A new report in the Annals of the Royal College of Surgeons of England shows how little elective outpatient experience is being gained by some surgical trainees.

During an average 25 months of orthopaedic experience, the trainees surveyed had attended an average of only 40 hours of elective clinics. Unsurprisingly, 39% now felt out of their depth.

It gets worse. Under the new model of run-through training, trainee orthopods may have only 9 months of orthopaedic experience before ST3 grade, including only 14 hours of elective outpatients. The report comments:

Many current early-years trainees find it difficult to attend clinics… We noted that one trainee attended only five elective outpatient sessions

and chillingly remarks

96% are likely to start clinic duties from the first week of the ST3 placement. Our data show that this might prove hazardous for patient care.

The report recommends that more training clinics should be introduced, with dedicated training and no service commitment. Who could disagree with that? Well, anyone concerned about the knock-on implications for outpatient productivity might want to say something. Orthopaedics already has greater 18-week pressures than any other specialty, and carving out more time for training is not going to help. So what can be done?

We already know that things are not perfect in outpatient clinics with doctor time being needlessly wasted. So while clinics are being restructured anyway to accommodate training, it would make sense to design the revised clinics to eliminate some of this waste: booking all the doctor time available, reserving the right amount of time for urgent referrals, reducing clinic over-runs, and so on.

So if you are a consultant who wants to carve out more training time in clinic, why not present managers with a package: extra training time on the one hand, but better-designed clinics that raise productivity on the other?