Can a district general hospital serving a population of 480,000 offer subspecialty training? --A prospective audit.
BACKGROUND
Subspecialty training has been mostly restricted to teaching hospitals. We aimed to assess whether higher surgical trainees can be offered subspecialty training in a district general hospital serving a large population.


METHODS
The surgical unit consisted of four subspecialty firms (upper gastrointestinal, vascular, colorectal and breast/endocrine). Each firm consisted of two consultants, one higher surgical trainee and one basic surgical trainee. The breast/endocrine firm had, in addition, a staff grade surgeon. Trainees collected data prospectively on their subspecialty experience and this was then compared with the subspecialty workload in the respective firms.


RESULTS
Subspecialty related workload was 48% on the vascular, 57% on the colorectal and 53% breast/endocrine firms. Subspecialty workload on the upper gastrointestinal firm (27%) was skewed by one non-specialist consultant Trainees on the respective firms were involved in 74% vascular, 82% upper gastrointestinal, 79% colorectal and 54% breast/endocrine index subspecialty operations. Supervision with regards to index operations was 63%, 70%, 81% and 100% on the colorectal, breast/endocrine, upper gastrointestinal and vascular firms, respectively.


CONCLUSIONS
50% of the workload on the vascular, breast/endocrine and colorectal firms is subspecialty-related with the potential for training. With shortened training and some specialities having disproportionately more trainees, higher surgical training committees need to identify more subspecialty units that offer such training.
Menon
K V
KV
Department of Surgery, Royal Berkshire Hospital, Reading, UK.
Dehn
T C B
TC
D002309:Cardiology / Q000193:education; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004704:Endocrinology / Q000193:education; D004739:England; D005762:Gastroenterology / Q000193:education; D013502:General Surgery / Q000193:education*; D006176:Gynecology / Q000193:education; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008485:Medical Audit; D011446:Prospective Studies; D016526:Workload