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    Hi everyone, long time reader, first time poster :worm2:

    I'm applying to CT1 after my fp. I'm looking to go into core surgical training after having a really good experience on some ortho and trauma wards on my fy1. I've been based at Southend but want to move closer to London for personal reasons. Apparently surgery there is generally rubbish- any ideas about which hospitals are best or what area to look at?

    Thanks in advance : )

    Jamie
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    Surgical training in London is generally poor at all levels. The tension between service and training for core surgical trainees is abysmal in most regions but is worse in London. Unlike general surgical departments, many T&O services no longer have foundation doctors and so core surgical trainees risk being exploited as surrogate FY1s. The only thing you could really do to worsen the combination of CST + London + T&O is to base your rotations in famous teaching hospitals.

    You may still find some good training environments in DGHs around London but there is little training to be had for core surgical trainees at teaching hospitals (St George's, St Mary's, King's, UCLH, etc). You might find some other benefits in these places (name dropping, research projects, etc) but you'll get much more surgical experience out of mid-sized DGHs (Kingston, University Hospital Croydon, Hillingdon, the Whittington Hospital, etc).
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    Thanks for the great advice guys, yeah I was hoping the rumours wouldn't be true but maybe if I apply and try get a post in a smaller hospital on the outskirts it'll be better. MonteCristo do you know where the best place for T&O training is in the UK? Just wondering if I should look at some other areas in teh South to broaden my search. Also I know its ridiculously competitive, do you know anyone who's got in? Thanks + rep for the excellent replies : )
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    (Original post by jamie_hervie)
    MonteCristo do you know where the best place for T&O training is in the UK?
    Wow - that's quite a question!

    I don't know that there is any one region that will guarantee "the best" T&O core training experience. I personally would decide where you want to live and then try to pick the best training environments in that area. I'm sure there are good training environments in London but there are lots of large/unhappy/dysfunctional units as well.

    In an ideal world, you want smaller hospitals (e.g. a mid-sized DGH) that:

    1. Treats lots of patients with hip and wrist fractures, as these are the cases you are most likely to be allowed to "do". They are also the cases that typically come up at ST3 selection centres. The National Hip Fracture Database publishes an annual report that will include the number of hip fractures treated at each hospital in England and Wales.

    2. Uses ward juniors that are FY1s/FY2s rather than Physicians Associations or Nurse Practitioners. Although the latter are very good, they can also be assertive and won't necessarily accept your absence from the ward in the same way as FY1s.

    3. Allows core trainees to work on the SpR rota. I don't know how many hospitals do this but some DGHs include core and higher surgical trainees on the same on call rota. This will essentially mean gaining SpR experience/confidence early and avoid the prospect of having to compete for cases with junior SpRs.

    There's no reason why you shouldn't email trusts with questions or call and ask the on call T&O SHO whether they'd be willing to talk or receive an email with questions.
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    Amazing . Thanks so much again for taking the time for such a detailed response... how do you know so much? I feel like I must've been living in a box all these years compared to you!
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    (Original post by jamie_hervie)
    Amazing . Thanks so much again for taking the time for such a detailed response... how do you know so much? I feel like I must've been living in a box all these years compared to you!
    I'm quite a few years further ahead in my T&O career, although at my current rate of progress you might well CCT before I do! Good luck.
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    (Original post by MonteCristo)
    Wow - that's quite a question!

    I don't know that there is any one region that will guarantee "the best" T&O core training experience. I personally would decide where you want to live and then try to pick the best training environments in that area. I'm sure there are good training environments in London but there are lots of large/unhappy/dysfunctional units as well.

    In an ideal world, you want smaller hospitals (e.g. a mid-sized DGH) that:

    1. Treats lots of patients with hip and wrist fractures, as these are the cases you are most likely to be allowed to "do". They are also the cases that typically come up at ST3 selection centres. The National Hip Fracture Database publishes an annual report that will include the number of hip fractures treated at each hospital in England and Wales.

    2. Uses ward juniors that are FY1s/FY2s rather than Physicians Associations or Nurse Practitioners. Although the latter are very good, they can also be assertive and won't necessarily accept your absence from the ward in the same way as FY1s.

    3. Allows core trainees to work on the SpR rota. I don't know how many hospitals do this but some DGHs include core and higher surgical trainees on the same on call rota. This will essentially mean gaining SpR experience/confidence early and avoid the prospect of having to compete for cases with junior SpRs.

    There's no reason why you shouldn't email trusts with questions or call and ask the on call T&O SHO whether they'd be willing to talk or receive an email with questions.
    This has been really helpful, thank you.
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    I thought the training in the T&O department at Wexham Park was actually excellent. I had the opportunity to do loads of stuff despite being an FY2. I didn't take that opportunity because I wasn't interested, but i could have. They take trainees from both London and Oxford.

    The only problem is that they don't take CSTs when i was there. Only FYs and SpRs.
 
 
 
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