Leaving orthopaedic surgical training: the LOST surgeons - a qualitative study exploring why UK trauma and...

The study aimed to explore why trauma and orthopaedic registrars decide to discontinue surgical training. Understanding the factors that influence a decision to leave may help to inform changes which enhance the experiences of surgeons and retention of the future workforce.

Qualitative study using semi-structured interviews.

Between October 2022 and March 2026, interviews were conducted with participants who had left the UK National Health Service (NHS) trauma and orthopaedic specialty training before completion. Reflexive thematic analysis was performed on 1727 min of interview data.

23 respondents were interviewed. Most respondents exited specialty training in the middle years (ST5 and 6). 13 retrained in the NHS and 10 left the NHS entirely. Three overarching themes were identified: (1) 'The Hidden Curriculum' describes the presence of unwritten rules, attributes and behaviours which must be met to succeed in training (2) 'Flawless Care in a Flawed System' describes surgeons' responsibility for delivering faultless care while lacking agency to address system failures and (3) 'Interchangeable and Underappreciated' depicts the dissonance between trainees' professional status and their perceptions of being interchangeable.

The loss of surgical registrars from training programmes comes at a high cost to the healthcare system and society as well as to the individual. Understanding what triggers surgeons to leave training allows consideration of how challenges can be modified to prevent further attrition and ensure sustainability of the profession.