we welcome original articles fortheTrainees’ Forum on any subjectof interest to surgical trainees(maximum 1,500 words).we willalso consider letters commentingon articles published in theTrainees’Forum. please email submissions tobulletin@rcseng.ac.uk.

we welcome original articles fortheTrainees’ Forum on any subjectof interest to surgical trainees(maximum 1,500 words).we willalso consider letters commentingon articles published in theTrainees’Forum. please email submissions tobulletin@rcseng.ac.uk.

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The Association of Surgeons inTraining (ASiT) is a sizeable organisation with the aimof ensuring pan-specialty representation of surgical trainees. in this month’s articleJRLWild and colleagues outline the benefits of being a member of ASiT and discuss theorganisation’s role in addressing some of the important issues that have arisen with theevolution of surgical training in the UK.

Bijan ModaraiSeries Editor

Trainee’s FOrUMDOi: 10.1308/147363513X13588739440690

asiT: the pursuit of excellence in trainingJrlwildVice-president of ASiTaJ BeamishVice-president of ASiTJeF Fitzgerald past president of ASiTp sinclair Director of Education of ASiTsT hornby president of ASiTOn behalf of the Association of Surgeons inTraining

The Association of Surgeons inTraining(ASiT) has grown in size and influencein recent years. Despite this manytrainees are still unaware of the extent ofmembership benefits that ASiT can offer.in this article we discuss ASiT’s recentwork and success in promoting the higheststandards in surgical training and outlinethe strengths and benefits that a pan-specialty trainee organisation has to offer.

Background ofasiTASiT is a professional body andeducational charity dedicated to thepursuit of excellence in surgical trainingfor the benefit of trainees and patients.ASiT was established in 1976 by a groupof senior registrars in order to meetsocially and discuss issues in surgicaltraining.The last four decades have seenthe association expand, especially in thelast five years, with ASiT now boastinga membership of 2,200 surgical traineesacross all 10 surgical specialties, makingASiT the second-largest UK surgicalspecialty association.The ASiT council canalso count numerous professional leadersand royal college presidents among itsalumni.

who makes up theasiT council?Figure 1 outlines the structure of theASiT council.As an umbrella organisation,ASiT is built upon the objective of

achieving complete representation acrossall surgical specialties and all regions ofthe UK and ireland.The ASiT councilcomprises elected representatives fromsurgical trainee specialty organisationsand 24 regions. An executive committeeof ten individuals is elected from counciland include the roles of president, twoVice-presidents, past-president, HonorarySecretary, Director of Education,Treasurer,Webmaster, Publicity Officer andYearbookEditor, all of which are voluntary.

an independent voice representingsurgeons in trainingASiT representatives attend almost 40committees which influence surgicaltraining, varying from the Joint Committee

on Surgical Training (JCST), RCS Counciland the RCSEd Faculty of Surgical Trainersto a range of education and specialtyassociation committees and public interestgroups such as the RCS patient LiaisonGroup (pLG).

The independent nature of ASiT’srepresentation ensures the voices oftrainees are not only heard, but carryinfluence on decisions affecting the futureof surgical training. Despite the recentradical overhaul of surgical training in theUK, including the introduction of formaltraining curricula, competency-basedassessment and the new core surgicaltraining and run-through programmes,numerous threats remain to sustaining

Figure 1The structure of ASiT council ensures pan-specialty representation of all training grades.

Ann R Coll Surg Engl (Suppl) 2013; 95: 107–109

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high-quality surgical training and educationin the modern working environment,especially service delivery pressures andthe reduction of working hours.ASiT’scontribution to the current debate issummarised in a 34-action-point plan,Improving the future of surgical trainingand education: recommendations from theAssociation of Surgeons inTraining,1 whichhighlights areas for improvement atnational, regional, local and individuallevels.

contemporary issues in surgicaltrainingThe Health and Social Care Act 2012 willcome into force this year with potentiallyfar-reaching alterations to the surgicaltraining landscape. increasingly, there willbe more training opportunities availablein the independent sector as privateproviders have a greater role in deliveringhealthcare for the NHS.As employersand members of the local education andtraining boards (LETBs), private providersfunded by the NHS will be expected tocontribute to the education and training ofsurgeons.As numerous aspects of surgicalpatient care shift towards independentsector centres, in particular day-caseand low-risk procedures, appropriateaccess to the training opportunities thataccompany each patient will be essentialfor trainees to achieve their logbookrequirements. in a recent interview inBMJ Careers2 our president outlinedsome of the training opportunities inthe independent sector but also warnedabout potential indemnity pitfalls.whetherindependent sector providers will fullycommit to their training obligations andhow trainees will be relieved from NHSservice requirements in order to accesssuch training opportunities also remainsto be seen.

The financial cost of surgical trainingcontinues to rise each year, as doesthe proportion of these costs that ismet from the trainee’s pocket. in lightof recent changes to the funding anddelivery of training,ASiT has investigatedthe costs of surgical training borne bytrainees themselves, demonstrating thatcontemporary surgical trainees are payingfor around one-third of their postgraduatetraining costs.3 Study budgets are beingtop-sliced to support local curriculumdelivery and are frequently insufficientto support trainees undertakingmandatory courses and exams required

for progression.Also of concern arethe effects of university tuition fees onpostgraduate finances that are only nowbeing seen by doctors, given the time lagto qualification. Recent penalising increasescould in future preclude or dissuadetrainees who are not independentlywealthy from embarking on expensivesurgical training.

while the JCST has recently worked toimprove awareness among trainees of itsimportant role in surgical training, via abi-annual newsletter and through socialmedia, there remains dissatisfaction amongtrainees regarding the fee to support theJCST with many feeling that it does notrepresent good value for money. Furtherrises in the JCST fee are inevitable andwith the General Medical Council (GMC)and Department of Health apparentlyunwilling to make a significant financialcontribution to the process, despite theJCST’s work being carried out on behalfof the regulator, further disproportionatecosts may be transferred to trainees.One solution may be for all surgicalroyal college members and fellows, notjust trainees, to share the increasedoperational costs of the JCST via theannual college membership subscription– a move that would be welcomed by ASiT.

Of particular concern to trainees is theongoing issue of the ‘sub-consultant’grade, which has reared its head againrecently with a projected oversupply oftrained hospital doctors and an estimated£2.2 billion increase in consultant salarycosts in 2010.4,5ASiT firmly believes thatthe certificate of completion of training(CCT) equips the individual to deliverhigh-quality care as a leader of the surgicalteam, rather than just a member, and thatthis gold standard must be maintained.Asub-consultant grade is likely to lead todemotivating and undesirable posts andproduce significant workforce migration.we must all work hard to ensure thathighly qualified and motivated CCT-holdingconsultant surgeons with autonomy, buta strong sense of collaborative practice,remain central to the delivery anddevelopment of excellent safe patient care.ASiT strongly opposes the introduction ofa sub-consultant grade, whether it be inname or in terms and conditions.

ASiT continues to oppose the EuropeanworkingTime Regulations (EwTR),which have led to a reduction in surgical

training opportunities, with multiplehandovers and fragmented care potentiallyjeopardising patient safety.6-10Actual workbears little resemblance to the hours laiddown by official rotas,11 as trainees aredisregarding the legislation and takingtheir own steps to protect their surgicaltraining and the provision of safe patientcare.12ASiT maintains its recommendationthat a flexible working week up to amaximum average of 65 hours is requiredto provide an appropriate balance ofthe technical and non-technical trainingnecessary for the craft specialities.13weare pleased to see that our message isgetting through to politicians as ASiT’sstance on working time restrictions wasreferred to by several Mps in a recentHouse of Commons debate on the EwTRearlier this year.The president of ASiTwas also invited and provided evidence toa parliamentary committee investigatingthe impact of the EwTR on trainingand patient care.ASiT’s views on theEwTR, opposing those of the BMA juniordoctors committee, were recently voicedon BBC’s Newsnight.while we await theoutcome following a scheduled review ofthe EwTR by the European parliament,14

and of course whether the EwTR willfactor in the prime Minister’s recentpromise to negotiate a “better deal” forthe UK in Europe following his pledgefor a referendum on the EU, traineesmust continue to be active in protectingtraining while at the same time remainingprofessional and ensuring patient safety.

Surgical simulation training has beenshown to reduce the technical learningcurve and is now well recognised asan adjunct to surgical training.whileproviding additional learning opportunitiesto expand training and improve patientsafety, simulation may compensate inpart for reduced training time in theoperating theatre.ASiT has already heavilyendorsed the opinion that high-qualitysimulation programmes must increasinglybe incorporated into surgical training.

professor Normanwilliams chats to trainees in thewelcome drinks reception at the 2012ASiT Conference

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However, as highlighted in a recent ASiTsurvey and summarised in The availability,introduction and role of simulation in surgicaleducation and training: review of currentevidence and recommendations from theAssociation of Surgeons inTraining,15 thereis a paucity of surgical skills simulatorfacilities across all specialties andavailability (or awareness of availability)varies widely between regions. Forsimulation training to become establishedwithin existing training programmes andintegrated into the surgical curriculum itis imperative that consultants have timeavailable to deliver simulation training.ASiT supports the General MedicalCouncil’s proposed recognition andapproval of trainers16 and hopes thatthis planned licensing of surgical trainerswill be implemented robustly in orderto ensure training responsibilities areproperly reflected in NHS job plans.

The annualasiT conferenceAs the only pan-specialty nationalconference for surgical trainees in the UKand ireland, the ASiT annual meeting offersa unique opportunity for clinical updates,training courses, research presentationsand careers talks specifically aimed atsurgical trainees.with numerous traineeprizes, a charity gala dinner and theopportunity to socialise with colleaguesfrom across the country, the weekendhas become an essential date in the diaryfor all surgical trainees.As the associationcontinues to grow, so does the scale andpopularity of the annual conference, asdemonstrated by the climbing delegateregistrations and abstract submissionsover recent years. Following a rigorouspeer-review process, the highest-scoringabstracts are accepted for posterpresentations, with the best selectedfor presentation in one of the four oralprize presentation sessions.Acceptedabstracts are published in citable formin the International Journal of Surgery (IJS).The 2012 ASiT conference at City Hall,Cardiff, brought together almost 700delegates, speakers and guests for whatwas the most successful conference todate17.we certainly look forward to seeingeven more fellow trainees in attendance atManchester Central Convention Complexfor the 2013 ASiT conference over theweekend of 5–7 April 2013.

asiT prizes and awardsDuring 2011 and 2012,ASiT awardedover £30,000 worth of prizes to trainees.

In addition to the 18 prizes awarded atthe annual conference, other prestigiousawards were made throughout theyear, including the highly competitiveASiT CovidienTravelling Fellowship, theShorland Hosking and pitts-Tucker ASiTOperation Hernia Fellowships, the ASiTDutch MicrosurgeryTravelling Bursary,multiple ASiT research and regionalmeeting grants, and many others.Theseawards are generally made through opencompetition, with applications judged byASiT council.

asiT educationASiT aims to provide high-quality,affordable educational opportunitiesfor our members. By securing industrysupport and volunteer faculty, we providecourses to our members either free ofcharge or, when necessary, for a nominalfee to help cover some costs.within thelast 3 years,ASiT has directly organised34 courses and additionally securedsignificant discounts and free places forour members on many more coursesrun by third-party providers.ASiT alsoplans to expand its portfolio of coursesin 2013, including microsurgery coursesin Amsterdam, a local flap reconstructioncourse, an ultrasound course for surgeonsin training and operative skills courses inneurosurgery, cardiac surgery and ENT.

ASiT is also undertaking a new ventureto support surgical trainees through apeer-to-peer national mentoring scheme.we believe that mentoring has a valuablerole to play in enabling trainees to achievetheir maximum potential, while developingleadership and interpersonal skills.we arecurrently running a survey on mentoringto understand what surgical trainees wantfrom a national mentoring programme.From the preliminary survey data (n=500),48% of surgical trainees did not have amentor, 47% acted as mentors and 83%wanted some formal mentoring training.we are developing a one-year pilot and akey component of this will involve trainingmentors in coaching and group feedbacktechniques using an accredited coach.we aim to have trained mentors locatedacross the country to act as local contactsfor the mentoring scheme and ultimatelytutor new mentoring volunteers. in thisway, we hope to create a mentorshipscheme that is robust, self-sustaining andavailable to all ASiT trainees acrossthe UK.

asiT: run by trainees for traineesThe ASiT website (www.asit.org) is ourmost important channel of communicationwith our members.within its pages canbe found information relating to all of theactivities and benefits described in thisarticle as well as details of your regionaland specialty representatives and the latestnews, events and resources for surgicaltrainees. if you have any thoughts as tohowASiT can assist surgical trainees, orif you have any concerns or issues aboutyour training, please contact your regionalrepresentative, consult our website oremail info@asit.org.You can follow us onTwitter @ASiTOfficial and also find ASiTon www.facebook.com/ASiT.org.

References1. Fitzgerald JE, Giddings CE, Khera G, Marron CD.improving the future of surgical training and education:consensus recommendations from the Association ofSurgeons in Training. Int J Surg 2012; 10: 389–92.

2. Oxtoby K. private providers: a help or hindrance totraining? BMJ Careers 4 Sept 2012 (cited Jan 2013);http://careers.bmj.com/careers/advice/view-article.html?id=20008682.

3. Harrison E, Shalhoub J.The Cost of Surgical Training:position Statement by the Association of Surgeons inTraining. London:The Association of Surgeons inTraining;2007.

4. Centre forworkforce intelligence. Shape of the medicalworkforce. Starting the debate on the future consultantworkforce. London: CFwi; 2012.

5. Hornby S,wild J, Shaloub J, et al. Shape of the medicalworkforce. Starting the debate on the future consultantworkforce.A response from ASiT. London: The Associationof Surgeons inTraining; 2012.

6. Kara N, patil pV, Shimi SM. Changes in working patternshit emergency general surgical training. Ann R Coll SurgEngl (Suppl) 2008; 90: 60–63.

7. Stephens MR, pellard S, Boyce J et al. Influence ofEwTD compliant rotas on SHO operative experience.Ann R Coll Surg Engl (Suppl) 2004; 86: 120–21.

8. Maxwell AJ, Crocker M, JonesTL et al. implementationof the EuropeanworkingTime Directive inneurosurgery reduces continuity of care and trainingopportunities. Acta Neurochir (Wien). 2010; 152:1,207–10.

9. Marron CD, Byrnes CK, Kirk SJ.An EwTD CompliantShift Rota Decreases SHOTraining Opportunities. AnnR Coll Surg Engl (Suppl) 2005; 87: 246–48.

10.Bates T, Cecil E, Greene i.The effect of the EwTD ontraining in general surgery:An analysis of electroniclogbook records. Ann R Coll Surg Engl (Suppl) 2007; 89:106–109.

11.Tait MJ, Fellows GA, pushpananthan S et al. Currentneurosurgical trainees’ perception of the EuropeanworkingTime Directive and shift work. Br J Neurosurg.2008; 22: 28–31.

12.Khan MEA, Jordan AD, StrangeT,Vig S. Response to:post-EwTR: is the UK still a centre of excellence forsurgical training? Ann R Coll Surg Engl (Suppl) 2012; 94:268–73.

13.Fitzgerald JEF, Caesar BC.The EuropeanWorkingTimeDirective:A practical review for surgical trainees. Int JSurg 2012; 10: 399–403.

14.williams N.The long and winding road to bettertraining. Ann R Coll Surg Engl (Suppl) 2012; 94: 334–35.

15.Milburn JA, Khera G, Hornby ST et al. introduction,availability and role of simulation in surgical educationand training: Review of current evidence andrecommendations from the Association of Surgeons inTraining. Int J Surg 2012; 10: 393–98.

16.GMC. Recognition and approval of trainers.www.gmc-uk.org/education/10264.asp (cited March2013).

17.Fitzgerald JEF,Wild JRL, Khera G.The Association ofSurgeons in Training Conference: Cardiff 2012. Int J Surg2012; 10: 383–88.