Strategic Thinking to Improve Surgical Training in the United Kingdom.

Surgical training in the United Kingdom (UK) is facing crucial challenges. Multiple fundamental changes in recent years have meant the same high-quality training needs to be delivered in a shorter duration. In this review, we consider the current training pathways for surgery in the UK, the impact of the European Working Time Directive (EWTD), the ongoing issue of service delivery versus training, and briefly the new Junior Doctor contract and the effects of Brexit on surgical training. The purpose of the review is to attempt to apply strategic thinking and strategy development to improve the current state of surgical training given the current climate new trainees find themselves in. Strategic thinking and wicked issues are defined, and three umbrella suggestions to improve surgical training are explored. Whether these suggestions can be implemented with reference to different models of strategic decision making is discussed. Finally, despite a new pilot scheme aimed at improving surgical house officer (SHO) surgical training, little change is offered to current trainees. The impact this has on surgical trainees is discussed and suggestions on how they can make the most of the current climate are made in this article.