CST-HST Bulge: A New Lost Tribe?

ASiT has had the opportunity to review a recent Medical Programme Board paper regarding the progression from core surgical training (CST) into higher surgical training (HST).

There appears to be a new bulge rapidly developing, with several hundred core trainees failing to progress into higher surgical training each year.

In summary:

The intake to CST at CT1 is 621 posts (in 2010) when the number of training appointments at ST3 is only 288 in 2010.

In 2010 the overall likelihood of progressing to ST3 from a CST post is approximately 36%, varying according to specialty.

This is largely unchanged from 2007, and equates to more than 500 core surgical trainees with no higher training place in August 2010.

There is no consistent relationship between the number of themed CST posts and opportunities to progress to ST3.

The 2010 application ratios from CST to HST in England and Wales are currently:

General surgery 2.9:1 (93 ST3 numbers available)
T&O surgery 2.9:1 (90 ST3 numbers available)
Plastic surgery 7:1 (9 ST3 numbers available)
Paediatric surgery 3.7:1 (6 ST3 numbers available)
Urology 1.4:1 (41 ST3 numbers available)
ENT surgery 2.7:1 (27 ST3 numbers available)
Cardiothoracics 0.45:1 (22 ST3 numbers available)

The factors behind this are clearly multifactorial. Progression into higher surgical training was never easy, and should remain competitive. Nonetheless, we are concerned that post-MMC trainees still have little chance (and unrealistic expectations) of continuing into higher surgical training.

The Medical Programme Board has made a number of recommendations for 2011 that include the following points:

Transitional arrangements to manage excess doctors trained in CST are introduced.

Number of CST1 posts recruited to in 2011 should not be greater than ST3 opportunities.

Free-standing CT2 posts should be removed.

Reliable and transparent career planning information must be developed.

Acceptable headroom is determined for CST posts and reviewed annually.

Alignment is made between themed CST posts and ST3 opportunities in surgical specialtes.

It is not yet clear whether these recommendations will be introduced.

We have invited the JCST to comment on this issue on behalf of the SACs, together with the actions being taken to address this, and the timeline for these. A copy of our letter is available for download below and the response received from Mr Chris Munsch, JCST Chair is also available to download below.

ASiT has further meetings with the Royal Colleges and JCST to discuss this matter, and we have submitted a response to the Medical Programme Board, which can be downloaded below. We will keep you informed with the outcomes.

CST-HST Bulge: A New Lost Tribe?

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