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The survey by Mr Ray and his colleagues (June 2005 JRSM1) will be of great help to the Specialist Advisory Committee (SAC) in Otolaryngology in our deliberations on the structure of training for those entering after August 2007. Their findings tend to support decisions already taken by the SAC, which has long recognized the variation in operative experience of trainees from area to area. Regarding major tympanomastoid surgery the SAC has recommended, for accreditation, a minimum of 10 operations in a 6-year training programme, a modest number that reflects the realities of existing training. We are trying to determine reasonable minimum numbers for other areas of practice.
In moving from the apprenticeship system to a more structured and taught method, we hope to deliver a higher standard of training in the reduced total period of 6 years; a 6-year training is the clear recommendation from the SAC in Otolaryngology, with the early years spent in Basic Otolaryngology Training rather than basic surgical training, though the two will overlap. Part of the aim of these changes is to reflect current practice in the UK: those accredited in the specialty must be capable of delivering a general service including management of a wide range of emergencies. Those planning a career in the more advanced aspects of otolaryngology will undergo further training via SAC-accredited 'fellowships'. Curricula have been established for the subspecialty areas.