General Surgery
Overview of the Specialty:
This speciality includes the sub-specialities of upper and lower gastrointestinal surgery, hepatopancreatico-biliary surgery, breast and endocrine surgery, vascular surgery and transplantation. In addition, the core skills required by a trainee and subsequently a consultant in general surgery include those required to provide emergency care. There is an increasing adoption of the techniques of minimal access surgery, particularly in upper and lower gastrointestinal surgery. Government drivers are progressively dictating the location of provision of surgery, particularly the delivery of care for malignant and early rectal cancer, upper GI and pancreatico-biliary disease and transplantation services are provided on a regional and supra-regional basis. The speciality integrates increasingly with diagnostic and interventional radiology, diagnostic and interventional gastroenterology, medical oncology and clinical oncology.
Training Programmes:
The training programme provides a 6 year programme leading to a CCT. The programme is currently in transition from the Calman SpR scheme to the ISCP StR competency-based programme and all new entrants will follow the ISCP and adhere to its assessments.
The following hospitals have StR appointments in General Surgery in the Yorkshire School: Airedale; Bradford; Calderdale and Huddersfield; The General Infirmary and St James’ Hospital, Leeds; Castle Hill and Hull Royal Infirmary; Pinderfields and Dewsbury; York; Scarborough; Grimsby; Scunthorpe; Harrogate and Northallerton. The training committee endeavours to provide a broad-based general training for the first two to three years, enabling the intermediate and initial “final” competencies to be gained and this training will be usually, but not exclusively in district general hospitals in the Deanery. Appointments to each institution will be for one year but with internal rotation each 6 months.
The final 3 years will usually be spent in specialist units providing Level 3 training, allowing the final competencies to be gained and trainees will be expected to evaluate and develop a sub-speciality interest during these appointments. The training committee will facilitate appropriate placements to give the trainee access to this sub-speciality training, accepting that placements in some sub-specialities are limited.
All trainees will have an Assigned Educational Supervisor (AES) for each placement, and training will be delivered by the AES and Clinical Supervisors, Consultants in the institution. Progress through training is dependent on the satisfactory accretion of competencies, as defined by the ISCP and assessed at the Annual Review of Competency Progression. In addition, there is a bi-annual review of the trainee and the training conducted by the Training Committee.
Years out of the programme (OOPE) to gain specialist training and competencies in other national and international units will require prior agreement from the Training Committee, the Deanery and GMC.
There are active research programmes in many of the units in the Deanery and all trainees will be expected to participate in audit and research in the course of their training. It is envisaged that “academic” training posts will be available in Hull with the development of 1 or 2 “Surgical Lecturer” posts in the future.
Teaching and Learning:
All trainees will be registered with the ISCP and the Training Programme Director will set Global Objectives for their particular level of training. The trainee and AES will complete a Summary of Learning Agreements and the trainee will progress through the appropriate assessments as defined by the ISCP. Progression through the training programme is dependant on achieving the required competencies, and in the event that these are not achieved, one twelve month period of remedial training will be allowed.
In addition to the training in each institution, the region has a variety of training modules, either available through the Yorkshire Deanery or via individual institutions e.g. Basic and Advances Endoscopy courses and Laparoscopic training in Hull, to which the trainee may apply.
Study Leave
Study leave is accessed via the Yorkshire School and requires agreement by initially the Consultant Supervisor and the AES, then the Training Programme Director. The current study leave year is from April to March and the current yearly allowance is £800, which is critically policed by the Speciality Study Leave Advisor (SSLA) who is also the Training Programme Director. Study leave, in most instances, will only be granted for activities with a strong educational content which contribute to the gaining of appropriate curriculum competencies or for mandatory course requirements.