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We agree with Owais and co-workers that the introduction of the European Working Time Directive (EWTD) has had a negative impact on the surgical experience gained by SHOs. They also show that popularisation of laparoscopic appendicectomy had no negative impact on this. However, in their study, none of the laparoscopic procedures were performed by SHOs. Inevitably, if it were not for these cases, more appendicectomies would have been performed by SHOs. From their Figure 1, it is evident that since February 2004, when laparoscopic appendicectomies were increasingly performed, they have been inversely proportional to the number of appendicectomies by SHOs.
One method to ensure unbiased training opportunities is having guidelines on the number of times a procedure should be performed by trainees. As the ability to train others is a reflection of surgical proficiency, there should also be a required number of times a senior trainee has to supervise juniors performing appropriate procedures. This will free up the number of procedures available for juniors and, at the same time, senior trainees will get due credit. Since the intercollegiate surgical curriculum is used by trainees across all stages and has already got benchmarks for each level, it is an ideal platform for delivering such coherent guidelines.1