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How to Pick a Subspecialty

The question of how to choose a subspecialty is an anxiety that has insidiously been creeping into the periphery of my consciousness over the past few months. I am now midway through my ST5 training year, and thoroughly comfortable with my identity as a surgical registrar. Unfortunately, my levels of self-regard have clearly not yet reached sufficiently lofty levels, and I am still utterly unable to imagine myself as a consultant. I am therefore at rather a loss as to how to answer my TPD’s recent enquiries as to my thoughts regarding a subspecialty, and have ignominiously left that particular e-mail unanswered for an unacceptably long time. But this is a big decision! Training feels preposterously long and arduous; but is actually only a trivial 8 years compared to potentially 30 to 40 years of sub-specialist consultant practice! Nonetheless, before the end of training, a declaration must be made as to which of the five sub-specialties is preferred; the major sub-specialties being Bre...
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When there is just too much trauma!

The hospital in which I currently work is unfortunately not a Major Trauma Centre, although the head of Emergency General Surgery tells me that the Big Wigs have aspirations to make it one in the next 10 years - so long as Neurosurgeons can be persuaded to work here. Nonetheless, in a typical on-call week you can currently only be expected to be dragged down to A&E once or twice for a trauma call and consequently trauma laparotomies are vanishingly rare! Last weekend however, my Sunday afternoon got a bit exciting! The Consultant was being supportive and hanging around unscrubbed in theatre whilst I attempted a somewhat troublesome Hartmann's for perforated diverticular disease that had been brewing on the ward for a little while before deteriorating that morning. As I was firing the Contour stapler to divide the rectum, the trauma bleep went off, so we sent the SHO off to investigate and the Consultant scrubbed in to help me. Not long afterwards, the SHO called back to excited...
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Why does it take so long to train a surgeon?

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Why does it take so long to train a surgeon? The typical trainee will not finish training until the age of 35-40 years old. I am currently 34, and still have years of moving around the region, jumping through hoops and fighting to get operating time and sign-offs to look forward to. Surgical training is not a comfortable place, and I have not met a single trainee who is content with year after year of no fixed routine, no certainty, constantly moving around, no time for friends and family, difficulties setting up a home, financial worries and concerns about the future. Furthermore, new consultants are now very much  not  expected to be the finished product, and it is anticipated that they will still be learning how to operate and function as a senior surgeon for some time after completion of training! Elsewhere in the world however, surgical training is often much quicker than our minimum of 8 years of surgical training. The Americans for example, despite all of their advanced...
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