General Surgery

Introduction

The HEE London training programme in General Surgery is a six year programme, leading to CCT accreditation in General Surgery and a sub-specialty of the candidate’s choice.  Currently these are in Breast, Upper GI, Colorectal, Endocrine or Transplant Surgery. The programme is led by Ms Celia Riga-Theodoreli, Head of School, and the Training Programme Directors in each of the 4 London regions.  To find out more about their roles visit the Meet the Team webpage.

By choosing London as your training region, trainees will have the opportunity to develop a broad base of specialty experience in busy urban general district hospitals as well as world-class centres of excellence in London teaching hospitals.  There are numerous fantastic training opportunities within the region delivering Breast, Upper GI, Colorectal and Transplant surgery, as well as Advanced Trauma and Endocrine surgery.

Trainees will be appointed to one London region and will rotate mainly within that region.  However, he or she can also be placed pan London, to achieve the training to enable you to become a well-rounded and confident General surgeon and an excellent specialist within your sub specialty.

Head of School

Ms Celia Theodoreli-Riga is the Head of the London Specialty School of General Surgery.

Deputy Head of School

Mr Dominic Nielsen is the Deputy Head of the London Postgraduate School of Surgery. Mr Nielsen is a consultant orthopaedic surgeon at St George’s Hospital in London. His clinical interests are foot and ankle surgery and complex lower limb trauma. He is a keen advocate of surgical education and was previously the Training Programme Director for Higher Orthopaedics in South London.

Training Programme Directors

South East London

Ms Avril Chang FRACS, FRCS

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I am a Consultant Surgeon specialising in Upper Gastrointestinal surgery (Bariatric and Minimally invasive surgery).  I was trained and educated in Melbourne, Australia and obtained my FRACS there.  I undertook advanced laparoscopic surgical training in Leeds General Infirmary and was a Senior Lecturer at Imperial College London, before being appointed to King's College Hospital London in 2006 where I have remained. 

I have had a lifelong interest in surgical training and was previously the Tutor in Minimally Invasive Surgery and the Director of the Core Laparoscopic Skills courses at the Royal College of Surgeons England.  I obtained honorary FRCS (Eng) in 2013.  I have been the Training Programme Director for General Surgery in South East London since 2013 and am currently the Chair of the pan London Specialty Training Committee.

South West London

Robert Hagger 

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I have a long association with South West London having graduated from St George’s Hospital Medical school in 1991.  I trained on the South West Thames General Surgery programme before taking up a Consultant General and Colorectal Surgery position at St George’s Hospital in 2004.  

I have a keen interest in both undergraduate and postgraduate medical education.  I am a trainer on the JAG Basic Skills in Colonoscopy Course, and Co-Director of the Care of the Critically Ill Surgical Patient course based at St George’s Hospital.

Since 2014 I have been Training Programme Director for Higher Surgical Training in South West London with Miss Stella Vig.  I thoroughly enjoy my role in guiding, advising and mentoring the surgical registrars who are in, and have been through, our region.

Curriculum

The current 2013 general surgery curriculum will be replaced by the 2021 curriculum from August 2021.  The curriculum contains the guidelines for trainees to achieve a competency and capability based CCT. All new trainees will commence on the 2021 curriculum.

Senior trainees may choose to remain on the 2013 curriculum but all trainees will transfer to the 2021 curriculum by August 2023 and all trainees will be assessed against the 2021 curriculum criteria after that date.

In the 2021 curriculum, trainees will complete training with the specialty choices of:

Emergency General Surgery with one of the subspecialty below:

  • Colorectal
  • Oesophagogastric (OG)
  • Hepatopancreaticobiliary (HPB)
  • Breast Surgery
  • Gastrointestinal (GI) with General Surgery of Childhood (GSoC)
  • Endocrine Surgery
  • Renal Transplant with Dialysis Access
  • Trauma Surgery

Or one of the Specialty interest below without EGS

  • Breast Surgery with Oncoplastic Reconstruction
  • Multiorgan Transplantation and Retrieval
  • Hepatopancreaticobiliary and liver / pancreas transplant

Training programme

London posts are organised into four geographical regions (North West, North East and Central, South West and South East).  National Training Numbers (NTNs) will be advertised specifying the regions.  Exact hospital placements and overall rotation through the programme will be confirmed with the trainee by HEE and the Training Programme Directors.

Depending on training requirements, there may be an opportunity to stay in one location for at least two years, i.e. provide ‘mini rotations’.  Trainees will be invited to give their preferences for placements at recruitment and at the annual interim review, but the Training Programme Directors will need to ensure above all, that placements meet trainees individual training needs, while at the same time maintaining overall programme balance. TPDs will have the final say in the placements, taking into account training requirements and balancing the needs of the individual as well as the group with individual preferences and circumstances.

There are many fantastic training opportunities within the region which are based in the following locations:

North West placements

TPD: Ms Katy Hogben (Breast surgeon at Charing Cross)

Trust

Hospital

Specialties

Chelsea & West NHS Foundation Trust

Chelsea & Westminster

(Teaching hospital)

Bariatric/ upper GI benign, Colorectal, General/Emergency, Endocrine.

Chelsea & West NHS Foundation Trust

West Middlesex

Breast & Colorectal/emergency

Imperial College NHS Trust

Charing Cross

(Teaching hospital)

Breast

Imperial College NHS Trust

Hammersmith

(Teaching hospital)

Transplant, HPB, Endocrine, Upper GI malignant.

Imperial College NHS Trust

St. Mary’s

(Teaching hospital)

Colorectal, Bariatric

London North West University Hospital NHS Trust

Ealing

Colorectal, UGI Benign

London North West University Hospital NHS Trust

Northwick Park

(Teaching hospital)

Breast, Emergency GI, Upper GI benign

London North West University Hospital NHS Trust

St Mark’s Hospital

(Teaching hospital)

Colorectal Specialty

Royal Free NHS Trust

Barnet Hospital

Colorectal, General/Emergency

Hillingdon Hospitals NHS Trust

Hillingdon

Colorectal, General/Emergency, Breast

Royal Marsden NHS Trust

Royal Marsden

(Teaching hospital)

HPB, Colorectal, Breast, Sarcoma, UGI Malignant

 

North East & Central placements

TPD: Mr Chetan Bhan (Colorectal Surgeon at Whittington Hospital)
Deputy TPD: Ms Jennifer Hu (Breast surgeon at Bart’s Hospital)

Trust

Hospital

Specialties

Homerton University Hospital NHS Trust

Homerton

(Teaching hospital)

Colorectal, Bariatrics, General/ Emergency

Barking, Havering and Redbridge University Hospitals NHS Trust

(BHRUH)

King George

Colorectal, Breast,

BHRUH NHS Trust

Queens

Colorectal, UGI, General

Royal Free London NHS Foundation Trust

Royal Free

(Teaching hospital)

Colorectal, HPB , Transplant

Royal Free London NHS Foundation Trust

Barnet Hospital

Colorectal, General/Emergency

North Middlesex University Hospital NHS Trust

North Middlesex Hospital

Breast, General/Emergency

Bart’s Health NHS Trust

 

St. Bartholomew’s

(Teaching hospital)

Breast

Bart’s Health NHS Trust

 

Royal London

(Teaching hospital)

Colorectal, HPB , Transplant, UGI, Trauma/Emergency

Bart’s Health NHS Trust

 

Whipps Cross

Breast, Endocrine, Colorectal, Benign UGI

Whittington Health NHS Trust

 

Whittington

Bariatrics, Colorectal

University College London Hospitals NHS Foundation Trust

 

University College

(Teaching hospital)

 

Specialist Endocrine, UGI malignant, colorectal, Bariatrics

 

South West London placements

TPD: Mr Robert Hagger (Colorectal Surgeon, St. George’s Hospital)
Deputy TPD: Ms Stella Vig (Vascular/General Surgeon, Croydon university hospital)

Trust

Hospital

Specialties

St. George’s University Hospitals NHS Foundation Trust

St. George’s Hospital

Colorectal, Bariatrics, General/Emergency, Breast

Epsom & St. Helier University Hospitals NHS Trust

Epsom & St. Helier University Hospital

Colorectal, Upper GI

Croydon Health Services NHS Trust

Croydon University Hospital

General, Upper GI , Breast, Colorectal

Kingston Hospital NHS Foundation Trust

Kingston Hospital

Colorectal, Upper GI, Emergency

The Royal Marsden Hospital NHS Foundation Trust

The Royal Marsden Hospital (Sutton)

Breast

 

South East London placements

TPD: Ms Avril Chang (Upper GI/Bariatric Surgeon, King’s College Hospital)

Trust

Hospital

Specialties

King’s College Hospitals NHS Foundation Trust

King’s College

(Teaching Hospital)

Colorectal, Bariatrics, HPB, Trauma/Emergency

King’s College Hospitals NHS Foundation Trust

Princess Royal University

Colorectal, Breast

Guy’s and St Thomas’ Hospital NHS Foundation Trust

Guy’s Hospital

(Teaching Hospital)

Upper GI , Breast, Colorectal, Transplant

Guy’s and St Thomas’ Hospital NHS Foundation Trust

St Thomas

(Teaching Hospital)

Colorectal and UGI Emergency

Lewisham and Greenwich NHS Trust

Lewisham

Upper GI/Bariatrics, Colorectal

Lewisham and Greenwich NHS Trust

Queen Elizabeth Queen Mary

Colorectal, Upper GI, General/Emergency

 

Teaching and Learning

Induction

At the beginning of the academic year, trainees are invited to attend an induction meeting over an evening.  This is a broad introduction to all aspects of your training.

All trainees will also receive inductions based at each hospital that they are placed in.

FRCS exam

Trainees will be supported to prepare and pass their Intercollegiate exams wherever they are working. You will only be signed off to do the exam when you have obtained a satisfactory outcome (Outcome 1) at ARCP to assess the completion of your ST6 year.  Hence you will usually sit the exams in your ST7 year.

In the 2021 curriculum, you will be eligible to sit exams at the satisfactory completion of Phase 2 of your training, which is equivalent to the above.

Training courses

Trainees are expected to attend a monthly regional training day, which is based in central London at Stewart House or Senate House.  This training is currently being delivered via remote learning on MS Teams.  The trainee representatives are responsible for organising the training days which are geared towards delivering the curriculum and preparation for the Intercollegiate Exams. 

In addition there is a mandatory Skills based simulation course for ST3 to ST6 based at Imperial College London.   Practical skills teaching is given by expert consultant trainers and includes an assessment of progress at the end of each module. Sub-specialty modules are available for senior trainees.

Specialty Training Board Information

The whole of London has joined to form the pan-London Surgical Training Committee.  The current Chair of the Speciality Training Committee is Ms Avril Chang.

The STC is composed of Surgical Consultant leads from each Trust, the Head of School, Healthcare Education Team administrative staff, the Training Programme Directors, the SAC liaison members for each region, and trainee representatives from each region of London.   We feel this is a responsive committee and feedback from trainees is encouraged. 

In the past, this has led to various changes, which we think has improved the standard of training. This has been welcomed by trainees and is another means of ensuring that problems and ideas for improving training are fed back to the highest levels of the Postgraduate Medical and Dental Education department at Health Education England (London).

Audit and Research

There are opportunities for out-of-programme research experience within the different London teaching hospitals with opportunities for Specialist Trainees to get involved in research. Overseas fellowships are permitted subject to authorisation from the Training Programme Director or Head of School. These fellowships may or may not be counted towards your training and require authorisation from the JCST.

Collaborative research among trainees has developed across the country as a way of running high quality research projects by collecting data from many departments across departments, regions and internationally. Participation in these projects at a data collection level is a good introduction into how to organise research project and getting names associated with the papers that come from it (all participants in the collaboratives are usually index linked to any papers that are published as a result). Taking a leadership role in one of these research projects offers the opportunity to produce papers that will count towards CCT with the support of the collaborative.

Trainee support

The transition to Higher Speciality Training can often be quite daunting. Overnight trainees change from being an experienced core trainee, competent in dealing with all aspects of surgery at this level of training to being a junior registrar. The difference between the two grades is significant and can be challenging, especially at the start. Trainees may feel that there is an expectation from some of your senior colleagues regarding your ability to perform surgical procedures. Trainees may find that decision making and leadership of the firm can be a vastly more testing experience than you have previously been exposed to. The learning curve is steep and requires hard work, but can be extremely rewarding.

Your TPD and your Educational and Clinical Supervisors are there to help you negotiate your training requirements and help you with your transition to being a Registrar.  Trainees also gain enormous support from their more senior colleagues.

To improve communication amongst trainees, there is a trainee WhatsApp group run by the trainee reps.  This has given the trainees on the rotation the ability to communicate with other trainees across the region.  Communication is key in order to share important and relevant information about training (such as teaching events, courses, conferences and research projects) as well as more logistical issues (such as finding out who is on call at a particular hospital on a certain day). Trainees have the option to be added to this once they start. This will usually be done at the Induction day or the first Regional Training Day.

Vision

The vision for the London School of Surgery is to provide the highest quality of training using the vast wealth of clinical resources across London. London has a population of almost eight million. With its rich variety of cultures, nationalities and social backgrounds, the capital offers any trainee a full and rewarding experience in emergency medicine.

The London School of Surgery also seeks to provide:

  • World class education for world-class healthcare
  • Excellence of postgraduate training and education
  • Producing clinical leaders of tomorrow

Useful Information and Links

Curriculumhttps://www.gmc-uk.org/education/standards-guidance-and-curricula/curricula/general-surgery-curriculum

ePortfolio - https://www.iscp.ac.uk/

Examshttps://www.jcie.org.uk/content/content.aspx?ID=12

JCST guidelines and checklists - https://www.jcst.org/quality-assurance/certification-guidelines-and-checklists/