Trainee Surgeons’ in the COVID-19 Era: In Their Own Words

30 September 2020

In our last blog, we highlighted the groundbreaking new research (which can be viewed in full here) released by the Confederation. This data made headlines across the nation, and revealed a horrifying culture of suppression around the risk factors affecting surgeons and other medics; as well as insights into the level of dissatisfaction among surgeons regarding the lack of preparation for the COVID-19 pandemic. The perceived disregard for the safety of healthcare workers was so great that 1 in 12 surgeons who responded said they were considering changing their discipline or leaving the field of surgery altogether.

The Confederation’s findings highlighted the urgency for investment in chronically underfunded areas – particularly within education and training - and we strongly feel that investment must also be made in these areas using other resources, such as time and effort. We therefore see it as timely and critical to discuss some of the many issues affecting individuals in the surgical training pathway, and to present some of their proposals to ameliorate training processes.

At the end of March, controversial measures for trainee medics were announced as part of general principles agreed by HEE, NES, HEIW and NIMDTA for medical training programmes. These measures included requiring applicants halfway through the interview process to restart applications; and, in specialties that had not yet held interviews for recruitment at ST3/ST4 levels, it was required to use self-assessment and shortlisting scores as the sole means of ranking applicants. The measures outlined what was explained as a high-trust model proposing to limit the use of clinician’s time in COVID-19’s unprecedented circumstances, however this model would offer no validation of self-assessment scores where they formed part of initial applications. It was noted that for general and vascular surgery where scores had not been collected, that a proportion would have been validated with a small amount of clinical input.

Following this, ASiT and the Trainee Specialty Associations wrote a joint letter to surgical trainees, citing a number of concerns that had been raised in response to these measures. The letter stated that they did not agree with the measures, and highlighted the significant risk that trainees would be disadvantaged as a result of the imposed processes, as well as in future application rounds.

Since that time, new Quality Indicators (QI) were developed by the Joint Committee on Surgical Training as a tool to monitor the quality of training placements and programmes, to be implemented in 2021. The QIs were created to coincide with the new curricula, and the Committee stated that The Specialty Advisory Committees considered specialty-specific requirements to ensure that QIs were in alignment with the new curricula.

Although the scope of work has been disrupted for the vast majority of surgical trainees, the JCST, in association with other surgical associations have undertaken significant work to support trainees during these unprecedented times. Feedback from their initiatives - such as the #NoTrainingTodayNoSurgeonsTomorrow hashtag on social media - have highlighted trainees’ feedback on how they feel they can be better supported, and their insights utilised in building a sustainable framework in the ‘new normal’. Chief among the feedback, trainees;

Cited the need for improved communications and feedback from senior surgeons;
Requested to better learn how to obtain consent in the COVID-19 era;
Proposed that more senior surgeons might learn from engaging with trainees about individual cases or functionality within the unit;
Suggested the involvement of trainees in the Multidisciplinary meeting, giving them ownership of cases for discussion, and offering feedback;
Asked for trainees to receive help in the process of learning what aspects are critical in planning, by involving them in COVID-19 recovery planning;
Proposed that trainees might be invited to assess an emergency admission case, or that senior surgeons might take a ‘backseat’ on occasion to observe trainees’ leads, and then provide feedback;
Suggested senior surgeons might attend virtual clinic with trainees to observe as trainees would ‘see’ patients, then providing feedback; and
Proposed that more senior surgeons might seek to obtain feedback from trainees on the training they provided, in order to optimise surgical training.

As CBS has previously discussed, the challenges of meeting a ‘new normal’ are significantly more complex, since they are compounded by many surgical peers (along with all members of essential hospital staff) suffering the effects of illness and burnout (see the June blog, Mutual Support and Limiting Moral Distress in the Time of C-19); by hospitals’ facing a pressing backlog of delayed operations at 12-year-high; and as inadequate protections and provisions are made for the wider communities of medical professionals and healthcare support workers - resulting in demoralisation and serious concerns, despite the camaraderie among teams. We acknowledge that on top of these factors, the unique challenges faced by those in the surgical training pathway are significant, since they are likely to feel additional pressures due to the interruption of their regular programmes, and indeed about the implication for their professional futures.

While CBS understand that we must act together to meet the challenges of the coming months, and we reflect that current circumstances make it difficult to have answers where additional information remains vague; we are keenly aware of the need to provide clear guidance and support for those in the surgical training pathway, and to ensure the future surgical workforce are not left disadvantaged by these unprecedented times.

CBS is keen to hear from those involved in training at all levels, so that we can best support the education and training of our future surgeons. As always, we welcome your views and comments, please engage with us via @UKsurgeons across social media platforms.

Read other news articles