Surgeons lack basic skills due to reforms

Surgeons are arriving in operating theatres unable to stitch up wounds or tie knots because of drastic cuts in the length of training, experts have warned.

Reforms that have cut a senior house officer's (SHO) training period from 30,000 hours to 8,000 has left many taking up consultants posts without basic skills, they say.

Writing in the British Medical Journal, they warned that plans to cut training further to 6,000 hours could create a system unable to produce less skilled specialists or general surgeons.

Joanna Chikwe, Anthony de Souza and John Pepper, all from the Royal Brompton Hospital, London, said the 1993 reforms by Sir Kenneth Calman had combined with the European Working Time Directive to reduce training so much that most consultant surgeons would not want to be operated on by junior colleagues.

"To become a competent surgeon in one fifth of the time once needed either requires genius, intensive practice, or lower standards. We are not geniuses," they said.

There was no evidence of an increase in the intensity of teaching to compensate for the fivefold decrease in training. A survey of SHOs in orthopaedic surgery showed a third of trainees were not taught in theatre or clinics.

"That many SHOs arrive at posts...without any real competence in operative skills as basic as suturing and tying knots is therefore unsurprising," they said.

The authors said that most current trainees were supposed to become the new "generalist" surgeons who carry out common procedures and refer more complex cases to "specialist" consultant colleagues.

But they said 6,000 hours of training might not be enough to produce the generalists, "let alone consultants".

Royal College of Surgeons president Sir Peter Morris said it supported much of the consultants' views and said it was facing "serious challenges" as a result of the cut in junior doctors working hours.

Sir Peter said the college was trying to ensure that the best use was made of the reduced hours available for training.

"No one can truly regret that trainees are no longer expected to work over 30,000 hours, which equates to 85 hours a week.

"As someone who trained in a long hours culture I can attest that it is not good for trainees or patients," he added.

The Department of Health said shorter training for doctors "emphatically" did not mean lower standards. "The key is to make sure that newly-qualified consultants meet patient and service needs and all consultants have the opportunity for further specialisation as service demand requires."