National trends in general surgical trainees' operative numbers (2013-2022)

Over the past two decades, surgical training in the United Kingdom has evolved, driven by cultural change, laparoscopic and robotic technologies, healthcare reforms and a pandemic. Anecdotally, all of these have potentially contributed to a decline in trainee operative volume and independence.

This study aimed to examine trends in operative numbers and supervision levels of UK General Surgery trainees from 2013 to 2022 across a range of index procedures.

Anonymous logbook data was requested from JCST for trainees on a general surgical programme at CT1 to ST8 level between 2013 and 2022. Differences over time were compared using Spearman's and Pearson's rank correlation.

The total number of procedures recorded across all training grades declined significantly from 209,661 in 2013 to 147,026 in 2022 (Spearman's r = -0.9758, p < 0.0001∗∗∗∗, Pearson's r = -0.9188, p = 0.0002). There was a greater shift over time to consultant presence, with reduced levels of supervised-trainer unscrubbed (STU) and above being recorded. For ST6 trainees, the number of inguinal hernias recorded as STU and above decreased by 47% (Spearman's r = -0.9758 p < 0.0001∗∗∗∗, Pearson's r = -0.9722 p < 0.0001∗∗∗∗). For ST8 trainees, cholecystectomies recorded as STU and above decreased by 46% (Spearman's r = -0.9273 p = 0.0003∗∗∗, Pearson's r = -0.9191 p = 0.0002∗∗∗).

A significant decline in total operative procedures was recorded across all General Surgery training levels, with senior trainees particularly affected by reduced operating. These findings underscore the need to adapt training to ensure trainees attain sufficient surgical expertise to become the consultants of the future.