Variation in costs to complete surgical training: a cross-sectional observation analysis.

Introduction: Surgical training is expensive. The aim of this study was to quantify the costs surgical trainees are expected to pay related to the ten surgical specialties in a single Statutory Education Body (SEB).

Methods: Intercollegiate Surgical Curriculum Programme (ISCP) and Joint Committee on Surgical Training (JCST) certification requirements including mandatory and highly recommended courses, related to specialty, along with professional registration and examination fees were estimated.

Results: Assuming an uninterrupted eight-year training pathway from Core (CST) through Higher Specialty Training (HST) to Certification of Completion of Training, median cost of mandatory courses was £1,498 (interquartile range (IQR) £1,498-£1,998). Highly recommended courses increased median cost to £5,998 (£4,880-£6,840); £749.75 per year (py) (£610-£855). Annual individual study budget (£600) was exceeded in 30.7% of the total trainee cohort (n=309) by mandatory and recommended curriculum course cost (n=95). Examination fees and professional subscriptions further increased costs to a median £17,669.50 (£16,552-£18,512); £2,148.75 per person py (£2,069-£2,251.38). Cost varied related to specialty, with General Surgery associated with the most cost (>£21,000; £2,626 py) compared with Otolaryngology the least (£15,613; p<0.001).

Conclusion: Surgical training expense varied by more than 33%. Mandatory and highly recommended courses exceeded SEB study budgets for almost one-third of trainees, with a theoretical fivefold study budget overspend. Trainees, trainers and schools of surgery alike should be aware of these costs when designing curricula and teaching programmes.