Current attitude of British trainees (BOTA Members) towards trauma surgery in UK.

J Bone Joint Surg Br 1997; 79-B (Supplement II): 221

Zadeh HG; Sakka SA
Royal National Orthopaedic Hospital Trust, Stanmore,
Middlesex, England.

We are embarking on major changes in training with the introduction of the continuum training, reduction of on call hours and increase in the number of consultant posts. The delivery of trauma services in the UK is changing to consultant delivered care with an increasing number of consultants being appointed as either full time trauma surgeons or expected to devote the main part of their clinical practice to trauma surgery.

Similar changes were implemented in the USA over 10 years ago. However recent reports from the USA highlight the fact that these changes have altered the attitude of the residents in a negative way towards trauma surgery as a career. The purpose of this study is to establish the current trends in the UK and establish a baseline for future comparison.

The members of the British Orthopaedic Trainees’ association (BOTA) were contacted by a postal Questionnaire. A total of 480 questionnaires were posted and 253 (52%) replies received. The respondents comprised consultants 37%, senior registrars 34%, career registrars 22% and others 7%. 53% were working at teaching hospitals, 43% in non-teaching hospitals and 3% in research. 77% are Advanced and Trauma Life Support (ATLS) providers and 14% instructors.

Although over 90% of the respondents found trauma surgery enjoyable and exciting, only 55% considered it attractive and rewarding as a career. Even fewer 39% foresee good future prospects for trauma surgery being a major part of their clinical practice. 64% did not think trauma surgery will bring financial rewards in the future. Only 19% expressed trauma surgery as one of their subspecialties of interest.

Some of the main reasons for the disaffection shown towards trauma surgery by the respondents are: lack of provision for out of hours work (77%), demanding on call commitments (65%), lack of private patients (58%), HIV risk (58%), poor career structure (49%), excessive work load (42%) and inadequate training (36%). Furthermore only 20% consider trauma surgery is given sufficient accreditation or acknowledgement in the UK.

Other details including the differences between the three main grades i.e. consultants, senior registrars and registrars will be presented.

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