Inefficiency in surgical training has been identified as a result of low rates of supervision, with direct teaching of operating by consultants occurring in less than 20% of cases in papers dealing with general surgery and cardiac surgery training. The introduction of an audit system in an orthopaedic training programme was associated with an improvement of teaching from an already high 30% to 40% of cases. A logbook programme was introduced which allows easy analysis of the distribution of experience on an anatomical basis.
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