Transition From Higher Surgical Training to Consultant Surgical Practice: What We Don't Know but Need to Know

Abstract Background Higher surgical training (HST) focuses on delivering clinical knowledge and technical skills to fulfil day-one consultant clinical competencies. Introduction of capabilities in practice (CiPs), shifts curricula to outcome-based assessment related to direct clinical care. To aid the transition into consultant surgical practice, we must identify deficiencies in HST related to wider professional capabilities outside of direct clinical care. Aim To identify deficiencies in HST by exploring challenges faced by recently appointed T&O consultants. Method The experience of T&O consultants, appointed in the last five years, was explored using a phenomenological approach. Field notes from unstructured interviews with five consultants (convenience sampling), was used to develop a topic guide for semi-structured interviews with six new consultants (purposive sampling). Interviews were transcribed and thematically analysed. Results Consultants transitioning into the new role emphasized comprehensive clinical knowledge, technical and non-technical skills as attributes required to be a good day-one consultant. Further identifying various deficiencies in their non-clinical training; categorised into two themes and further sub-themes: Adapting identity Practice management, Building a reputation, Leadership identity, Trainer identity, Awareness of limitations, Independence vs support Discovering responsibilities Job planning, Management structure, Service provision and procurement, Complaints and complications. Conclusions This study provides an in-depth account of deficiencies in professional capabilities outside of direct clinical care required by day-one consultants. Furthermore, highlighting the pressing need to equip trainees for transition to consultant-surgical practice. We make recommendations on how stakeholders such as surgical-trainees, newly appointed consultants and employing organisations can modify identified deficiencies at different training levels.