Competencies of basic surgical trainees

The primary objective of the Hospital Recognition Committee is to ensure that the so-called lost tribe of SHOs in surgery obtain a properly structured training during each six-month post (I). Systematic, supervised training for Senior House Officers (SHOs) is a vital prelude to optimum Higher Specialist Training(2). The identification of the components of competence would be a good starting point for training, appraisal and ultimately assessment. Competence is more than performance based on knowledge(3), skills (4) and professional attitudes(5). It is the way in which these elements are combined and applied in the clinical arena that makes the concept of competence crucial to good practice (6). This integrated approach to competence was the reason that a piece of research - jointly funded by the National Health Service Executive and the Department for Education and Employment - was undertaken. It was conducted within the Yorkshire and Northern Region. Its object was to identify the competencies - both core and specialty specific - of SHOs, in a variety of specialties. This paper presents our findings in relation to Basic Surgical Training. Clearly there is a continuum which starts on the first day in the grade and ends after two years, or when they have developed the appropriate skills. During this period the SHO should gradually increase his competence so that at the end he is able to accept the responsibilities of a specialist registrar. Our continuum defines initial and target competency standards which can be used as the basis of SHO appraisals and possibly inspection visits. Our attention has focused upon SHOs rather than those elements of training that are provided by the post, eg, rotas, time-tables, and teaching sessions (7).