Barriers to operative exposure in foundation training

Area of Science:

• Medical Education
• Surgical Training
• Healthcare Workforce Research

Background:

• Early operating theatre exposure is vital for surgical career interest and skill development.
• Limited contemporary data exists on barriers to theatre access for UK foundation doctors.
• This study characterizes perceived barriers to operative exposure in a large regional cohort.

Purpose of the Study:

• To identify and characterize the perceived barriers faced by foundation doctors in accessing operating theatre experience.
• To inform strategies for improving surgical training opportunities for early-career doctors.

Main Methods:

• A 41-item online survey was administered to foundation doctors (FY1, FY2) in the South West of England.
• Survey included questions on career intentions, operative exposure, and perceived barriers, with quantitative and qualitative analyses.
• Data collected from 296 respondents (20.5% response rate) between July-August 2025.

Main Results:

• Ward workload (57.6%) was the primary barrier, followed by rota inflexibility (25.5%) and surgical culture (7.4%).
• Qualitative themes included ward dependency, inflexible rotas, competition for cases, and cultural pressures.
• Most doctors gained theatre exposure during rostered hours (68.0%), with 11.7% using unpaid time; only 50% of aspiring core surgical trainees felt on track for required cases.

Conclusions:

• Foundation doctors encounter significant structural and cultural obstacles to operating theatre access.
• Recommendations include mandated protected theatre time, improved ward staffing, and structured skills teaching.
• These interventions can mitigate constraints and support equitable preparation for core surgical training.