Health Education England, Local Education and Training Boards (LETBs) and reform of healthcare education: implications for surgical training

Abstract

BackgroundNational Health Service (NHS) reforms have changed the structure of postgraduate healthcare education and training. With a Government mandate that promotes multi-professional education and training aligned with policy driven initiatives, this article highlights concerns over the impact that these changes may have on surgical training.DiscussionThe creation of Health Education England (HEE) and its local education and training boards (LETBs), which are dominated by NHS healthcare providers, should result in greater accountability of employers in workforce planning, enhanced local responsibility and increased transparency of funding allocation. However, these changes may also create a potential poacher-turned-gamekeeper role of employers, who now have responsibility for junior doctors’ training. Analysis of LETB membership reveals a dearth of representation of surgeons, who comprise only 2% of board members, with the input of trainees also seemingly overlooked. A lack of engagement with the LETBs by the independent sector is a concern with increasing numbers of training opportunities potentially being lost as a result.The new system also needs to recognise the specific training needs required by the craft specialties given the demands of technical skill acquisition, in particular regarding the provision of simulation training facilities and trainer recognition. However, training budget cuts may result in a disproportionate reduction of funding for surgical training. Surgical training posts will also be endangered, opportunities for out-of-programme experience and research may also decline and further costs are likely to be passed onto the trainee.SummaryAlthough there are several facets to the recent reforms of the healthcare education and training system that have potential to improve surgical training, concerns need to be addressed. Engagement from the independent sector and further clarification on how the LETBs will be aligned with commissioning services are also required. Surgical training is in danger of taking a back seat to Government mandated priorities. Representation of trainees and surgeons on LETB committees is essential to ensure a surgical viewpoint so that the training needs of the future consultant workforce meet the demands of a 21st century health service.

A Multispecialty Evaluation of Thiel Cadavers for Surgical Training

“…Simulation has been a part of healthcare education for the past 50 years [ 1 ]. A significant amount of research demonstrates its value in surgical training [ 2 , 3 ] and health authorities have identified simulation as a medium to improve patient safety [ 1 , 4 ].…”

Perceptions About the Present and Future of Surgical Simulation: A National Study of Mixed Qualitative and Quantitative Methodology

“…10 The recent National Health Service (NHS) restructuring has brought significant change to health care education, 11 which some authors consider to have potentially imposed additional challenges to the funding of postgraduate education and surgical training. 12 In addition, the rather poor representation of surgeons in relatively recently formed Local Education and Training Boards (LETBs) and the (thought to be) reduced trainees' input, raises concerns about the future of surgical education. 12 These changes are expected to have direct implications on the implementation of simulation in surgical training.…”

“…12 In addition, the rather poor representation of surgeons in relatively recently formed Local Education and Training Boards (LETBs) and the (thought to be) reduced trainees' input, raises concerns about the future of surgical education. 12 These changes are expected to have direct implications on the implementation of simulation in surgical training.…”

ABC of Surgical Teaching: Time to Consider a Global Blueprint for Holistic Education

“…Using the UK National Health Services (NHS) as an example, healthcare reforms aimed at improving healthcare provision have created concerns over fewer training opportunities in surgery [6]. Particularly when service provision formulates a large portion of surgical training, increasing demands on trainees often mean nurturing of skills become more difficult, with a greater reliance on extracurricular study, e-learning or external courses to support application and progression.…”