n=37) Higher (n=60)
ARCP 6 18 (32%) 1 48 (80%)
ST8 8 (14%) 4 (7%)
ST7 11(19%) 1 4 (7%)
ST6 10 (18%) 1 -
ST5 8 (14%) 2 1
ST4 2 (4%)
Surgical national training number in England outside HEYH - 11 (30%) 1
Not in surgical training post in England - 20 (54%) 2
Changed specialty - 1 -

*Completion=annual review of competence progression (ARCP) outcome 6

Progression of core trainees into higher training programmes

In 2009, 95% of the core trainees appointed in 2007 had completed their core training. We analysed the Joint Committee on Surgical training database in 2013 to see whether core trainees appointed to HEYH in 2007 obtained surgical national training numbers in other English regions. In 2013, 46% of these core trainees were in training posts in England and Wales. Eleven (30%) of the 37 core trainees obtained national training numbers in a surgical specialty in other deaneries in England and Wales (table 3).

Demographic characteristics of trainees appointed in 2007

At appointment, the run-through trainees were generally younger than the higher and the core trainees (fig 2). They were also more likely than higher and core trainees to be women: 37% of run-through trainees were women, versus 8% of core trainees and 23% of higher trainees.

Fig 2 Year of birth of trainees

Almost half (28/57 (49%)) of the run-through trainees were two years post-qualification and 16/57 (28%) were three years post-qualification when appointed in 2007. Many of the higher trainees had five to eight years’ postgraduate experience before being appointed (fig 3). The trainees appointed to core training had a wide range of postgraduate experience (2-19 years).

Fig 3 Year of primary medical qualification for trainees appointed in 2007

Most of the run-through trainees obtained their primary medical qualification in the United Kingdom (91%). This compares with 73% of higher surgical trainees and 30% of core trainees.

Conclusions

The progress of run-through surgical trainees, as measured by ARCP outcomes, was similar to that of higher surgical trainees. Run-through trainees were more likely than higher trainees to take time out of programme. The run-through trainees were generally younger and more likely to be women than the higher and core trainees. None of the run-through trainees left the training programme.

The results are important for those managing run-through training programmes, as trainees taking time out of programme will usually leave a gap in the rota to be filled. Workforce planners need to be aware that two thirds of run-through trainees in this review took an extra one to three years to complete their surgical training.

Competing interests: We have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.

John Jolly associate postgraduate dean
David Wilkinson postgraduate dean
Jon Hossain deputy dean
Julie Honsberger senior business manager
Michael Gough head of school of surgery Health Education Yorkshire and the Humber

 john.jolly@yh.hee.nhs.uk

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