Training young adult hip surgeons for the future: the Cambridge vision

Surgery is a form of art which has transformed over the last six centuries from an individual’s craftsmanship to a team-based approach to ensure patient safety.1 Surgical training has also seen a compelling change from being a primarily apprentice-based training to a competency-based model.2,3 Although the traditional model of apprentice-based training is still valid in modern surgical training, there has been a gradual shift over the last two decades towards achieving specific competencies in an objective manner to deliver safe surgical care.2,3 There are several reasons for this change. A reduction in working hours in the UK and Europe, as dictated by the European Working Time Directive (EWTD), has reduced the total training time between qualification and becoming a consultant (specialist) from 30 000 hours to 6000 hours.4 This five-fold reduction in hours has not only reduced the amount of surgical exposure gained by the resident during training, but has also resulted in significant variability in the orthopaedic caseload for the trainee.5⇓⇓-8 In parallel with this, the introduction of consultant-delivered care in an effort to improve patient outcomes may have an indirect effect on surgical training by reducing the number of cases a resident performs as primary surgeon.9 A final driving force for the shift in curriculum is the continued evolution of technically demanding surgery with steep learning curves, such as arthroscopy, which is now increasingly performed in orthopaedic practice due to several technical advances.10⇓-12 The current orthopaedic curriculum in the UK is based around three core themes: applied clinical knowledge, applied clinical skills and professional and management skills.13 Competency-based training encompasses several work-based assessments, of which procedure-based assessment (PBA) is one. PBAs provide the opportunity for a detailed assessment of …