Surgery

There are some six million operations carried out each year in England and almost 5,000 consultant surgeons (see table below). Operations range from the most simple, such as adenoidectomy (curetting a child’s adenoids) to the most complex, such as a liver resection for cancer. Surgery is carried out with the traditional tools of surgical knife, scissors and forceps and with modern stapling devices, endoscopes and microscopes. A typical week for surgeons involves operating lists (one to two days), clinics, patient administration (phone calls, letters), management (organising operating lists and clinics) and teaching.

Training pathway

Once the programme of Modernising Medical Careers (MMC) is fully implemented, most surgical trainees will be selected onto a surgical programme during their F2 foundation year. It will not be necessary to have done a surgical post during foundation years to enter surgery and selection will be based upon demonstration of appropriate qualities of character, ability and commitment. Selection will be competitive, conducted nationally and include assessment of the candidate’s professional and undergraduate portfolio of achievements and an interview that assesses knowledge and communication skills. Once accepted onto a surgical training programme, trainee surgeons will be given a national training number in surgery (NTN-S) and will undertake core surgical training (CST). At the end of two years, trainees will formally enter their specialty of choice and their NTN will be converted to a subspecialty NTN. At the end of training, surgeons will achieve a certificate of completion of training (CCT), which will allow entry into specialist registrar positions and appointment to a consultant post. All trainees accepted into surgical training are expected to finish training, although progress will depend upon achievement of defined competences. 

CST takes place during years ST1 and ST2 and will either be generic (for surgery in general) or themed towards a specific surgical specialty. The curriculum will include surgical sciences (anatomy, physiology and pathology), generic technical surgical skills (tissue handling, haemostasis, instrument use, biopsy) and clinical management (assessment, preoperative, post-operative and emergency care). Trainees will undertake two years of four or six month placements on surgical or para-surgical (eg critical care) firms. The trainee’s progress will be evaluated by workplace assessments, interviews, a training portfolio and examination. In addition to providing core surgical training, these early years will help the trainee confirm his or her choice of a career in surgery and permit trainers and assessors to confirm the trainee’s suitability for such a career.

Best and worst

As a surgeon, you and your skills are important. Your job can be demanding but is almost always rewarding. Surgery is often an important life event for patients and sometimes you operate to save life. To be greeted warmly by a patient you have helped, or by the smile of a child who came in frightened as an emergency, is perhaps the best part of surgery. You work in a team, which sometimes does not work – at times there can be a lot of waiting around. At times surgery does not go as planned, and then you have to face your patient and yourself honestly.

Specialties and subspecialties

There are nine surgical specialties within the Royal College of Surgeons of England:

• General surgery :  Association of Surgeons of Great Britain and Ireland
• Orthopaedic surgery : British Orthopaedic Association
• Otorhinolaryngology, head and neck surgery : British Association of Otorhinolaryngologists and Head and Neck Surgeons
• Urology : British Association of Urological Surgeons
• Maxillofacial surgery : British Association of Oral and Maxillofacial Surgeons
• Plastic surgery : British Association of Plastic Surgeons 
• Cardiovascular surgery : Society of Cardiothoracic Surgeons of Great Britain and Ireland
• Neurosurgery : Society of British Neurological Surgeons 
• Paediatric surgery : British Association of Paediatric Surgeons

Within each surgical specialty there are subspecialties. In general surgery, these are especially numerous: upper gastrointestinal surgery, hepatobiliary surgery, lower gastrointestinal surgery, vascular surgery, breast surgery, endocrine surgery, transplantation, general surgery of childhood and trauma.

Key information resources

• Intercollegiate Surgical Curriculum Project
• The Association of Surgeons in Training (ASiT)
• Women in Surgical Training (WIST)
• The Royal College of Surgeons of England 
• The Royal College of Surgeons of Edinburgh
• The Royal College of Physicians and Surgeons of Glasgow
• The Royal College of Surgeons in Ireland

Chris Bem FRCS, DiplRCOG, MD, MPH, FRCS (ORL–HNS) is consultant ENT and neck surgeon at Bradford Teaching Hospitals and careers adviser for the Royal College of Surgeons of England.