Wolfe J H
St Mary's Hospital London.
Ann R Coll Surg Engl. 1998 May;80(3 Suppl):112-6.
Surgical training in this country was coveted by many trainees from abroad, who remember their period of clinical apprenticeship with affection. The twin pillars of this success were the considerable clinical workload and a school of surgeons that were well trained and skilled in the full breadth of general surgery (see Figure 1). This led to a degree of complacency and little effort was made to change a system that produced experienced, well trained surgeons (even if some were a little jaded and embittered by the time they finally obtained a consultant post). More recently surgical training has been in a state of flux and standards have adapted to both market forces and European directives on doctors' hours. The Calman Report addressed these issues and has wide reaching implications. The prospect of a more focused and organised training that could produce consultants by the age of 32-33 was welcomed by most. The vagaries of an apprentice system needed to be addressed and tightly focused training programmes developed. Following endless committees the structure of general surgical training is now defined and will be dealt with in the first part of this paper. Having defined the structure we then need to assess the trainers'/ training programmes and finally the trainees.
在这个国家，外科培训受到许多国外学员的青睐，他们深情地回忆起自己的临床实习阶段。这一成功的两大支柱是相当大的临床工作量以及一批在普通外科各个领域都训练有素、技术娴熟的外科医生队伍（见图1）。这导致了一定程度的自满情绪，而且几乎没有做出努力去改变一个能培养出经验丰富、训练有素的外科医生的体系（即使有些人在最终获得顾问职位时有点疲惫和愤懑）。最近，外科培训一直处于不断变化的状态，标准也已适应市场力量和欧洲关于医生工作时间的指令。卡尔曼报告解决了这些问题，并产生了广泛影响。大多数人欢迎这样一种前景，即开展更有针对性、更有条理的培训，到32 - 33岁就能培养出顾问医生。学徒制的种种变幻莫测需要加以解决，并制定出重点明确的培训计划。经过无数次委员会会议后，普通外科培训的结构现已确定，并将在本文第一部分进行阐述。在确定了结构之后，我们接着需要评估培训者/培训计划，最后评估学员。
