BACKGROUND: Subspecialty training has been mostly restricted to teaching hospitals. We aimed to assess whether higher surgical trainees can be offered subspecialty training in a district general hospital serving a large population. METHODS: The surgical unit consisted of four subspecialty firms (upper gastrointestinal, vascular, colorectal and breast/endocrine). Each firm consisted of two consultants, one higher surgical trainee and one basic surgical trainee. The breast/endocrine firm had, in addition, a staff grade surgeon. Trainees collected data prospectively on their subspecialty experience and this was then compared with the subspecialty workload in the respective firms. RESULTS: Subspecialty related workload was 48% on the vascular, 57% on the colorectal and 53% breast/endocrine firms. Subspecialty workload on the upper gastrointestinal firm (27%) was skewed by one non-specialist consultant Trainees on the respective firms were involved in 74% vascular, 82% upper gastrointestinal, 79% colorectal and 54% breast/endocrine index subspecialty operations. Supervision with regards to index operations was 63%, 70%, 81% and 100% on the colorectal, breast/endocrine, upper gastrointestinal and vascular firms, respectively. CONCLUSIONS: 50% of the workload on the vascular, breast/endocrine and colorectal firms is subspecialty-related with the potential for training. With shortened training and some specialities having disproportionately more trainees, higher surgical training committees need to identify more subspecialty units that offer such training.
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