Launch Pad “Between a rock and a hard place”: Surgical specialty training in the spotlight

Vascular trainee Claire Dawkins argues that vascular surgical training needs to “move with the times” in order to avoid “alienating” the next generation.

SURGICAL TRAINING HAS ALWAYS BEEN thought of as a particularly gruelling time, with a demanding rota, long on-calls, little sleep and difficulties fitting a family life around it. But vascular training is something that needs to move with the times, particularly as we are seeing an increase in the number of primary caregivers within our ranks.

At present, doctors looking to commence speciality training are between a rock and a hard place. Applying for a National Training Number (NTN) is competitive and can be stressful, only to find that you have met the requirements for a training number but, due to your ranking nationally, you will be dispatched to a distant region. You move there, disrupting any family you may have, only to be told that over the following six years you will be rotating through several distant hospitals. Do you find somewhere to settle in the region and face significant commutes throughout your training, or accept that you may move yearly (even up to six monthly for some)?

At work you may find that some of your colleagues in the same role did not apply for or get an NTN. They have a fixed job, in one hospital, where they can settle their family without the disruption of moving every year. They know the team who understand how they work due to the consistency they have had. Unfortunately, it is not all rosy as a non-NTN trainee. A recent UK survey suggests that non-NTN trainees do not have comparable access to educational and clinical supervisors, they do not have priority when there is competition for surgical cases or projects (audit, quality improvement work or research) and can struggle to gain leadership and management experience. The Certificate of Eligibility for Specialist Registration (CESR) process, which technically expects the same level of evidence as is required of an NTN trainee to complete training, is a laborious and expensive process without the structure of NTN training.

The junior doctor workforce is fed up and downtrodden. They are balloting for potential strike action. The intensity and demands of medical care continues to increase. Their working conditions and quality of life need to change. But this is unlikely to improve without a significant change in the structure of training. In vascular surgery, we are already facing a workforce planning deficit and need to increase our inclusivity rather than alienating both NTN and non-NTN trainees. We need to manage the pathway better, with better locality and less disruption for NTN trainees and more structure and opportunity for non-NTN trainees. I accidentally managed to achieve a relatively undisrupted pathway through my training—only rotating every two years. This gave me the continuity to work with a team for a longer amount of time, to better develop professional relationships and to gain a better understanding of different approaches, techniques and pathways, while not having to frequently move house or disrupt my family to meet my training requirements. However, there are individuals for whom this would still pose difficulties, particularly single parents with school age children, or those with non-traditional care-giving responsibilities. Unfortunately, I do not have the answers. I do not think it is a problem that one person can easily fix. It needs a complete overhaul of both NTN and non-NTN pathways. The potential gains of better recruitment and retention of the best individuals to vascular surgery (or any UK training pathway) are huge, but depend on being able to provide a stable, supportive working environment for medical professionals, usually in their thirties, to develop their skills and attain specialist registration.