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The training pathway

From the trainee’s perspective, he or she will be able to undertake surgical training via differing routes depending on which training scheme they choose or are selected for, within a School of Surgery in one of the postgraduate deaneries in the United Kingdom.

Run-through training (UK only)

For those trainees who are certain of their specialty choice, and who choose to enter 'run-through' training, competitive entry into ST1 leading to certification will be possible in their chosen specialty, where this is offered by the specialty. As well as specialty-specific competences, those on this route will still need to attain the level of competence common to all surgeons before entering ST3 (ST4 in Neurosurgery) and this will be assessed through the MRCS, WBAs and the ARCP. This route is currently available in Neurosurgery (and in some deaneries/LETBs, Cardiothoracic Surgery, Oral and Maxillofacial Surgery and Trauma and Orthopaedic Surgery).

Uncoupled training

This route is currently available in General Surgery, Cardiothoracic Surgery, Oral and Maxillofacial Surgery, Otolaryngology, Paediatric Surgery, Plastic Surgery, Trauma and Orthopaedic Surgery, Urology and Vascular Surgery.

For those trainees who are either uncertain of their chosen specialty, who are unable to gain entry to run-through training, or who choose a specialty that does not offer the run-through route, a period of 'Core' surgical training will be necessary. During this period trainees will attain the common surgical knowledge and skills and generic professional behaviours, while sampling a number of surgical specialties. In addition to attaining common competences, trainees will need to complete their speciality-specific competences to be eligible to enter ST3 in their chosen specialty. They will then seek to enter specialty training at the ST3 level by competitive entry. Open competition will test trainees against SAC-defined competences for ST3 entry.

This model has a number of possible variants. Core training might sample several specialties, without any particular specialty focus. In such cases some specialty top-up training may be needed later on in order to reach specialty entry at ST3 level. Another variant would organise core training along a theme that supports progression to a specific specialty. In these situations many trainees may pass straight from CT2 to ST3 in their chosen discipline if selected. In practice, core surgical training will run over an indicative timescale of two years (CT1-2).

Academic training

In the UK some early years’ trainees may wish to pursue an academic surgical career and will devote a significant proportion of their time to additional academic pursuits including research and teaching. For the majority this will lead (later in specialised training) to a period of time in dedicated research, resulting in the award of a higher degree in a scientific area related to their chosen specialty. For others who wish to revert to full-time clinical training, this will also be possible, providing that the relevant clinical competences are achieved.

General information on UK academic pathways can be found in the Gold Guide.

The JCST is keen to support academic careers within surgery and has ensured that the surgical curriculum is flexible enough to accommodate an academic pathway. The curriculum specifies that each individual trainee’s training is planned and recorded through the learning agreement.

In England, Academic Clinical Fellows (ACFs) are generally expected to achieve the same level of clinical competence as other surgical trainees within the same timeframe. In order to progress through training pathways the ACF, in addition to demonstrating competence in clinical aspects, will generally be required to have obtained a funded Research Training Fellowship in order to undertake a PhD or MD, which they will complete during an out of programme period. Some trainees during their period of full-time research may want to carry out some clinics or on-call, if they and their academic supervisor feel that it is in their best interests. On successful completion of a PhD or MD the ACF will either return to their clinical programme, apply for an Academic Clinical Lecturer (ACL) or Clinician Scientist post.

Arrangements for academic training differ in detail in the devolved nations of the UK and in the Republic of Ireland. Click here for further information on Wales, Scotland or Northern Ireland.

In the Republic of Ireland trainees with an interest in academic surgery may choose to spend time out of training in a dedicated research post.

Academic trainees will need to complete all the essential elements of their specialty syllabus satisfactorily in order to be eligible for certification/CESR-CP (UK) or a CCST (Ireland). It is acknowledged that clinical academics may take somewhat longer in training to achieve competence at the level of certification/CESR-CP (UK) than trainees taking a clinical pathway; however they will be supported fully and treated as individuals with their personal progress being matched to their learning agreement.

Moving from one discipline of surgery to another

In the early years it is possible that a trainee who has started to develop a portfolio consistent with a particular specialist discipline might wish to move to another. One of the strengths of the flexible early years programme is that it will be possible, depending on the local circumstances, to make such changes with an identification of suitable educational competences that may be transferred. This is strictly conditional on a trainee achieving the educational milestones so far agreed for them. Moving from one discipline to another because of the need to remediate in the original discipline would not normally be permitted. All common requirements (for example, possession of the MRCS) would be transferable. Those leaving ENT however could not use the DO-HNS examination as equivalent to the MRCS examination and those wishing to enter ENT (and already having the MRCS) would be required to sit the Part 2 DO-HNS examination.

In order to be eligible to move from one discipline to another the following conditions therefore apply:

  1. Achieve a satisfactory outcome in ARCPs up to that point including all relevant WBAs.

  2. Fulfil the minimum period in the new speciality of choice in order to progress to ST3 in that discipline (ST4 in Neurosurgery).

  3. Obtain the new position through open competition in the annual selection round.

  4. The MRCS, MRCS(ENT) (or DO-HNS in addition to the MRCS) examination.

The process in practise would be subject to local negotiations between the postgraduate dean or appointed nominee in the Republic of Ireland, designated training supervisors and the trainee making the request. If the decision to change theme in core programmes occurs early the effective increase in training time may be minimal. If the decision occurs later or during run-through, more time spent in the early years is almost inevitable. The progression to ST3 is in essence competence rather than time-dependent. Those spending longer having made a change may be subject to limitations on any subsequent period required for remediation, although this ultimately would be a Deanery/Local Offices decision.

Completion of training

Successful completion of the programme in the UK will result in certification or a Certificate of Eligibility for Specialist Registration via the Combined Programme (CESR-CP) and, in Ireland, a Certificate of Completion of Specialist Training (CCST), and placement on the Specialist Register of the GMC or the Medical Council of Ireland (MCoI). This will indicate that the surgeon has reached the curriculum standards of competence to practise as a consultant surgeon in the UK or the Republic of Ireland. These requirements are set by the SACs and the surgical royal colleges, are approved by the GMC in the UK or Medical Council of Ireland and translate into the ability to manage a significant proportion of the elective work within the specialty and to undertake the primary management of emergencies. It is anticipated that where additional, well-recognised specialist skills are required by the service, these will be gained by the completion of additional modules before the completion of training and the award of the specialty certificate.

Doctors who wish to join the GMC’s Specialist Register and have not followed fully or in part a training programme approved by the GMC in the UK leading to certification/CESR-CP but who may have gained the same level of skills and knowledge as certification/CESR-CP holders can apply for a Certificate of Eligibility for Specialist Registration (CESR).

Once on the Specialist Register, all surgeons will be expected to maintain their professional development in line with Good Medical Practice for the purpose of revalidation in the UK or in line with the Guide to Professional Conduct and Ethics in Ireland.

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