8/11/2019 Less Than Full Time Training in Surgery
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TRAINEES AND STUDENTS
44 | Surgeons News | September 2014
Less Than Full-time Training (LTFT) is trainingundertaken while
working a reduced numberof hours, resulting in a relative
lengthening inthe number of years spent training. LTFT isusually no
less than 50% of full-time training, butcan be less (to a minimum
of 20% for up to 12
months) if agreed by all interested parties. To be eligiblefor
LTFT, there must be a well-found reason for not beingable to work
full time, perhaps because of disability or illhealth, or being a
carer for children or an ill or disabledpartner, relative or other
dependant, or there are uniqueopportunities for personal or
professional development.
Approval for LTFT is given by the trainees postgraduateLocal
Education and Training Board (LETB) in agreement with the local
hospital trust. Funding for LTFT postsis provided by the
postgraduate LETB (educationalcomponent of basic pay) and the local
hospital trust (on-call banding arrangement).
GROWING NEED FOR LTFTDespite increasing numbers of female
doctors in the UK 1 and female trainees applying to core surgical
trainingand higher surgical training (30% and 16%
respectively,20122 ), only 10% of consultant surgeons are women
3.
TIME FORA RETHINK
How can we make it easier to implement Less Than Full-time
Training in surgery?
RhiannonHarriesASiT
Webmaster andRepresentativefor Wales andGeneral
SurgicalRegistrar, WalesDeanery
ContributingAuthors,ASiT Council:Ciara McGoldrick
,LauraDerbyshire ,Justice Reilly and EdwardFitzgerald
8/11/2019 Less Than Full Time Training in Surgery
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THERE IS CONCERN OVER THESUPPORT GIVEN TO TRAINEES DURINGLTFT
SURGICAL POSTS, IN PROVIDINGAND MAINTAINING A BALANCED
TIMETABLE TO MEET THE NECESSARYCOMPETENCIES OF THEIR
TRAINING
It is suggested that women choose not to continue with higher
surgical training, as this is the peak age forchildrearing 2. As
the majority of females in LTFT are women returning to work after
having children, it wouldsuggest that LTFT is vital to maintaining
the inevitablyincreasing female surgical workforce 4.
CURRENT CONCERNS
The numbers of LTFT posts available in the UK arecurrently low,
with only 151 LTFT surgical trainees in 2011 5,and may become
inadequate with rising numbers of femalesurgical trainees. Concerns
have been raised over the lack ofinformation surrounding access to
LTFT posts for surgicaltrainees, as well as a significant
difference between LETBs.There is also concern over the support
given to traineesduring LTFT surgical posts, in providing and
maintaining a balanced timetable to meet the necessary competencies
oftheir training.
The current system supports three ways that LTFT can be
incorporated into the system. The trainee can be in afull-time
slot, supernumerary or slot sharing. Althoughlogistically easier
for local hospital trusts to manage, slot
sharing requires two surgical trainees to work the hours ofone
full-time trainee. From a surgical training perspective,slot
sharing has a number of problems. There may be noother trainees
eligible for LTFT within the same LETB andspecialty, making slot
sharing impossible.
There may be eligible trainees, but they have differentspecialty
or operative needs, making slot sharing unsuitable.Surgical
rotations (particularly for smaller surgicalspecialties) often
cover larger geographical areas, makingslot sharing
impractical.
It is considered unacceptable that higher surgical trainees
in LTFT should have to share operative training sessions with
another higher surgical trainee, as this has an impacton their
training experience and competencies gained.
RECOMMENDATIONSThere should be increased provision and funding
forLTFT posts in surgery, in all specialities, in all
postgraduateLETBs. Information, which is consistent throughout
theUK and Republic of Ireland, should be readily availablefor all
surgical trainees considering applying for LTFT.Individual LETBs
should outline basic information,including eligibility criteria and
the application process,as well as a point of contact for advice on
their websites.
On a practical basis, having a LTFT adviser within each
school of surgery, in addition to within each LETB, who would
have closer links with trainees and trainers on alocal level, could
ease ongoing challenges. Education andencouragement should be
provided to junior trainees andmedical students to make them aware
that LTFT can becompatible with surgical training.
The ARCP panel should support surgical trainees inLTFT and help
to meet their individual learning needs.Higher surgical trainees in
LTFT should not have toshare operative training sessions with
another highersurgical trainee.
For those undergoing LTFT training after returning to work
following childbearing, ideally the options for andavailability of
LTFT posts should be initiated by the LETB
and the training programme director with the trainee when they
inform them of their intention to take a periodof maternity leave.
The length of time required to approvea LTFT post varies between
LETBs and trainees should be made aware of this. Additionally,
training programmedirectors should be transparent with trainees at
this stage ifthere have been significant difficulties in approving
LTFTslots in the past so that modifications and alternatives can be
considered.
The Association of Surgeons in Training has produceda position
statement discussing the issues aroundprovision of LTFT within
surgical specialities, whichcan be found at www.asit.org
REFERENCES1. GMC State of
Medicine
2011.www.gmc-uk.org/State_of_medicine_Final_web.pdf_44213427.pdf
2. McNally S.Surgical training:still very
competitive, butstill very male.Bulletin of theRoyal Collegeof
Surgeons ofEngland 2012;94(2): 53 55.
3. NHS Hospitalsand CommunityHealth Services:Medical andDental
Staff,England 19972007. Leeds, UK:The informationCentre forHealth
andSocial Care.2008.
4. Jones M,MontgomeryJ & Thomas S.Flexible traininghas
matured.BMJ
2008.http://careers.bmj.com/careers/advice/view-article.html?id=3062
5. Departmentof Health.WorkforceCensus 2011.
