Trainee surgeons perform operations alone

First-time surgeons are carrying out operations without supervision, including kidney transplants and mastectomies, that they have neither seen nor assisted at before, a survey has revealed.

Almost nine out of ten general surgeons and two-thirds of head and neck surgeons admit to performing procedures, for the first time, without a senior and more experienced colleague being present. In some cases there was no senior doctor present in the hospital.

Junior doctors said they had removed gall bladders, spleens and had repaired hernias for the first time without supervision. Registrars had performed major abdominal operations unsupervised, including removal of the bowel, amputations and, in one case, a kidney transplant.

The survey was conducted among 450 trainee surgeons and young consultants of whom 276 returned the questionnaire.

Professor Janet Wilson, of the department of head and neck surgery at the Freeman Hospital, Newcastle upon Tyne, who conducted the survey published in the British Medical Journal, said the findings were disturbing. "I had known from anecdotal reports that this went on but I was surprised by the scale of it and by the complexity of the operations performed. A lot of surgeons I discussed it with expressed frank disbelief, so I am glad to have it published because this is a large sample and there is no doubt about the figures."

Among the young consultant surgeons, most reported having performed a procedure that they had not seen during training, but Professor Wilson said that this was less worrying. "As consultants are fully trained they should have the capacity to take on new techniques," she said.

The reasons for the lack of supervision were pressure on surgeons to cut waiting lists, together with the reduction in junior doctors' hours. This increased the burden on consultants who had to spend more time doing routine surgery and so had less time for training. Consultants were expected not to let training delay operations. Some unsupervised procedures were carried out as emergencies at nights and weekends.

However, John Spiers, chairman of the Patients' Association, claimed some senior consultants were putting their private work before the NHS. "If these doctors are unsupervised, where are their supervisors when they're supposed to be in the operating theatre? There's evidence to suggest that they are in their private consulting rooms."

Professor Wilson said the surgical training colleges should keep closer checks on the records kept by trainees to ensure operations were supervised the first time they were performed. The pressure on trainers might be eased by breaking complex operations into parts - opening the abdomen, repair, and closing, for example - so that only that part of the procedure that was unfamiliar would need supervision.

The Royal College of Surgeons said yesterday that the findings were worrying, but questioned whether they were representative of the 4,000 senior house officers and 2,000 specialist registrars in surgical training.