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PWE-404 Emergency general surgery: emergence of a subspecialty by stealth
  1. L Pearce1,
  2. E Parkin2,
  3. S Smith3,
  4. J Kennedy2,
  5. A Macdonald2
  1. 1Colorectal Surgery, Manchester Royal Infirmary
  2. 2Wythenshawe Hospital
  3. 3Royal Bolton Hospital, Manchester, UK

Abstract

Introduction Emergency surgical patients account for around half of all NHS surgical workload and 80% of surgical deaths. Few trainees opt to CCT in General Surgery, and there is no recognised subspecialty training program in Emergency General Surgery (EGS). Despite this lack of training and relevant assessment by examination, there appears to be an increasing number of EGS posts advertised. This may be associated with a reduction in the numbers of breast or vascular surgery posts that have general surgical commitments. We sought to explore changes in consultant surgeon job adverts over time.

Method All consultant surgeon posts, advertised in the British Medical Journal between January 2009 and December 2014 were included. Posts in 'non-general surgical' specialties were excluded. Data collected included specialty, region and institute of advertised post. For the purposes of statistical analysis, data was divided into two separate year bands: 2009 – 2011 and 2012 – 2014. Statistical analysis was by Chi-squared test; p < 0.01 was considered statistically significant.

Results Over the six-year study period, there were 1240 consultant job adverts in a general surgical specialty. Nine hundred and seventy-five were substantive posts; the region with the most jobs was London and the South East (n = 278). The total number of posts was 645 in 2009–11 and 595 2012–14. The most common specialties advertised were colorectal (313), breast (248), upper GI (207), pure general surgery (170) and vascular (80). There were 55 jobs advertised in EGS, either with (20) or without (35) another subspecialty. The number of EGS adverts increased significantly in 2012–14 compared to 2009–11 (p = 0.008). London and the South East were the highest recruiters to EGS posts (10% of all consultant surgeon posts advertised in the region). There was a borderline decrease in the number of breast with general surgery posts advertised (p = 0.021). Numbers of vascular with general surgery jobs and purely general surgery jobs did not change significantly over time.

Conclusion This data demonstrates increasing societal need for EGS consultants over the last six years and the emergence of Emergency Surgery as a new subspecialty. The current training system in EGS on an ‘ad hoc’ basis alongside subspecialty training, may not adequately prepare newly appointed consultants. This is confounded by shortened training times in pre-existing subspecialties and introduction of EWTD. In order to meet the EGS needs of the NHS, general surgical training and the examination system need to be revised.

Disclosure of interest None Declared.

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