Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom(a).
Int J Surg. 2013;11(8):578-83. doi: 10.1016/j.ijsu.2013.09.010. Epub 2013 Sep 26.
The optimal workforce model for surgery has been much debated historically; in particular, whether there should be a recognised role for those successfully completing training employed as non-Consultant grade specialists. This role has been termed the 'sub-consultant' grade. This paper discusses historical and future career structures in surgery, draws international comparisons, and presents the results of a national trainee survey examining the post-Certificate of Completion of Training (CCT) non-consultant specialist grade. Junior doctors in surgical training (i.e. pre-CCT) were invited to participate in an electronic, 38-item, self-administered national training survey. Of 1710 questionnaires submitted, 1365 were appropriately completed and included in the analysis. Regarding the question 'Do you feel that there is a role in the surgical workforce for a post-CCT non-consultant specialist ("sub-consultant") grade in surgery?', 56.0% felt there was no role, 31.1% felt there was a role and 12.8% were uncertain. Only 12.6% of respondents would consider applying for such a post, while 72.4% would not and 15.0% were uncertain. Paediatric (23.3%), general (15.7%) and neurosurgery (11.6%) were the specialties with the highest proportions of trainees prepared to consider applying for such a role. For both questions, there was a significant gender difference in responses (p < 0.0001, Chi-square test) with female trainees more likely to consider applying. Overall 50.8% of respondents felt that the introduction of a post-CCT non-consultant specialist grade would impact positively upon service provision, however, only 21.6% felt it would have a positive impact on patient care, 13.9% a positive impact on surgical training, 11.1% a positive impact on the surgical profession and just 7.9% a positive impact on their surgical career. This survey indicates that the introduction of a 'sub-consultant' grade for surgeons who have completed training would be unpopular, with the majority believing it would be to the detriment of both patient care and surgical training. Changes to surgical career structures must be made in the interests of patient safety and quality, and on this basis ASiT supports the continued provision of primarily Consultant-delivered care.
手术领域的最佳劳动力模式一直是人们争论的焦点；特别是，是否应该为那些成功完成培训的人提供一个被认可的非顾问级专家角色。这个角色被称为“副顾问级”。本文讨论了手术领域的历史和未来职业结构，进行了国际比较，并介绍了一项全国性学员调查的结果，该调查研究了完成培训证书（CCT）后的非顾问级专家级别的情况。邀请正在接受外科培训的初级医生（即 CCT 前）参加了一项电子的、38 项内容的自我管理式全国培训调查。在提交的 1710 份问卷中，有 1365 份问卷填写恰当并被纳入分析。关于“您是否认为在外科劳动力中，对于完成 CCT 后的非顾问级专家（“副顾问级”）有需求？”这个问题，56.0%的人认为没有需求，31.1%的人认为有需求，12.8%的人不确定。只有 12.6%的受访者会考虑申请这样的职位，而 72.4%的人不会，15.0%的人不确定。儿科（23.3%）、普通外科（15.7%）和神经外科（11.6%）是最愿意考虑申请此类职位的培训生比例最高的专业。对于这两个问题，回答存在显著的性别差异（p<0.0001，卡方检验），女性培训生更有可能考虑申请。总体而言，50.8%的受访者认为引入 CCT 后的非顾问级专家职位将对服务提供产生积极影响，但只有 21.6%的人认为这将对患者护理产生积极影响，13.9%的人认为对手术培训有积极影响，11.1%的人认为对手术专业有积极影响，只有 7.9%的人认为对他们的手术职业生涯有积极影响。这项调查表明，对于已经完成培训的外科医生引入“副顾问级”职称将不受欢迎，大多数人认为这将对患者护理和手术培训不利。为了患者安全和质量，必须对手术职业结构进行改革，因此 ASiT 支持继续提供主要由顾问提供的护理。
