Colorectal operative experience in general surgical training

Background: Surgical trainees often feel that their operative training is inadequate – trainers usually do not share this view. Methods: The distribution of colorectal operative surgical workloads between consultants and trainees was examined over a 15-year period in the Colorectal Service at the Wellington School of Medicine. Results: Consultants performed 947 operations and trainees performed 1012 operations. The average age of patients operated on by trainees was lower than that of those operated on by consultants. Trainees performed more emergency surgery. Anorectal surgery, except fistula surgery, was more commonly performed by trainees, whereas abdominal colorectal surgery was more commonly performed by consultants. Trainees had lower postoperative morbidity and mortality rates. The diseases predominantly treated by consultants and trainees differed. Twenty-four percent of patients with colorectal cancers and 25% of patients with diverticular disease were managed operatively by trainees. Yearly trainee workloads for minor anorectal conditions were similar to those of trainees in the USA. Conclusion: Although this small colorectal audit provides some information about trainees' operative experience, until all surgical procedures performed by all surgical trainees are accurately audited and criteria for adequacy of operative training are clearly stated, it will not be possible to say whether our training programs provide adequate operative training or not.