SP 4.05 Is The UK Foundation Programme Adequately Preparing Future Surgeons? A Narrative Literature Review and Semantic Thematic Analysis of Surgical Exposure, Training Barriers and Opportunities for Reform
Shazia Sarela, Abeezar SarelaAbstract
Introduction
The UK Foundation Programme (UKFP) is critical in developing future surgeons, providing early exposure to surgical practice and career decision-making. Rising competition for surgical training and attrition raise concerns about surgical preparation. This review examines the UKFP’s role in preparing aspiring surgeons, evaluates current training, identifies barriers, and synthesises evidence-based strategies for improvement.
Methods
A narrative literature review of national workforce data, trainee surveys and published studies of surgical training during the UKFP was conducted. A structured semantic thematic analysis focused on the importance of foundation training; current surgical exposure and skills; barriers to training; and interventions improving preparedness, progression and retention in surgery.
Results
Competition for post-foundation surgical training posts has undergone a 2.5-fold increase over the last decade. Despite 99% of FYs completing at least one surgical rotation, 73% of F1s report insufficient exposure to make informed career decisions. Operative experience is limited: only 24% attended theatre more than ten times, and fewer than 5% received regular surgical teaching. Confidence in core skills is low, with 16–33% of FYs reporting competency. Key barriers include reduced working hours, loss of firm-based mentorship, competition for theatre time, and financial constraints. Interventions improving confidence and engagement include protected theatre and clinic time, structured mentorship, mandatory surgical skills courses, and surgically themed foundation pathways.
Discussion
Current UKFP surgical exposure does not consistently equip aspiring surgeons with sufficient operative experience, skills confidence, or career clarity. Surgery-specific reforms are required to support early engagement, direct progression, and long-term retention in surgical careers.