Twice as long and twice as much 

As you know, I am getting old, being a part time trainee with several years of maternity leave has meant that I am finishing my training 7 years later than the original date. One of the many happy and incredible things about being a part time trainee is that as I have done all my on call full time, as the rota couldn’t support a part time on call member (apparently, I was too timid to disagree) and so I have been the registrar  in emergency theatre for a total of 10 years compared to the 6 years of a full time trainee. 

This, as you would expect, translates into lots and lots of operations and one area where I have not struggled is in achieving the requisite numbers that have been deigned the minimum prior to being granted your ticket, your certificate of completion of training, the passport to consultant practice. 

Whilst preparing for consultant interviews this week (a task which feels as big as the FRCS and not as fun) I came across this interesting document (link click here)  from the Nuffield Trust about emergency surgery and the future of providing emergency surgical care. 

Hidden inside it is this rather terrifying table that shows how many trainees make the minimum numbers of operations performed independently (this can include supervised operations as long as you did it) from each subspecialty. 

I’m sorry if you can’t read it well here, it’s in the document. The gist is that the average newly qualifying consultant has done nowhere near enough. No wonder there is so much talk of fellowships following CCT to “get your numbers up”. 

It terrifies me as a parent, as a daughter, as a soon to be trainer of trainees that people are being signed off having not reached these requirements. 

I’ve personally taken out over 200 gallbladders and assisted and watched about another 70 be taken out. I still worry about doing something awful to the common bile duct, or God forbid, the hepatic artery. I would say I feel ok about gallbladders, I think after another 200 I’ll be a lot better. After 600, I hope and expect to be good at gallbladders. 

I am an average surgeon, most of us are, I am of average intelligence and motivation. I probably have above average insight into the complications of bile duct disasters as I worked in a liver unit for a year and dealt with the biliary messes of the region. So, here’s me, of average abilities in my view, about to embark on the start of my real career having done four times the number of gallbladders recommended by the JCST. I have a healthy respect bordering on distrust of the timorous beasty gallbladder. How must the chap who has only done 50 feel? Or not even managed 50? He must be shiting himself. Or worse, be totally deluded that he is the emperor of gallbladder removal. 

Hartmann’s resection; this operation can be sublime or it can be a mess beyond imagination. They recommend you do 5 of them!!  I have almost 50, and would still worry about fucking the ureter and getting the rectum closed nicely and safely. 

The JCST and the GMC were most insistent that I attend an ATLS course (£550), as well as a poxy management course that would embarrass 12 year olds it’s so bad (free thankfully) and of course Training the Trainers (£780). There are all sorts of other boxes that must be ticked, like having some observation of your teaching and audits etc. Nobody gets away without doing these courses and the waffly bits for their CCT so why are we letting people CCT without doing the operations? Arguably that is the most important part of training a surgeon, that you have actually produced a surgeon, not a person with some certificates. 

I started work in the final days of the 48 hour weekends and 24 hour on calls when we would work shifts that left you destroyed. I now work in a 48 hour week limited environment but have gloriously managed to get away with the impact of this on my training by being part time, working less in theory, but I go to theatre the same as a full timer and I have been going for almost twice as long. Which makes me think I should be so much better than I am, but I am distinctly average on a good day. It just shows that you can really train anyone to do anything given enough time! 

One of the questions I am preparing for at these awful upcoming interviews, is if I feel being part time has hindered my training in any way. On the contrary, it has been the biggest advantage imaginable, I have had twice the time to do twice the operating. And it’s not just me, the other part timer I know is the same. 

It would be interesting to know from the JCST if part time trainees are hitting their numbers as from my limited survey of me and one other, we have both exceeded by a mile the minimums required. 


15 thoughts on “Twice as long and twice as much 

  1. I am sure you are far from average.

    I completely agree with what you say. Working part time to me is a dream as one can “prolong” training. With no family, I had been a proper MMC trainee (FY to ST) and worked full time to CCT. Currently finishing my post-CCT fellowship with a second one to go to in August. 8-year surgical training coupled with EWTD is by no means enough!

    • It is terrible. What annoys me is the way that they make us tick every other box, those courses that are at best ok and make a huge fuss about your assessment of audits! Hope your fellowship is going well. Part time training has been a joy for me. I would love to see how people answer their self rating questionnaires for the MSF surveys. I put satisfactory for it all, who seriously thinks they are outstanding?

  2. Dear KBW
    just to let you know its totally okay to takr twice as long to be twice as good. and i do not believe you are ‘just’ average.
    I work in a Malaysian hospital now as a surgeon where I’m probably twice less busy than you are ( that explains why I’m always free to read your blog)
    and pls Keep writing, you don’t know how many young doctors were actually inspired by your blog! I’ve told my junior registrars who were all whiny about marriage, milk and diapers to read your blog and start living like a mother and a surgeon!

    Yee Ling

    • Thank you for that lovely comment. I don’t beat myself up for taking so long, I have loved the journey. I will keep writing, it’s hard to find the time but it is amazing to think people read it regularly and would recommend it! Thanks. You have made my day x

      • You definitely have above average insight. Why stop at operative numbers? Urology log the number of emergency referrals they assess. Should there be a requirement of clinics attended and patients managed, or ward rounds lead.
        These are domains of elementary aspects surgical practice which are overlooked in current training and minimum numbers.

      • We assume that so much is done along the way in training. Formalising the process I think is a good thing and I feel iscp is an excellent tool. Perhaps we should have a receiving round as an assessment, much like an operative pba.

  3. KBW, could you perhaps elaborate on your preparation for the consultant interviews? I have been invited to an interview, but have no idea what to focus on during my preparation. Any advice would be much appreciated!

    • Ok. I am very busy with work and a major family event over this weekend but I will try and do a post on it soon. I have approached it like the management version of the FRCS. There is no acronym I haven’t learned for various “institutes of making things better” and I have read all the Kings Fund stuff etc. Have you got any colleagues who have just been through the interview process? X

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