Training
and ‘service’ roles, and rethinking rotational models so that educational progression is balanced with trainees’ personal circumstances. Workforce planning must consider both location and service needs, with real-time evolving demand driving training supply; matching it to past allocation means we will never be able to meet this demand. On top of that, trainers need resources and stable structures to be able to deliver effective curricula, and England must cooperate with the other UK nations in order to coordinate, implement, and future-proof reforms. Inequity cannot be ignored. How can we be
sure recruiting is fair without first investigating where it has gone wrong in the past? With so many surgical trainees reporting disparities in recruitment pathways, we need independent investigations to address inequities and offer transparency around what is going wrong. Clear and honest appeal and escalation processes are fundamental to fairness, and trainees must be offered a timely route to challenge decisions and to raise concerns, not left to wait for a calendar year before they can reapply. Trainee representation within an independent body could help address concerns in real-time and provide oversight. A key factor to consider in reforms is not only the impact on trainees, their health, their families, and their support networks, but also the impact on patients of the non-financial cost of surgical training. When trainees are overworked, undervalued, undertrained, stressed, unwell, and burnt out, patient safety is compromised. When exposure to operations is thwarted by bureaucracy, learning is also thwarted. When bottlenecks prevent progression, consultant shortages persist. When educators leave their roles because they are unable to feasibly find the hours to continue, knowledge dissipates. Neither surgical trainees, the NHS, nor patients can afford this cost. A sustainable workforce model is non-negotiable for all concerned, with training treated as infrastructure, not something to be aspired to. Time off must be protected, operative exposure guaranteed, and wellbeing supported for the system to work fairly. As it stands, the £334 million annual investment into surgical training is being absorbed into an unstable infrastructure. Without reform, we are at risk of producing
fewer fully trained surgeons, resulting in further destabilisation of the workforce, longer waiting lists, and an increased personal toll. This report is a warning that change is needed: we cannot continue putting these pressures onto surgical trainees and the system and expect no consequences.
When trainees are overworked, undervalued, undertrained, stressed, unwell, and burnt out, patient safety is compromised. CBS president Mark Henley says: “At CBS, we
are committed to the welfare of surgeons at every stage of their careers. The ASiT report has uncovered some shocking statistics, highlighting systemic issues that require immediate change. These challenges simply cannot be addressed through minor adjustments. Surgical training underpins the future of patient care and, at its very core, it must be structured, accountable and sustainable. Above all, the system must protect trainees as professionals in development, not treat them as expendable labour within service pressures.” In a nutshell, training must be credible,
thwarting the current steady de- professionalisation of surgical trainees. Where staggering numbers are reporting that their career progress is being stalled, to the detriment of patients, that their mental and physical wellbeing is compromised, and that they are experiencing workplace stress so high that 90% are burning out, we must finally admit that change is not only needed, but that we must start working on it imminently. Trainees are not just providers of a service;
they are training and developing professionals, and must be given the tools and experiences that allow them to develop fairly and safely.
Instead of relying on goodwill, learning opportunities must be built on processes and structured programmes that really work, and are not just copies of what used to work. The culture that trainees are experiencing and describing is restrictive, harmful, and not conducive to good learning or emotional safety. Trainees are future consultants, and to be
treated as service providers who simply fill gaps in rotas undermines morale, as well as risking reducing engagement and retention. It is abundantly clear that the workforce is not sustainable in its current form, and it must be rebuilt on the principle that trainees are learners first, service providers second. Progression should be measured on competence and growth, not endurance. CSJ
About CBS
CBS offers all its members a 24/7 counselling helpline, with qualified counsellors who can provide a pathway to structured therapy sessions. Members also have access to wellbeing and health support. Visit: https://
www.cbsgb.co.uk/
April 2026 I
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