The requirements for training in trauma and orthopaedic (T&O) surgery have changed significantly over the past 10 years. As a result, there has been a need to rationalise and improve training within T&O training programmes throughout the UK. All trauma and orthopaedic (T&O) specialist registrars (SpRs) require subspecialty training, but opportunities for training in paediatric, hand and spinal surgery can be limited. In each region both extrinsic and intrinsic factors have driven the changes in training provision. Of the extrinsic factors, concordance with the European training regulations introduced by Calman and the restriction on junior doctors' working hours (A New Deal) have reduced the total hours trainees will spend in higher surgical training. Training in T&O surgery has, by necessity, become more concentrated and structured.
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