Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland

ObjectivesApplications for surgical training have declined over the last decade, and anecdotally the costs of training at the expense of the surgical trainee are rising. We aimed to quantify the costs surgical trainees are expected to cover for postgraduate training.DesignProspective, cross-sectional, questionnaire-based study.Setting/ParticipantsA non-mandatory online questionnaire for UK-based trainees was distributed nationally. A similar national questionnaire was distributed for Ireland, taking into account differences between the healthcare systems. Only fully completed responses were included.ResultsThere were 848 and 58 fully completed responses from doctors based in the UK and Ireland, respectively. Medical students in the UK reported a significant increase in debt on graduation by 55% from £17 892 (2000–2004) to £27 655 (2010–2014) (p<0.01). 41% of specialty trainees in the UK indicated that some or all of their study budget was used to fund mandatory regional teaching. By the end of training, a surgical trainee in the UK spends on average £9105 on courses, £5411 on conferences and £4185 on exams, not covered by training budget. Irish trainees report similarly high costs. Most trainees undertake a higher degree during their postgraduate training. The cost of achieving the mandatory requirements for completion of training ranges between £20 000 and £26 000 (dependent on specialty), except oral and maxillofacial surgery, which is considerably higher (£71 431).ConclusionsMedical students are graduating with significantly larger debt than before. Surgical trainees achieve their educational requirements at substantial personal expenditure. To encourage graduates to pursue and remain in surgical training, urgent action is required to fund the mandatory requirements and annual training costs for completion of training and provide greater transparency to inform doctors of what their postgraduate training costs will be. This is necessary to increase diversity in surgery, reduce debt load and ensure surgery remains a popular career choice.

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Surgical training in the UK: is cost a barrier to entry?

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139170 ◽

2021 ◽

pp. postgradmedj-2020-139170

Author(s):

Zak Vinnicombe ◽

Max Little ◽

Jonathan Super ◽

Raymond Anakwe

Keyword(s):

Medical Students ◽

Surgical Training ◽

Student Loan ◽

Socioeconomic Background ◽

Training Costs ◽

Surgical Trainees ◽

Important Relationship ◽

Surgical Career ◽

Barrier To Entry ◽

The Uk

BackgroundThere is good quality evidence linking socioeconomic background and the likelihood of a surgical career. Additionally, training in surgery is more expensive than in other specialties. Our aim was to assess the awareness and perceptions of trainees and medical students of the relative costs of surgical training and to determine whether perceptions of cost deter potential surgical trainees.MethodsMedical students, foundation doctors and core trainees in England were surveyed over a 2-week period. χ2 tests of independence were used to assess statistically significant associations between measured variablesMain findingsA total of 284 responses were received. More than half of respondents (54%) were not previously aware of the high costs of surgical training. More than a quarter of respondents (27%) did not take out a student loan. There was a significant association (p=0.003) between familial income and being less likely to consider a surgical career due to the costs. Respondents who reported receipt of a student loan were also significantly less likely to consider a surgical career due to the costs (p=0.033).ConclusionOur study demonstrates an important relationship between perceived costs of surgical training and future career aspirations. This suggests that access to surgical training may still be difficult for many. This study also highlights a general lack of awareness of high surgical training costs. It is important that surgical training is accessible. Financial status should not be a significant disincentive and widening access to surgical training can only serve to enrich and advance the specialty.

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An analysis of the cost of postgraduate training in surgery in Ireland compared to other specialties

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02641-z ◽

2021 ◽

Author(s):

Earley H. ◽

Mealy K.

Keyword(s):

Surgical Training ◽

Financial Support ◽

Postgraduate Training ◽

Medical Training ◽

Medical Council ◽

List Type ◽

Training Costs ◽

Considerable Cost ◽

Surgical Trainees ◽

The Cost

Abstract Introduction Postgraduate specialty training in Ireland is associated with considerable cost. Some of these are mandatory costs such as medical council fees, while others are necessary to ensure career progression, such as attendance at courses and conferences. In particular, surgical specialities are believed to be associated with high training costs. It is unknown how these costs compare to those borne by counterparts in other specialities. Aims The aims of this study were to Quantify the amount that trainees in Ireland spend on postgraduate training Determine whether a difference exists between surgery and other non-skill-based specialties in terms of expenditure on training Methods A standardised non-mandatory questionnaire was circulated to trainees across two training centres in Ireland. Trainees at all levels were invited to participate. Results Sixty responses were obtained. Fifty-seven questionnaires were fully completed and included for analysis. The median expenditure on training was higher for surgical than non-surgical specialities. Subgroup analysis revealed surgical training was associated with higher expenditure on higher degrees and courses compared to medical training (p = 0.035). > 95% of trainees surveyed felt that greater financial support should be available for trainees during the course of their training. Conclusions This study demonstrated that a career in surgery is associated with higher ongoing costs for higher degrees and courses than counterparts in non-surgical training. All surgical trainees surveyed felt that better financial support should be available. Increasing financial support for may be a tangible way to mitigate against attrition during training.

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P38 COVID-19 impact on Surgical Training And Recovery Planning (COVID-STAR) Survey

BJS Open ◽

10.1093/bjsopen/zrab032.037 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

◽

Joshua Clements

Keyword(s):

Surgical Training ◽

Negative Impact ◽

Healthcare Delivery ◽

Cross Sectional Study ◽

Surgical Trainee ◽

Surgical Specialty ◽

Cross Sectional ◽

Training Time ◽

Surgical Trainees ◽

And Training

Abstract Background The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May - 8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n = 301) were redeployed with 74% (n = 223) redeployed > 4 weeks. Complete loss of training was reported in elective operating (69.5% n = 474), outpatient activity (67.3%, n = 457), Elective endoscopy (69.5% n = 246) with > 50% reduction in training time reported in emergency operating (48%, n = 326) and completion of work-based assessments (WBA) (46%, n = 309). 81% (n = 551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA’s were the primary reported factor affecting potential training progression. Overall, > 50% of trainees (n = 377) felt they would not meet the competencies required for that training period. Conclusion This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

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Experiences in academic publication among ENT trainees in the UK: results from a national survey

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000864 ◽

2021 ◽

pp. 1-7

Author(s):

S Shahidi ◽

M S Osborne ◽

G M Jama ◽

S Bola ◽

J Murphy

Keyword(s):

Surgical Training ◽

Full Time ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Surgical Trainees ◽

Current Survey ◽

Academic Publications ◽

The Mean ◽

Higher Surgical Training ◽

The Uk

Abstract Objective This study aimed to provide an objective means of identifying patterns in academic publication among ENT trainees during their higher surgical training. Method A cross-sectional survey was distributed to ENT higher surgical trainees. Results A total of 153 ENT specialty trainees participated, giving a response rate of 46.5 per cent. Across all years of training, the mean number of first author publications was three and the mean number of non-first author publications was two. For trainees at specialty trainee year 8 level, these figures were nine and five, respectively. Participants with doctoral degrees and those in academic programmes published more papers but the mean difference was only significant for the doctoral subgroup (p < 0.0001). Those with additional undergraduate degrees and those in less than full-time training had an overall lower number of publications. Conclusion Participants in the current survey achieved a higher average number of academic publications than is presently required to successfully complete higher surgical training in ENT. It is hoped that these results act as a guide for trainees planning the research component of their training to ensure that they remain competitive at consultant interview.

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1012 Surgical Trainee Satisfaction Variations with Seniority and Region: An Evaluation of General Medical Council National Training Survey

British Journal of Surgery ◽

10.1093/bjs/znab134.186 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

K S Fan ◽

J McKenna ◽

J Chan

Keyword(s):

Clinical Supervision ◽

Maxillofacial Surgery ◽

General Medical Council ◽

Oral And Maxillofacial Surgery ◽

Medical Council ◽

Surgical Trainee ◽

Surgical Trainees ◽

Training Stage ◽

Speciality Training ◽

National Training

Abstract Aim The General Medical Council (GMC) National Training Survey invites all doctors in training and this study evaluates satisfaction in surgical training and variations with speciality, seniority, and training region. Method All survey results were obtained from the GMC website. Responses of trainees, ranging from foundation training to registrar, were collected and categorised by speciality, training stage and location. Results 9465 surgical trainees completed the study in 2019. The highest indicators were Educational Supervision (97.68), Clinical Supervision (87.42) and Clinical Supervision (out of hours) (87.28). The lowest were Workload (44.60), Rota Design (56.00) and Local Teaching (59.31). Highest and lowest ranking specialities were oral and maxillofacial surgery (84.25) and vascular surgery (73.95). Satisfaction varied significantly across training stages, with speciality trainees highest (82.58) overall and foundation year 1 lowest (70.03). London scored highest (77.95) and Northern Ireland, Scotland and Wales collectively scored 77.13. Within England, South England ranked highest in five specialities but only orthopaedics and neurosurgery showed significant national variations. Conclusions Our data show variations in training satisfaction across many training cohorts. Satisfaction increases with surgeon seniority. Trainers and educational boards should target interventions to improve the quality of training for all grades of trainees and ensure appropriate curriculum coverage and address specific concerns.

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Procedure-based assessments: the past, the present and the future

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136794 ◽

2019 ◽

Vol 96 (1131) ◽

pp. 7-8

Author(s):

Ahmed Abdelaal

Keyword(s):

Surgical Training ◽

Surgical Trainee ◽

The Past ◽

Surgical Trainees ◽

The Future ◽

The Uk ◽

Almost All

One of the most significant changes to the structure of surgical training in the UK was the introduction of workplace-based assessments (WBAs). Since its integration into the Intercollegiate Surgical Curriculum Programme, we as surgical trainees became the children of WBAs. Procedure-based assessment (PBA) is one of the pillars of WBAs and no surgical trainee portfolio is complete without a significant number of PBAs completed. As a senior trauma and orthopaedics trainee myself, I have encountered PBA on a regular basis, both as a trainee and as an assessor to my junior colleagues. My journey in understanding and implementing PBAs has not been a smooth one. This is also a reflection of almost all surgical trainees across all specialties. In this review, I aim to shed some light on my perspective on PBA, its values, limitations and concerns that have risen as a result of its introduction. I also aim to use my experiences to highlight possible ways of improvement in PBA.

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79 Remote Delivery of an International Surgical Education Webinar Series for Medical Students During COVID-19

British Journal of Surgery ◽

10.1093/bjs/znab259.842 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

V Zaver ◽

D Ahari ◽

P Jayawardena ◽

M A Sayed

Keyword(s):

Medical Students ◽

Surgical Education ◽

Undergraduate Curriculum ◽

Positive Outcome ◽

University Teaching ◽

Surgical Trainee ◽

Teaching Programme ◽

Surgical Trainees ◽

Novel Coronavirus ◽

The Uk

Abstract Aim The 2019 novel coronavirus (COVID-19) pandemic caused the cancellation of lectures and clinical placement-based education for medical students across the UK. With resumption of university teaching, remote delivery via online platforms has seen increased implementation to prevent overcrowding and comply with social distancing measures. This article explores the efficacy of an internationally delivered online surgical webinar series to facilitate undergraduate surgical education on a long-term basis. Method The University of Manchester undergraduate surgical society, Scalpel, in collaboration with three Junior Surgical Trainees designed and organised an online surgical teaching programme aimed at medical students. The syllabus was constructed in accordance with the Royal College of Surgeons England’s (RCSEng) National Undergraduate Curriculum in Surgery. Multiple-choice questionnaires (MCQs) were used to evaluate knowledge during the sessions and Likert scales were utilised to assess subjective improvement of knowledge. The teaching programme was delivered remotely using Zoom (Zoom Video Communications, Inc.). Results he average attendance for the lectures was 68. The reach of the webinar series was international. The average increase in correct answers between pre and post lecture MCQs was +78.7% (+72.4, +18.6, +76.6, +43.5, +161, +100). Likert scale analysis demonstrated 100% improvement of knowledge. Conclusions This study demonstrates a positive outcome to remote, extra-curricular surgical education in the time of COVID-19. The methodology outlined herein has the potential for easy replication on a more widespread scale to provide routine supplementation for medical student and surgical trainee education during the ongoing pandemic.

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962 COVID-19 And ST3 National Selection in Surgery: What Happens to Core Surgical Trainees When We Remove the Face-to-Face Interview?

British Journal of Surgery ◽

10.1093/bjs/znab134.184 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

D Leiberman ◽

M Trivedy ◽

A Kausar

Keyword(s):

Surgical Training ◽

Freedom Of Information ◽

Progression Rate ◽

Surgical Trainee ◽

Face To Face ◽

Surgical Trainees ◽

Higher Surgical Training ◽

National Selection ◽

The Uk ◽

The Impact

Abstract Introduction The 2020 ST3 recruitment year for Higher Surgical Training (HST) did not have a face-to-face interview due to COVID-19. Candidates were solely scored on portfolio self-assessment alone. We have assessed the impact on Core Surgical Trainee progression into ST3 by comparing the 2020 recruitment year with 2019. Method Total numbers of applicants to ST3 for all 7 surgical sub-specialties that recruit at ST3 level were obtained via Freedom of Information requests from Health Education England (HEE). These were sorted by those who were in CST, had completed CST or had an alternative equivalence certificate. Results Overall applicant numbers were up in 2020, mainly from an increase in applicants with a Certificate of Readiness to Enter Higher Surgical Training. Overall ST3 positions appointed to were down. CST progression rate was down slightly, with an increase in appointees >10 years since graduation. Conclusions The 2020 recruitment year for ST3 HST had a higher number of applicants and lower places available than 2019. The majority of the extra applicants were trainees who have not completed CST in the UK. CST progression rate to HST was down slightly. The lack of face-to-face interview may benefit some candidates graduating >10 years ago.

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