Winter pressure leaves surgeons short of training opportunities

Authors: Abi Rimmer 

Publication date:  23 Jan 2017

Surgeons are missing vital training opportunities because of the current winter crisis in the NHS, trainees have said.

Adam Williams, president of the Association of Surgeons in Training, told BMJ Careers that pressures on the NHS meant that opportunities to train were limited and trainees were often called out of operating theatres to assist on the wards.

“Ultimately, the emphasis has shifted from combining training with high quality service delivery, to maintaining basic service delivery at all costs. Patients are suffering, and trainees are suffering,” Williams said. “There are myriad examples of trainees having to leave teaching opportunities both in theatre or clinic to assist on the wards.”

Along with the British Orthopaedic Trainees Association, Williams said that the Association of Surgeons in Training had been concerned about the situation for a number of months, and that it had worsened recently.

“In surgery we often find that, while the pressures at the ‘front door’ and on the wards remain suffocating, the theatres remain eerily quiet because we have too few ward and intensive care unit beds. This is detrimental to the patients, and detrimental to trainee experience,” Williams said.

Williams said that there was a “very real fear” that a reduction in training opportunities would cause trainees to fail their Annual Review of Competence Progression. It could also have an effect on their ability to have worked on enough surgical cases to achieve their Certificate of Completion of Training, he said.

“We cannot learn when the cases never reach the operating theatre because there are no safe postoperative beds1 in which to care for the patients,” he said. “We cannot learn when the cases are being performed, but we are pulled away to help in the emergency department.”

A spokeswoman for the Royal College of Surgeons said that, although it was important for patients to remain the focus during the current crisis in the NHS, “we shouldn’t overlook the impact NHS pressures are having on staff and in particular on doctors in training.

“Surgeons in training are telling us that they are being asked to do work for emergency departments and under-staffed wards in addition to their own roles,” she said. “As a result they are losing out on the theatre time for their training.”

She added, “Definitive action to free up hospital beds must be taken to lessen the pressure on the whole system. We must not risk patient safety and irrecoverably damaging the training of our future NHS workforce.”

Abi Rimmer BMJ Careers

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