Surgical Training and Certification in the United Kingdom Andrew J. Smith Æ Rajesh Aggarwal Æ Oliver J. Warren Æ Paraskevas Paraskeva Received: 4 April 2008 / Accepted: 8 October 2008 / Published online: 21 November 2008 Ó Socie ´te ´ Internationale de Chirurgie 2008 Abstract Training in surgical disciplines in the United Kingdom has undergone tremendous change over the past two decades. The introduction of specialist training pro- grammes, working time directives, quality ratings and a drive toward ambulatory and minimal access surgery have led to challenges with respect to training and service commitments of healthcare professionals. A structured and centralised training system was introduced, with the con- cept of core followed by specialty-specific progression, in an openly competitive manner. Within this system is the need to commence training on simulation models, and to demonstrate proficiency prior to performance of tasks on patients. This should be underpinned by objective measures such as video or dexterity-based tools. There is also a clear need to provide personal, professional and leadership development in the form of mentorship and appraisal sys- tems. Though continuing to develop, the profession must be mindful of current and future advances to ensure the delivery of surgeons for the future who aspire toward excellence. Introduction The last 10 years have seen unparalleled amounts of change within the United Kingdom health-care industry. Nowhere has this been felt more keenly than within surgery where, in less than a generation, selection criteria, methods of training, and working roles have changed almost beyond recognition. Despite far-reaching changes, consultant sur- geons are still required to deliver key emergency and elective services, ensure high-quality undergraduate and postgraduate education, and participate in excellent, inno- vative research. This article describes surgical training within the United Kingdom: its history, the current struc- ture, immediate challenges, and future innovations, both technical and nontechnical, that may change the way we deliver surgical training in the future. The United Kingdom has traditionally created first-rate surgeons. Ensuring this continues to be the case is in everyone’s interest. The evolution of surgical training in the United Kingdom Since the Middle Ages, when a young trainee barber-sur- geon learnt both hair cutting and tooth extraction at the hand of a more experienced man, surgery has been learnt through apprenticeship. Even after the establishment of the National Health Service in 1948, there was little structure to surgical training in the United Kingdom. After leaving medical school, doctors would be granted provisional registration and be required to complete a year of super- vised practise as a preregistration house officer (PRHO). Usually, 6 months was spent working in a surgical disci- pline and 6 months in a medical specialty. After full registration was awarded, the aspiring surgeon would commence surgical training. Progressing through posts of increasing responsibility, trainees would gradually spe- cialise into one of the surgical disciplines. A distinct career pathway, however, was lacking, and it was not uncommon for surgeons to obtain an unlikely mix of skills on their way to specialisation. Furthermore, training was not time A. J. Smith Á R. Aggarwal (&) Á O. J. Warren Á P. Paraskeva Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor QEQM Building, St. Mary’s Hospital, London W2 1NY, UK e-mail: rajesh.aggarwal@imperial.ac.uk 123 World J Surg (2009) 33:174–179 DOI 10.1007/s00268-008-9814-3