title: Reduction in varicose vein services: impact on operative training.
abstract: BACKGROUND
  This study examines the impact of rationing varicose vein operations on operative training on a general surgical unit with a vascular interest.
  
  
  METHODS
  Log-books of middle-grade surgeons were analysed for 3-month periods before and after a decision by the local Primary Care Trust to ration varicose vein referrals. Number, intermediate equivalents and type of operations were recorded, whether they were general or vascular cases and whether the trainee had carried out or assisted with the operation.
  
  
  RESULTS
  There was a slight fall in the total number of operations in which the middle-grade surgeons were involved (208 to 186). There was a significant increase in general surgical cases with the fall in number of varicose vein operations (P < 0.0001). The fall in case-load and work-load operative training in vascular surgery was compensated by an increase in general surgical cases (P = 0.0003). This was largely due to increased number of hernia repairs (P = 0.0035).
  
  
  CONCLUSIONS
  From the point of operative training, a vascular unit in a district general hospital would not be sustainable following withdrawal of varicose vein services. However, this can be off-set by increasing general surgical case-load to fill the gap created.
authors.affiliation: Department of Vascular Surgery, Royal Berkshire Hospital, Reading, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bajwa
authors.forename: T R
authors.initials: TR
authors.lastname: Magee
authors.forename: R B
authors.initials: RB
authors.lastname: Galland
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D004502:Education, Medical, Continuing / Q000592:standards*; D004739:England; D015276:Health Care Rationing; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000193:education*; D012017:Referral and Consultation; D014648:Varicose Veins / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000193:education* / Q000706:statistics & numerical data; D016526:Workload