Brearley S
Whipps Cross Hospital, London, U.K.
World J Surg. 1994 Sep-Oct;18(5):725-9; discussion 724. doi: 10.1007/BF00298916.
Surgical education in the United Kingdom has evolved to meet the need of the National Health Service (NHS) for a relatively small body of consultants practicing autonomously and carrying ultimate clinical responsibility for their patients. This form of specialist practice is markedly different from that found in most other countries and has necessitated a longer, more comprehensive training program than is usual where hospital specialists work more in teams and under the supervision of a head of department. Because the ratio of specialists to population is low, case loads are high. Trainees obtain excellent experience and rapidly assume clinical responsibility. Service commitments have increasingly conflicted with the need for more formal educational activity, and the financial problems of the NHS have latterly reduced opportunities for clinical training as well. Scientific advances in surgery have removed a range of cases from the operative repertoire of younger trainees. As a result, it is becoming increasingly difficult to provide trainees with opportunities to develop their surgical skills. The duration of surgical training in the United Kingdom is largely dictated by the availability of consultant posts. It could be shortened substantially with no loss of quality, but only if considerable additional funding were made available to the NHS. There seems little prospect of this boost at present and the impoverishment of the NHS is having an increasingly detrimental effect on standards of surgical education.
英国的外科医学教育不断发展，以满足国家医疗服务体系（NHS）的需求，即培养相对少数能够自主执业并对患者承担最终临床责任的顾问医师。这种专科执业形式与大多数其他国家明显不同，因此需要比通常情况下更长、更全面的培训计划，在其他国家，医院专科医生更多地以团队形式工作，并在科室主任的监督下工作。由于专科医生与人口的比例较低，病例数量较多。实习生能够获得丰富的经验，并迅速承担临床责任。服务承诺与开展更正规教育活动的需求之间的冲突日益凸显，而且NHS的财政问题近来也减少了临床培训的机会。外科手术的科学进步使一系列病例不再属于年轻实习生的手术范围。因此，为实习生提供发展其手术技能的机会变得越来越困难。英国外科培训的时长在很大程度上取决于顾问医师职位的空缺情况。如果没有质量损失，培训时长可以大幅缩短，但前提是NHS能获得大量额外资金。目前似乎不太可能得到这笔资金支持，而NHS的资金匮乏对外科医学教育标准的影响越来越大。
