Michael El Boghdady

Progression through UK surgical training involves highly competitive national selection processes, particularly at entry into Core Surgical Training (CST) and subsequent entry into higher surgical training at ST3 level. Inequities in access to preparation resources and variability in mentorship remain recognized challenges. The Association of Surgeons in Training has developed national, trainee-led initiatives to support trainees at these key transition points. Preparing for a Career in Surgery (P4CS) and Preparing for Core Surgical Training (P4CST), established 10 years ago, supports foundation and early postgraduate doctors preparing for CST, while Preparing for ST3 (P4ST3), supports core trainees transitioning to higher surgical training. Both programmes are delivered nationally and incorporate thematic talks from successful candidates, portfolio clinics with personalized feedback, and mock interviews aligned with current CST and ST3 selection frameworks. Programme delivery has evolved from in-person to predominantly online formats to improve accessibility. Participation has increased steadily over time, with national reach across UK regions. Routine post-course evaluation demonstrated consistently high participant satisfaction across all programmes. Mean ratings for educational sessions ranged from 4.48 to 4.84 out of 5, while over 94% of participants reported adequate opportunities to ask questions and receive personalized feedback from faculty. Preparing for Core Surgical Training and Preparing for ST3 illustrate how trainee-led educational initiatives developed within professional associations can provide scalable, sustainable, and equitable support across the surgical training continuum. This model offers a transferable framework for supporting trainees navigating competitive postgraduate selection processes.

The importance of non-technical skills (NTS) to surgical performance and patient safety has been increasingly recognised by surgical teams. Inductions for new surgical team members in theatre often provide insufficient, non-standard and 'ad hoc' training in theatre behaviour and etiquette. We conducted a Delphi consensus study among senior surgeons to develop standardised guidance on theatre etiquette for those unfamiliar with the theatre environment, including resident surgical trainees and medical students. An international Delphi process of two rounds was conducted. An electronic survey was distributed among senior surgeons, anaesthetists and senior scrub nurses/practitioners, with participants recruited via surgical societies. Participants were asked to rank each statement on a Likert scale of 1 to 5. Consensus was considered if achieved for any statement for which 75% or more indicated agreement. The study was registered with the Open Science Framework. A total of 261 participants completed the Delphi process; 239 valid responses were included in round 1, with a 23% dropout in round 2. Participants were from 23 countries, 66% were from the UK, 58.2% were male, 51% were from the 30 to 40-year age group, 39% were consultant surgeons and 49% were senior trainees. General surgeons made up 68.6% of respondents, trauma and orthopaedic surgeons 13.4%, healthcare practitioners 2.1% and anaesthetists 1.3%. Thirteen statements were excluded, and 29 reached agreement and were included in the final guidance. There was agreement among a large international group of surgeons to develop a standardised guidance for theatre etiquette, addressing most of the key aspects of professional conduct and team dynamics. We anticipate that this guidance will serve as a valuable resource for orienting new members of the surgical team, providing a clear framework for maintaining professionalism and fostering effective communication within the theatre environment.

The future of surgery is challenged by two major issues: declining medical students’ interest in a surgical career and increasing burnout numbers among surgical residents. Addressing these issues is vital to maintain a vital and attractive surgical profession. Recruitment of suitable surgical trainees is there for increasingly important. In the Netherlands, the number of applicants for a surgical training position is stable, with a significant increase in female applicants. The applicant-training position is also stable. Nevertheless, as a surgical community, it is our responsibility to ensure that this situation is sustained in the long term in a durable manner. Encouraging medical students, functioning as role models, mentoring surgical trainees and addressing burnout is essential to keep our profession attractive for all.