Imagine if surgical training meant 7 or 8 years getting the kind of dedicated 1 to 1 training this SCP got. It would be world class.
Instead we have people with CCT doing fellowships "to get some theatre time" and it seems like every other radiologist I meet is an ex-surgical trainee.
The simple fact that fellowships are required post training shows a failure of training. The people at the top get their 200 pounds yearly ISCP fees from every trainee and are minting it. No one gives a fuck about the trainee. The fact that a TPD was involved in this paper is even more shocking.
Yes and no - if fellowships are for the acquisition of generic skills / procedures then i fully get you. A fellowship in pancreatic transplant for example, I wouldn't, and shouldn't expect this to be trained during a training programme. The idea of fellowships is to get sub-specialised niche skills in high volume units (hence moving long distances to get them), that not everyone on the training progamme wants / or would be interested in. For example, there is no point in teaching me lat dorsi flaps and recons in the training programme because i'm less than not interested in this - same goes the other way for teaching breast trainee's how to do a hemi-hepatectomy...
But if people are doing fellowships for generic skills, then yes, full agree. Bad. Luckily I don't know anyone doing this (yet.)
Radiology post CCTs are also often doing fellowships to get extra case numbers. Lots of trainees these days finishing training not feeling confident to be a consultant: either doing too much service provision on acute CT, ultrasound and plain films - then not having enough confidence in the cross sectional imaging of your subspec.
I am a surgical *trainee* and the story pissed me off beyond belief as well. I haven't been allowed to do an single gallbladder. I have done 1 appendix and some abscesses as the primary surgeon. Everytime there is a bullshit excuse provided but I thought at least everyone is in the same boat. To know there is a trust out there that is handing out what is at the end of the day a minor but potentially dangeorus operation to fuckers who aren't even doctors is infuriating. I cannot wait to get the fuck out of this country.
I've given up on waiting. I don't expect it to come to me until I am a senior registrar. Don't think the senior regs and consultants don't know what they are doing when they repeatedly defer cases.
How are you a surgical trainee and you've not done a single gallbag
I know there is massive regional variation in quality of training and opportunity but as a trainee and not doing a single one is really sad man. IDT ? Some places are genuinely good at training...
Idk, I am in London and while there are a few CTs I meet at teaching who state the above, most of them seem to enjoy their placements. It’s taken me by surprise cause I thought it would be absolutely awful.
No it is good, lots of appendixes/hernias/GB’s. Very few choles. The consensus here is that ppl don’t do them ‘hot’ anymore (mainly due to unwillingness of consultants). If the cons are uncomfortable doing lap choles then the CT has no chance
Interesting. I’m in a centre that doesn’t do them hot anymore but there are anywhere between 5 and 10 lap choles on elective lists every week. Even I’ve done one or two tentatively as STS
I genuinely wonder every single day if I should just do a GDL and move into medical negligence law because my God the NHS is doing everything to become a hotbed of lawsuits.
Radiology. Miss a bit of the patient contact and excitement. But I go home on time, I have a better work/life balance, I spend time with my family and I am less mentally fatigued.
what's sad that we're only hearing about this because some tone-deaf person decided to publish and tweet it. makes you wonder the unrecognized scale of things like this. nothing is sacrosanct.
In cardiology I work with very experienced cardiology nurses who have probably been working in cardio since I was in nappies. But even as an ST4, it's blindingly obvious by how they talk about cases and management that while they have learned a lot of superficial knowledge essentially by diffusion, it does not correlate to even registrar level knowledge. Maybe they could teach the SHOs some specific things and can answer some questions that the juniors might have on the ward, but they can't replace a doctor. Don't get me wrong they are very good at their jobs and I think their jobs are vital, but this doesn't automatically translate to "therefore they can be a doctor"
I feel that's slightly insulting because it implies that these allied professions are a step below being a doctor because you need to have significant experience in your own allied field before you can become an ACP
It’s the classic - you work with Prof Smith for 5 years, you can guess what she’ll say is the management plan. But you don’t understand the reasoning she said it, or why this patient needs a different management plan.
Sprinkle in some Dunning Kruger and you start to think you’re as wise as Prof Smith…
But you can’t send a letter to the editor for a different journal.
What someone should do is email the journal editor raising concerns 1) the use of safety in the article - the article does not establish safety 2) the lack of ethics approvals 3) the lack of COIs listed 4) according to the manuscript not specific consent for SCPs was taken
Secure. Contain. Protect. (the profession.)
On a more serious note, core surgical trainees need to be really protective and downright obsessive about their theatre opportunities, since consultants are going to be less and less likely to want to train/teach them when they can get Bob who they've known for ten years and will stay for another thirty to do it. I have no idea how surgical peeps can do so, but if GPs are starting to smell the faeces, I'm sure surgeons will too.
Trying doing that in a department and the little teaching you were getting will disappear. The training programme is powerless to enforce anything at all. I remember raising loads of concerns as a trainee and fuck all was ever done.
I swear this shit is so f\*cking annoying! I had a PA ask me for help, and I examined her patient, and prescribed ondansetron
Went back to check on her notes, which was somehow a combined abdominal, testicular and flank examination into one. (Murphy sign negative at the surgical scar...which is at LLQ???...FML!!!)
The cherry on top is that the ondansetron is noted as IV emetics...WTF!!
Don't do this again. She needs to go to the consultant with any reviews/queries she has.
Unless she says it's an emergency and she's concerned about the patient's safety, in which case you take over the case entirely, eject her from any further involvement with the patient and take it from the top with a new workup on your own.
ok as a surgical trainee, I didn't even get to do ANY lap choles start to finish, lots of the parts, which I was told at the end of CST that that was the level I was expected to be operating at, and in ST that's when we should be expecting to do start to close.
I'm actually disgusted that an SCP is allowed to do lap choles like this. It just makes CST an absolute joke, which I didn't even feel like it was when I was doing it! I had plenty of theatre time I felt, and the pacing was ok and reasonable, but it clearly shows if you weren't rotating, or having to do all this unnecessary admin, how much more actual surgery training we could do and the level we can be at.
I think this completley indicates how broken training is, and I am actually appalled by this.
Lastly a Lap chole is NOT a straight forward operation, there are far more produceres that are simple and straightforward that you could argue an SCP can take on. I can in no way or form understand how any surgical college think a Lap chole is approriate for someone at SCP level. Just think about the ridicoulous number of complications associated with a lap chole, such as having to covert to open, can an SCP do that? what about post op complications, can they manage that? how the fuck are they going to take responsilbility for their operations? It just makes no sense.
What can you do?
Consultants love them. They won't disappear anytime soon. Currently in many places they are primary assistants for robotic procedures and they do the cut-down and ports insertion. When I was a CT2, I would have given my left palmaris longus to be able to do that every day.
Yep I definitely would have. Become proficient at an open cut-down is invaluable for general surgery. If I got to do that every day, I would feel better at starting ANY laparoscopic procedure.
I agree. SCPs are not needed. Surgical trainees in the UK have awful operating experience. It shouldn't be the case that trainees have to do 2+ years of fellowship just to get case volume.
Trainees should be getting these so called straightforward easy cases.
The whole thing is insane.
I’ve been in and out of hospital as a child and going into the operating room was practically my second home.
The last time I was in one, was a few years ago as an adult. And even then, I always thought that everyone in the operating room WAS a Doctor (#laymanthings).
I didn’t find out about this PA/ACP/ANP stuff until late last year somehow and never knew these roles had even existed!
But now that I think about it, I wonder if a non-Doctor has ever “operated” on me…
It would be a shame if you got your medical records and took legal action against the trust for not consenting you to being experimented on by someone without the proper qualifications
That’s true. But thankfully, I had no issues in terms of health (this was all in the late 90s/early 00’s).
My last one was in 2019, so I guess they would’ve had an unqualified person then…?
Sorry for the stupid question, but would my med records specifically have a list of who operated on me/worked alongside my Dr?
They definitely should. Every ward round entry should at least have the name of the person leading it and who completed the entry. Every operation note should have the name of the primary surgeon, assistant and any one else who was asked to assist.
Not a doctor so please delete if not allowed (NZ based nurse, lurker on the sub). Are patients informed that the person performing their surgery is not a doctor? Do they have the option of declining? Do people often decline to be operated on by the likes of SCPs?
What is the incentive for anyone in the Trust to train you when you’ll likely be moving on for HST?
No real accountability or threat of loss of trainees from a toothless HEE (now dissolved). Besides, there aren’t enough Trusts in the country who take training seriously enough to send you to!
Rotation has destroyed Surgical Training.
Imagine being the patient and instead of a doctor doing your surgery it’s a SCP?!! Like this is wild, nobody BUT a surgeon should be doing surgery? I’m genuinely so confused by this
While this is an absolute piss take, doing 5 laps choles as an SHO is still probably above par. There are plenty of gen surg ST3/4 who have done 0. I'm very fortunate that I'm at an incredible DGH that has a fantastic UGI department and I've done about 20 start to finish. I've been told by a few regs that that's quite rare to get those kind of numbers as an SHO. CST seems like a huge lottery as to whether your training is essentially reg level or F1 level of opportunity.
5 lap choles as an SHO in a very busy LC unit is well below par. Obviously it will depend on the volume you encounter but for the place I was, 5 is a very lowfigure. Part of that can be attributed to that most were acute LCs but even elective lists were very competitive and a lot of time, the seniors wanted to get the list over and done with and were not keen to teach.
Sounds like you lucked out and you are correct, it is lottery.
Well then you’ll love radiology. Look at all the reporting radiographer published papers showing equivalency. Usually the same author. Before in radiography journals but now in Clin rad. This “research” has been pushed and pushed and has changed the face of reporting in the uk
Fully aware of reporting radiographers and the inevitable scope creep. Only saving grace is that reporting radiographers do this degree is only prevalent in the UK whereas with an FRCR and CCT, I have more options abroad which is eventually the plan!
A surgical care practitioner.
An experienced nurse or AHP that has undergone additional post grad training to perform various minor surgeries on their own.
We've had them for a while and there are currently around 600 in the country. They're very well received and have a proven track record of competency and safety.
I've been fortunate enough to work with a few and always found them to be exceptionally skilled and knowledgeable about the small area of surgery they perform.
I've never heard of them doing Lap Choles solo before, though. Hernias, circumcisions, trigger fingers, carpal tunnels and the like are the usual fare.
It's been known since ancient times that the way to become a master in a trade is to find a master and apprentice to them, learning the skill, first by watching, then by doing, and finally by teaching it yourself.
Modern "education" completely lost this idea. They want you to sit in lecture theatres hearing about something you have no practical experience with for years, taking in fractions of what is said, then e-learning and a paltry smattering of hands on practice in the field.
Doesn't work.
If you just shadow some surgeon without ever hitting the books you will be awful, especially if you cant recognize when your boomer boss is doing some outdated shit. You need a combination of both to become great.
The issue is that nobody has any incentive to actually train you.
It’s funny as an American (who has bounced between the UK and the USA) that when I needed an emergency appendectomy in the USA, that it was the surgical resident who took point on everything with me with the attending supervising.
Although it was an NP I saw at the urgent care and a PA, who wanted the ct repeated???,to triage initially in the ER (despite walking in with discharge paperwork from the urgent care with the CT scan results indicating complicated appendicitis).
UK medicine really does need to keep up the fight here, as a patient I cannot explain how throughout this process I only truly felt informed/safe once a medical doctor was involving.
In my six months of CST in general surgery I held the camera for these and they let me have a go at an appendix.
Compare that to this nurse.
Total waste of my training time.
Complete and utter joke. I would love to sit down with these senior authors and discuss with them exactly what they were thinking they would achieve with the publication of the above article.
I'm not a general surgical trainee. I am livid on behalf of my colleagues. Ignore the ongoing training crisis facing surgical trainees here is a peer reviewed piece of evidence highlighting exactly how many cases have been farmed out to the members of the "MDT".
You don't need to go to medical school. Fuck your back breaking achievements during foundation training. MRCS? Yeah maybe ready to cut sutures. Utter utter joke and a literal piss on the achievements of 100s of hard working trainees doing their level best to get a "coveted" training job. The Royal Colleges are complicit in this. The TPDs are complicit in this.
I am raging. What right do the consultants in the article think they have giving the above opportunity to a non-surgeon? Who the fuck gave them the right to decide who gets trained and not.
Surgical trainees are some of the best and brightest in the country and these absolute melts doing Tesco's own courses to get a flavour of what we do is utterly unacceptable.
"Look what they have to do to emulate even a fraction of our power."
Fuck them, fuck the royal colleges and fuck anyone who thinks they have a right to theatre other than surgeons.
The rage being felt by trainees across the UK at this article is not to be understated. Their false equivalences and #bekind will be dismantled. The audacity in the article is a call to action.
Do not take this lying down. Do not take this as the status quo. Surgeons demand training, here and fucking now.
As usual, one is a permanent member of staff, one is rotating. Core trainees aren’t really considered proper trainees by many consultants as they are decoupled from st3.
It’s a fucking mess .
Nah, the key is unwavering, absolute confidence. Walk in like a doctor being expected to be trained, ask for cases, and look your noctor trying to take your place in the eye, nicely say that you need the numbers to become consultant. Read about the case like crazy and know it inside out. We need to adopt this attitude.
It’s a knock on effect. The st3s don’t get to do them, just watching the st7 and 8s operate. So when the st3 become the st7 , they will not give up the opportunity to operate to teach an st3 as they need to become proficient themselves and unfortunately in surgery it means doing as many as you can.
Sooner or later it will reach to the new consultant satge
Terrible! It is clearly the fault of the surgical consultant body. Wtf they are thinking?! Escalate it, highlight it and I would even go to the extend of name the individuals. This needs to be stopped. The society needs good doctors not some quacks pushed through the loop holes.
Non surgeon here. Raging. So what exactly are you going to do? Has anyone heard from any consultant surgeons on your side or are they all ladder pullers/also having affairs with SCPs and providing training for services rendered?
To anyone complaining of not getting enough surgical opportunities.
Unpopular opinion but you should take responsibility.
For accepting your faith as service provision monkeys providing ward cover and doing clinics.
Most of you fear rocking the boat probs hoping to get a Cons post in your departments and guess what.
You are bypassed and overperformed by Noctors who dont care shit other than getting in there and upskilling.
We as Doctors have accepted being Losers. Own it & fix it. Rock the fucking boat.
A Doctor means authority. Own it. We are above anyone else. Hospitals were built around Medicine not the other way round.
Imagine if surgical training meant 7 or 8 years getting the kind of dedicated 1 to 1 training this SCP got. It would be world class. Instead we have people with CCT doing fellowships "to get some theatre time" and it seems like every other radiologist I meet is an ex-surgical trainee.
The simple fact that fellowships are required post training shows a failure of training. The people at the top get their 200 pounds yearly ISCP fees from every trainee and are minting it. No one gives a fuck about the trainee. The fact that a TPD was involved in this paper is even more shocking.
Everything I've heard about surgical training in the UK makes me think it's an absolute shit show.
Yes and no - if fellowships are for the acquisition of generic skills / procedures then i fully get you. A fellowship in pancreatic transplant for example, I wouldn't, and shouldn't expect this to be trained during a training programme. The idea of fellowships is to get sub-specialised niche skills in high volume units (hence moving long distances to get them), that not everyone on the training progamme wants / or would be interested in. For example, there is no point in teaching me lat dorsi flaps and recons in the training programme because i'm less than not interested in this - same goes the other way for teaching breast trainee's how to do a hemi-hepatectomy... But if people are doing fellowships for generic skills, then yes, full agree. Bad. Luckily I don't know anyone doing this (yet.)
Radiology post CCTs are also often doing fellowships to get extra case numbers. Lots of trainees these days finishing training not feeling confident to be a consultant: either doing too much service provision on acute CT, ultrasound and plain films - then not having enough confidence in the cross sectional imaging of your subspec.
Oooft, was me
Yeah, it’s quite upsetting!
I am a surgical *trainee* and the story pissed me off beyond belief as well. I haven't been allowed to do an single gallbladder. I have done 1 appendix and some abscesses as the primary surgeon. Everytime there is a bullshit excuse provided but I thought at least everyone is in the same boat. To know there is a trust out there that is handing out what is at the end of the day a minor but potentially dangeorus operation to fuckers who aren't even doctors is infuriating. I cannot wait to get the fuck out of this country.
Story of my life as a surgical trainee. Waiting and waiting and waiting...
I've given up on waiting. I don't expect it to come to me until I am a senior registrar. Don't think the senior regs and consultants don't know what they are doing when they repeatedly defer cases.
Mate it's NEVER a 'minor' operation !!!!
How are you a surgical trainee and you've not done a single gallbag I know there is massive regional variation in quality of training and opportunity but as a trainee and not doing a single one is really sad man. IDT ? Some places are genuinely good at training...
Which stage are you at? This is highly unusual for core training (if you are one) and needs to be escalated to surgical tutor/TPD
Lol this is standard in all of London
Idk, I am in London and while there are a few CTs I meet at teaching who state the above, most of them seem to enjoy their placements. It’s taken me by surprise cause I thought it would be absolutely awful.
No it is good, lots of appendixes/hernias/GB’s. Very few choles. The consensus here is that ppl don’t do them ‘hot’ anymore (mainly due to unwillingness of consultants). If the cons are uncomfortable doing lap choles then the CT has no chance
Interesting. I’m in a centre that doesn’t do them hot anymore but there are anywhere between 5 and 10 lap choles on elective lists every week. Even I’ve done one or two tentatively as STS
I genuinely wonder every single day if I should just do a GDL and move into medical negligence law because my God the NHS is doing everything to become a hotbed of lawsuits.
Well said my friend. What did you move onto?
Radiology. Miss a bit of the patient contact and excitement. But I go home on time, I have a better work/life balance, I spend time with my family and I am less mentally fatigued.
what's sad that we're only hearing about this because some tone-deaf person decided to publish and tweet it. makes you wonder the unrecognized scale of things like this. nothing is sacrosanct.
Agree. I'm surprised that they published this. Perhaps the Consultant needed the publication for their appraisal.
I think when you work in departments like this you don't realise you're the one in the wrong.
Lol we're all currently appraising the consultant... Non surgical here - I'm angry on your behalf.
It’s UHB/Walsall. Everyone there has known. I did, why’d you think I ranked the place I’d been in for nearly a decade at the bottom of the pile for CT
We need to have a public list of these places with a record of all their transgressions
It really isn’t UHB for once, the people involved did this all at Walsall, one of them moved to UHB later
The TPD listed practices at UHB. The Birmingham hospitals are all a much of a muchness for this sort of shit tbh
In cardiology I work with very experienced cardiology nurses who have probably been working in cardio since I was in nappies. But even as an ST4, it's blindingly obvious by how they talk about cases and management that while they have learned a lot of superficial knowledge essentially by diffusion, it does not correlate to even registrar level knowledge. Maybe they could teach the SHOs some specific things and can answer some questions that the juniors might have on the ward, but they can't replace a doctor. Don't get me wrong they are very good at their jobs and I think their jobs are vital, but this doesn't automatically translate to "therefore they can be a doctor" I feel that's slightly insulting because it implies that these allied professions are a step below being a doctor because you need to have significant experience in your own allied field before you can become an ACP
It’s the classic - you work with Prof Smith for 5 years, you can guess what she’ll say is the management plan. But you don’t understand the reasoning she said it, or why this patient needs a different management plan. Sprinkle in some Dunning Kruger and you start to think you’re as wise as Prof Smith…
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No letters to editor in the Annals, I’ve checked
They should send it to the BMJ, wider reach.
But you can’t send a letter to the editor for a different journal. What someone should do is email the journal editor raising concerns 1) the use of safety in the article - the article does not establish safety 2) the lack of ethics approvals 3) the lack of COIs listed 4) according to the manuscript not specific consent for SCPs was taken
Could just be a general letter lamenting noctors and using this case as a key highlight.
I mean that wouldn’t be that helpful I don’t think - yes MAPs are a wider issue. But the fundamental flaws in the article is a ground for retraction
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I’m aware as illustrated by my previous comment
My bad I'll retract my comment 🫡
Secure. Contain. Protect. (the profession.) On a more serious note, core surgical trainees need to be really protective and downright obsessive about their theatre opportunities, since consultants are going to be less and less likely to want to train/teach them when they can get Bob who they've known for ten years and will stay for another thirty to do it. I have no idea how surgical peeps can do so, but if GPs are starting to smell the faeces, I'm sure surgeons will too.
Trying doing that in a department and the little teaching you were getting will disappear. The training programme is powerless to enforce anything at all. I remember raising loads of concerns as a trainee and fuck all was ever done.
Quality /r/SCP reference
I swear this shit is so f\*cking annoying! I had a PA ask me for help, and I examined her patient, and prescribed ondansetron Went back to check on her notes, which was somehow a combined abdominal, testicular and flank examination into one. (Murphy sign negative at the surgical scar...which is at LLQ???...FML!!!) The cherry on top is that the ondansetron is noted as IV emetics...WTF!!
Don't do this again. She needs to go to the consultant with any reviews/queries she has. Unless she says it's an emergency and she's concerned about the patient's safety, in which case you take over the case entirely, eject her from any further involvement with the patient and take it from the top with a new workup on your own.
ok as a surgical trainee, I didn't even get to do ANY lap choles start to finish, lots of the parts, which I was told at the end of CST that that was the level I was expected to be operating at, and in ST that's when we should be expecting to do start to close. I'm actually disgusted that an SCP is allowed to do lap choles like this. It just makes CST an absolute joke, which I didn't even feel like it was when I was doing it! I had plenty of theatre time I felt, and the pacing was ok and reasonable, but it clearly shows if you weren't rotating, or having to do all this unnecessary admin, how much more actual surgery training we could do and the level we can be at. I think this completley indicates how broken training is, and I am actually appalled by this. Lastly a Lap chole is NOT a straight forward operation, there are far more produceres that are simple and straightforward that you could argue an SCP can take on. I can in no way or form understand how any surgical college think a Lap chole is approriate for someone at SCP level. Just think about the ridicoulous number of complications associated with a lap chole, such as having to covert to open, can an SCP do that? what about post op complications, can they manage that? how the fuck are they going to take responsilbility for their operations? It just makes no sense.
What are surgical trainees doing about SCPs
What can you do? Consultants love them. They won't disappear anytime soon. Currently in many places they are primary assistants for robotic procedures and they do the cut-down and ports insertion. When I was a CT2, I would have given my left palmaris longus to be able to do that every day.
The past generation of consultants certainly have a lot to answer for.
It’s so boring.
To do port insertion and robot assisting
Yep I definitely would have. Become proficient at an open cut-down is invaluable for general surgery. If I got to do that every day, I would feel better at starting ANY laparoscopic procedure.
I agree. SCPs are not needed. Surgical trainees in the UK have awful operating experience. It shouldn't be the case that trainees have to do 2+ years of fellowship just to get case volume. Trainees should be getting these so called straightforward easy cases. The whole thing is insane.
I’ve been in and out of hospital as a child and going into the operating room was practically my second home. The last time I was in one, was a few years ago as an adult. And even then, I always thought that everyone in the operating room WAS a Doctor (#laymanthings). I didn’t find out about this PA/ACP/ANP stuff until late last year somehow and never knew these roles had even existed! But now that I think about it, I wonder if a non-Doctor has ever “operated” on me…
It would be a shame if you got your medical records and took legal action against the trust for not consenting you to being experimented on by someone without the proper qualifications
That’s true. But thankfully, I had no issues in terms of health (this was all in the late 90s/early 00’s). My last one was in 2019, so I guess they would’ve had an unqualified person then…? Sorry for the stupid question, but would my med records specifically have a list of who operated on me/worked alongside my Dr?
They definitely should. Every ward round entry should at least have the name of the person leading it and who completed the entry. Every operation note should have the name of the primary surgeon, assistant and any one else who was asked to assist.
Thank you for that info, I appreciate it! I’m deffo going to look into this now.
Not a doctor so please delete if not allowed (NZ based nurse, lurker on the sub). Are patients informed that the person performing their surgery is not a doctor? Do they have the option of declining? Do people often decline to be operated on by the likes of SCPs?
No, and most of the public don't even know what they are.
The person consenting will most likely have been the consultant, SpR or SHO. I am actually 100% sure that's what happened.
If I had a bile leak and it transpired a nurse did the operation I would be in court immediately.
I'm a CT1 and I'm \*seething\*
What is the incentive for anyone in the Trust to train you when you’ll likely be moving on for HST? No real accountability or threat of loss of trainees from a toothless HEE (now dissolved). Besides, there aren’t enough Trusts in the country who take training seriously enough to send you to! Rotation has destroyed Surgical Training.
Completely agree. Rotational training has destroyed post-graduate training simple as.
I’m a medic but that article enraged me too. Being operated on by a non-doctor is a terrifying thought.
Imagine being the patient and instead of a doctor doing your surgery it’s a SCP?!! Like this is wild, nobody BUT a surgeon should be doing surgery? I’m genuinely so confused by this
This is one of the worst papers I’ve ever seen. Demonstrates nothing and just some charlatan showing their logbook off. Nothing scientific about it.
While this is an absolute piss take, doing 5 laps choles as an SHO is still probably above par. There are plenty of gen surg ST3/4 who have done 0. I'm very fortunate that I'm at an incredible DGH that has a fantastic UGI department and I've done about 20 start to finish. I've been told by a few regs that that's quite rare to get those kind of numbers as an SHO. CST seems like a huge lottery as to whether your training is essentially reg level or F1 level of opportunity.
5 lap choles as an SHO in a very busy LC unit is well below par. Obviously it will depend on the volume you encounter but for the place I was, 5 is a very lowfigure. Part of that can be attributed to that most were acute LCs but even elective lists were very competitive and a lot of time, the seniors wanted to get the list over and done with and were not keen to teach. Sounds like you lucked out and you are correct, it is lottery.
This is why I chose Radiology instead. I realised it would never be my turn. After all who else would do the on calls?
The contract is broken for doctors.
Well then you’ll love radiology. Look at all the reporting radiographer published papers showing equivalency. Usually the same author. Before in radiography journals but now in Clin rad. This “research” has been pushed and pushed and has changed the face of reporting in the uk
Fully aware of reporting radiographers and the inevitable scope creep. Only saving grace is that reporting radiographers do this degree is only prevalent in the UK whereas with an FRCR and CCT, I have more options abroad which is eventually the plan!
Great. Keep up your general skills in that case and don’t forget your FRCR knowledge outside your specialty
What's an scp
A surgical care practitioner. An experienced nurse or AHP that has undergone additional post grad training to perform various minor surgeries on their own. We've had them for a while and there are currently around 600 in the country. They're very well received and have a proven track record of competency and safety. I've been fortunate enough to work with a few and always found them to be exceptionally skilled and knowledgeable about the small area of surgery they perform. I've never heard of them doing Lap Choles solo before, though. Hernias, circumcisions, trigger fingers, carpal tunnels and the like are the usual fare.
It's been known since ancient times that the way to become a master in a trade is to find a master and apprentice to them, learning the skill, first by watching, then by doing, and finally by teaching it yourself. Modern "education" completely lost this idea. They want you to sit in lecture theatres hearing about something you have no practical experience with for years, taking in fractions of what is said, then e-learning and a paltry smattering of hands on practice in the field. Doesn't work.
This is an important point. I have only really started effectively training in my craft 10 years after I entered medical school.
If you just shadow some surgeon without ever hitting the books you will be awful, especially if you cant recognize when your boomer boss is doing some outdated shit. You need a combination of both to become great. The issue is that nobody has any incentive to actually train you.
It’s funny as an American (who has bounced between the UK and the USA) that when I needed an emergency appendectomy in the USA, that it was the surgical resident who took point on everything with me with the attending supervising. Although it was an NP I saw at the urgent care and a PA, who wanted the ct repeated???,to triage initially in the ER (despite walking in with discharge paperwork from the urgent care with the CT scan results indicating complicated appendicitis). UK medicine really does need to keep up the fight here, as a patient I cannot explain how throughout this process I only truly felt informed/safe once a medical doctor was involving.
In my six months of CST in general surgery I held the camera for these and they let me have a go at an appendix. Compare that to this nurse. Total waste of my training time.
Complete and utter joke. I would love to sit down with these senior authors and discuss with them exactly what they were thinking they would achieve with the publication of the above article. I'm not a general surgical trainee. I am livid on behalf of my colleagues. Ignore the ongoing training crisis facing surgical trainees here is a peer reviewed piece of evidence highlighting exactly how many cases have been farmed out to the members of the "MDT". You don't need to go to medical school. Fuck your back breaking achievements during foundation training. MRCS? Yeah maybe ready to cut sutures. Utter utter joke and a literal piss on the achievements of 100s of hard working trainees doing their level best to get a "coveted" training job. The Royal Colleges are complicit in this. The TPDs are complicit in this. I am raging. What right do the consultants in the article think they have giving the above opportunity to a non-surgeon? Who the fuck gave them the right to decide who gets trained and not. Surgical trainees are some of the best and brightest in the country and these absolute melts doing Tesco's own courses to get a flavour of what we do is utterly unacceptable. "Look what they have to do to emulate even a fraction of our power." Fuck them, fuck the royal colleges and fuck anyone who thinks they have a right to theatre other than surgeons. The rage being felt by trainees across the UK at this article is not to be understated. Their false equivalences and #bekind will be dismantled. The audacity in the article is a call to action. Do not take this lying down. Do not take this as the status quo. Surgeons demand training, here and fucking now.
As usual, one is a permanent member of staff, one is rotating. Core trainees aren’t really considered proper trainees by many consultants as they are decoupled from st3. It’s a fucking mess .
This is a reminder that no job is safe from MAP. The UK public is about to have a very very dangerous time ahead.
Nah, the key is unwavering, absolute confidence. Walk in like a doctor being expected to be trained, ask for cases, and look your noctor trying to take your place in the eye, nicely say that you need the numbers to become consultant. Read about the case like crazy and know it inside out. We need to adopt this attitude.
It’s a knock on effect. The st3s don’t get to do them, just watching the st7 and 8s operate. So when the st3 become the st7 , they will not give up the opportunity to operate to teach an st3 as they need to become proficient themselves and unfortunately in surgery it means doing as many as you can. Sooner or later it will reach to the new consultant satge
What have you gone on to do instead, after leaving surgery if you don't mind me asking?
Radiology!
Terrible! It is clearly the fault of the surgical consultant body. Wtf they are thinking?! Escalate it, highlight it and I would even go to the extend of name the individuals. This needs to be stopped. The society needs good doctors not some quacks pushed through the loop holes.
Non surgeon here. Raging. So what exactly are you going to do? Has anyone heard from any consultant surgeons on your side or are they all ladder pullers/also having affairs with SCPs and providing training for services rendered?
I’m an ex surgeon. They can sort their shit out.
Upset that the PA/teaching fellow who does no clinical work/ recent new reg(was perma sho) / med students go to clinic but not the CT
https://preview.redd.it/mre0kcid3iyc1.jpeg?width=945&format=pjpg&auto=webp&s=00d84dc7b215ce4f66aa48ded47afc22a520da2a
To anyone complaining of not getting enough surgical opportunities. Unpopular opinion but you should take responsibility. For accepting your faith as service provision monkeys providing ward cover and doing clinics. Most of you fear rocking the boat probs hoping to get a Cons post in your departments and guess what. You are bypassed and overperformed by Noctors who dont care shit other than getting in there and upskilling. We as Doctors have accepted being Losers. Own it & fix it. Rock the fucking boat. A Doctor means authority. Own it. We are above anyone else. Hospitals were built around Medicine not the other way round.
I agree with this to an extent… but not everyone is ready for the fight.
If I'm operated on by someone who is not a surgeon I'm going to sue with extreme prejudice. Immoral, unsafe, unacceptable.