Smith, A.J., Aggarwal, R., Warren, O.J. et al. World J Surg (2009) 33: 174. doi:10.1007/s00268-008-9814-3
Training in surgical disciplines in the United Kingdom has undergone tremendous change over the past two decades. The introduction of specialist training programmes, working time directives, quality ratings and a drive toward ambulatory and minimal access surgery have led to challenges with respect to training and service commitments of healthcare professionals. A structured and centralised training system was introduced, with the concept of core followed by specialty-specific progression, in an openly competitive manner. Within this system is the need to commence training on simulation models, and to demonstrate proficiency prior to performance of tasks on patients. This should be underpinned by objective measures such as video or dexterity-based tools. There is also a clear need to provide personal, professional and leadership development in the form of mentorship and appraisal systems. Though continuing to develop, the profession must be mindful of current and future advances to ensure the delivery of surgeons for the future who aspire toward excellence.