JRSM > Volume 97, Number 4 > Pp. 174-178

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The state of basic surgical training in the UK: ophthalmology as a case example

M P Watson MRCOphth  ¹ M G Boulton BSc PhD  ² A Gibson BSc MRCSOphth  ³ P I Murray FRCS FRCOphth  ⁴ M J Moseley BSc PhD  ⁵   A R Fielder FRCS FRCOphth  ⁵

¹ Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN
² Social Sciences and Law, Oxford Brookes University, Oxford OX3 0BP
³ Radcliffe Infirmary, Oxford OX2 6HE
⁴ Academic Unit of Ophthalmology, Division of Immunity and Infection, University of Birmingham, Birmingham B18 7QU
⁵ Department of Ophthalmology, Imperial College London, Charing Cross Campus, London W6 8RP, UK

Correspondence to: Professor Alistair Fielder, Department of Ophthalmology, Imperial College London, Room 9L02, Charing Cross Campus, St Dunstan's Road, London W6 8RP, UK
E-mail: a.fielder{at}imperial.ac.uk

Concern is being expressed about the state of basic surgical training in the context of growing demands to improve service provision in the National Health Service. Taking ophthalmology as a case example, we sent questionnaires to all 466 senior house officers (SHOs) in recognized surgical training posts in England, Wales, Scotland and Northern Ireland. The main outcome measures were intraocular surgery performed in the previous two weeks and since starting as an SHO in ophthalmology; access to protected teaching time or cases on theatre lists; and supervision during surgery. Phakoemulsification, the most common type of cataract surgery, was used as a generic indicator of intraocular procedures. 314 (67%) of the SHOs responded. Of those working in the hospital in the previous two weeks, 50% had performed at least one component part of a phakoemulsification (phako) operation and 44% had performed at least one full phako operation. The average number of full phako operations done per week was 0.741. 77% reported some protected surgical teaching time over the two weeks and those with protected teaching time reported more full phako operations per week. Of those who had performed at least one surgical procedure in the previous two weeks, 79% had been supervised by a consultant. Of those who had completed two or more years' training as an SHO, only 42% met the Royal College of Ophthalmologists minimum requirement of 50 complete intraocular operations performed under supervision. Women were less likely than men, and SHOs in district general hospitals were less likely than those in teaching hospitals, to have achieved this target. As many as half the SHOs in ophthalmology are not receiving an adequate basic surgical training. If this continues it may prove difficult to train sufficient new surgeons to an acceptable standard to meet the increasing demands of an ageing population. This is not an issue for ophthalmology alone but for all surgical specialties.

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