General surgery is an acute specialty that covers the sub-specialties of Breast, Colorectal, Hepatobiliary (HPB), oesophagogastric (OG), Benign Upper GI, Bariatric, Endocrine, and Transplantation surgery.
Every acute hospital in the region has general surgical staff, who have an elective practice which is often sub-specialised and are also responsible for covering the emergency on-call admissions. General surgery covers all branches of elective and emergency surgery.
The Higher Surgical Training Programme (ST3-8)
The Anglian Training Rotation provides full-time training in general surgery and all the sub-specialities listed above. Less than full time training is available, however, this must be approved by the Deanery and School of Surgery and appropriate training time tables prospectively arranged. The Higher Surgical Training Programme is a six year structured training programme (ST3 — ST8) with entry by competitive interview at ST3 level (through National Selection organised centrally by London Deanery). All the trainees will follow the latest approved curriculum which is currently the General Surgery 2013 curriculum. The first two years of the programme (ST3/4) involves a wide range of general surgical training with 6 monthly placements in breast/transplant/vascular/upper GI/colorectal/endocrine firms. During this period, the trainees will follow the intermediate part of the General Surgery 2013 curriculum. The next 2 years (ST5/6) will be spent in upper GI and colorectal firms and in exceptional circumstances in a different subspecialty. During this period, the trainees will follow the Final 1 part of the General Surgery 2013 curriculum. Trainees who successfully complete ST6 will be allowed to sit the Final FRCS exit exam at this point. The final 2 years (ST7/8) are allocated to the trainee’s special interest, however, this may not be possible if the training slots are not available or if the trainee is not deemed to have made adequate progress with the their general surgical competencies required for their CCT. Trainees will be assessed at least annually (ARCP) and their progress monitored on the JCST General Surgery CCT checklist. There are two teaching hospitals within the region, Addenbrooke’s Hospital, Cambridge and the Norfolk & Norwich University Trust Hospital in Norwich. The other hospitals within the training programme include: Peterborough General Hospital, Ipswich Hospital, Bedford Hospital, Luton & Dunstable Hospital, Queen Elizabeth Hospital in Kings Lynn, West Suffolk Hospital in Bury St Edmunds, James Paget Hospital in Great Yarmouth, Hinchingbrooke Hospital in Huntingdon, Lister Hospital in Stevenage, Watford General Hospital, Princess Alexandra Hospital in Harlow, Southend Hospital, Basildon Hospital, Colchester Hospital and Broomfield Hospital in Chelmsford. East of England Higher Surgical Training Programme covers a wide geographical area and trainees are expected to rotate to any of the hospital mentioned above. Rotations are managed to accommodate the training needs of the 65 Higher Surgical Trainees in the region in line with the curriculum. All newcomers to the rotation are given a half day deanery induction prior to their start date in the region.
The programme is directed by the Regional Training Committee under the auspices of the School of Surgery and the East of England Deanery in line with the recommendations of the Royal College of Surgeons. All surgical trainees are expected to register with the on-line Intercollegiate Surgical Curriculum Project (ISCP; iscp.ac.uk) and will be allocated formally to an Assigned Educational Supervisor (AES). Progress throughout the programme will be monitored by competency plus time based assessments and will be reviewed on ISCP. The AES should provide constructive and regular feedback on performance, and assistance in career progression. Prior to award of their Certificate of Completion of Training (CCT) trainees will have to pass the Intercollegiate Specialty Exit Examination and complete all the competencies stated on the JCST CCT guidelines. The aim of the programme is to produce an emergency competent general surgeon who has started to develop a sub-specialty interest.
There is an active Regional Teaching Programme with six centralised regional training days yearly, comprising of both topic teaching and examination/viva practice. A variety of educational courses are held within the region including anastomotic and laparoscopic workshops, endoscopic training, management of interview courses and educational training courses such as 'training the trainers'. Attendance at the advanced laparoscopic workshop, the annual cadaveric simulation courses and the teaching days are compulsory for a satisfactory ARCP outcome. Research is strongly encouraged but any time out of programme for research, will not be counted towards a CCT. Higher Degrees (MPhil, MS, MChir, MD and PhD) are awarded both by Cambridge University and the University of East Anglia.
The East Anglian Surgeons Meeting is held annually and encourages trainees to present their research at a regional level. The Covidien Travelling Fellowship is awarded yearly, and encourages trainees to visit specialist units abroad. One of the training posts within the region is linked with a one to two year period of research into small intestinal and pancreatic physiology/pathology, spent in Professor Ashley's unit at the Brigham Memorial Hospital, Boston, USA. There are two Walport Academic Fellowships and several Academic Clinical Lectureships' within the Department of Transplantation and HPB surgery at Addenbrooke’s Hospital.
Essential Qualifications for Entry
In addition to a basic medical degree, candidates for the Regional Training Programme in General Surgery must have successfully completed the MRCS Examination of one of the British Royal Surgical Colleges. At least 24 months experience (at ST1/ST2 level) in surgery (not including foundation module) is required by the start of the appointment, at least 12 months of which has to be in general surgery. ATLS, CCRiSP and basic surgical skills are desirable. Appropriate career progression has to be demonstrated and not more than four years general surgical experience following FY1 is desirable. Candidates need to demonstrate both understanding and participation in good audit practice. Please see National Selection website hosted by the London Deanery for further information.
- Good communication skills with patients, relatives and fellow professionals
- Good interpersonal skills to facilitate effective contribution to a multi-disciplinary team
- Self-motivation and a flexible approach to work commitments
- An alert intellect capable of responding appropriately to the changing circumstances of life threatening emergencies
- Manual dexterity and stamina
- Ability to critically analyse publications
Further advice may be obtained from:
Training Programme Director: Mr Raaj Praseedom, Addenbrooke's Hospital, Cambridge University Hospital Foundation Trust
Head of School of Surgery: Mr Neville Jamieson, Addenbrooke's, Cambridge University Hospital Foundation Trust