Overview

Entry into ST3 requires successful completion of IMRCS or equivalent at time of application as well as MBBS or equivalent medical qualification.

General Surgery is a large specialty dealing with high volumes of emergency admissions and a very wide range of elective procedures. The majority of patients presenting to general surgery as an emergency are suffering from acute conditions of the abdomen. A substantial minority of such patients, however, are suffering from other conditions including trauma that require a holistic approach to care and a wide range of skills and experience that may cross subspecialty and specialty divides.

Important institutions and links

• Royal College of Surgeons of England  
• Association of Surgeons in Great Britain and Ireland  
• General Surgery courses at the college
• Intercollegiate Surgical Curriculum Programme (ISCP)  

Intermediate General Surgery Training: ST3 and ST4

The intermediate phase includes training in emergency surgery and intermediate surgery but also some more specialist surgery, with the opportunity to be exposed to all of the major specialist areas over the two years. There should also be the opportunity for a limited exposure to one of the smaller areas of special interest such as paediatrics, transplant or remote and rural surgery.

These areas could be covered either by specific attachments to emergency/day case/specialist units or by working in a smaller hospital where practice is more general and emergency exposure gained throughout the entire period. This would depend on the local situation.

A possible rotation might be as follows:

• Six months of emergency surgery probably in at least two blocks
• Two attachments of 6 months in Breast and Endocrine; Vascular; Upper GI and Colorectal surgery
  • Six month “elective” period - the trainee can choose between Transplant surgery, Paediatric surgery, Remote and Rural surgery and a research project.

Depending on local circumstances different combinations of specialties might be more suitably combined but experience should be gained in each of the specialties above.

Final General Surgery Training:  ST5, ST6, ST7, ST8

The final phase consists of two strands, which are shown separately for ease of understanding, but which run concurrently throughout ST5-8.

• An emergency/general strand which must be covered by all trainees including those who have taken an academic pathway. Topics are described on the basis of indicative years throughout ST5-8.
• Training in areas of special interest. The degree of subspecialisation desired by the trainee may vary depending on his/her career aims. The principles are that the four indicative years are divided into eight 6 monthly modules (labelled A, B, C etc for each indicative 6 month slot) and that the trainee chooses a suitable combination of modules within one or more areas of special interest.

In order to participate in the general surgical on call rota as a consultant at least a year must be spent in both upper and lower GI surgery. However it must be emphasised that sufficient competency and experience to participate as a consultant covering general surgical emergencies will not be gained overall until CCT has been obtained. Even at this stage it is anticipated that certain complex cases will require consultation with more experienced or subspecialist consultants.

Thus a colorectal trainee would undertake 2 modules of upper GI surgery to equip them to provide a gastrointestinal acute service. Similarly, a trainee with an upper gastrointestinal interest would undertake two modules in lower GI surgery.  A trainee from a non-gastrointestinal subspecialty would expect to undertake 4 GI modules in order to deal with an acute GI take. Some breast and vascular trainees may wish to gain this experience but others may wish to confine themselves to their own specialty.

A small number of super-specialised areas will not be fully covered before CCT is gained e.g. liver transplantation, major upper GI resections, pelvic floor surgery and complex or redo pelvic surgery.

This schema allows the amount of flexibility needed for a variety of situations, including trainees who are pursuing an academic pathway, yet permits specialisation in a narrow field if this is appropriate. Academic trainees will be expected to demonstrate that they have achieved all the essential requirements of the CCT. It is however acknowledged that academic trainees are likely to take longer to achieve the essential competencies.

Training Programmes

Find out more:

• ST3 to ST4 syllabus 
• ST5 to ST8 syllabus