1.Training numbers for surgical trainees should be increased as the number of trainees has not kept up with the expansion of numbers of consultants and those choosing to work part-time or taking time out for maternity leave. This is borne out by the number of vacant posts particularly in rural areas and the dearth of applicants for consultant posts. Urgent discussions between SAC, Royal colleges, NES and SG are needed to rectify this. 2. Whilst the training needs to be city centre based for most of the training period because of the higher volume of cases, the trainers in these larger hospitals need to be aware of the general surgical needs of the populations surrounding the RGH's and the trainers should facilitate the broader training of the small minority who are considering working in an RGH, with opportunities to train in the routine procedures in urology, orthopaedics, plastic surgery, gynaecology and paediatric surgery. This would be in line with implementation of the 2013 Greenaway Report 'Shape of training - Securing the future of excellent patient care' [ https://www.gmc-uk.org/-/media/documents/shape-of-training-final-report_pdf-53977887.pdf ]and the report of the RCSEd SLWG 'Standards informing delivery of care in Rural Surgery' [ https://www.rcsed.ac.uk/media/4413/rural-surgery-report-march-2016.pdf ] 3. Credentialing of the general surgeon, by a super-specialist, to perform certain operative procedures within that specialty is essential to maintain an appropriate operative workload for the rural surgeon. This will also reduce the travelling for the patient and their family. 4. Training in routine diagnostic G-I endoscopy and some appropriate techniques in therapeutic endoscopy is essential for the rural surgeon and should be made available in JAG-accredited units during training. 5. There is genuine interest in R&R Medicine and Surgery in medical schools as evidenced by the popularity of the Rural medical Societies epitomised particularly by the Glasgow University Remote & Rural Medical Society (GURRMS) which holds an annual student medical conference in a remote setting; this is usually fully subscribed within 24 - 48 hours. A way of channeling this enthusiasm in to training the RGH Consultant needs to be found. The trainees have to select a super-specialty to continue in training, which is important that they have one main area of interest in their work but this should not be exclusive in the training of the RGH consultant, as there would not be enough specialist work in the RGH catchment area to justify such a narrow delivery of service. 6.The Rural Surgery Fellowship is essential in training the RGH consultant.
Resident Surgical , Anaesthetic and Medical Consultant staffing and training programmes for the Rural General Hospitals are crucial for the communities of Shetland, Orkney,Caithness, Western Isles, Lochaber and Argyll.
There should be exploration of distributed medical education whereby medical learners (family practice and specialty consultants) are trained in the rural and remote areas. This could include satellite campuses located in rural centres (away from the Edinburgh/Glasgow 'belt') to provide an immersive rural training experience under the guidance of experience rural physicians. Excellent models exist in Canada (e.g., Northern Ontario School of Medicine, University of British Columbia - Northern Medical Program).
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