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The article by Smith and colleagues rightly emphasises the learning curve in laparoscopic colorectal surgery. The department undertook a safe and step-wise approach to laparoscopic implementation. In this article, it took over 3 years before the consultants felt sufficiently experienced for a trainee to perform the procedure. As more departments opt for performing laparoscopic surgery, a similar process will be followed.
It must be recognised that this time period is going to have a significant impact on registrar training. It is the current group of registrars who will experience this effect, yet the expectations regarding what operations they are to perform has remained unchanged. Trainees are becoming very concerned that they will be criticised for being unable to manage bowel resections. Either, sub-specialisation needs to be properly implemented nation-wide on the on-call rota (thus reducing the number of trainees required to do extensive bowel resection) or training length is going to need to be increased. Surgical procedures are advancing, but there is fast becoming a void between trainee and consultant. The College needs to recognise this and assist the deaneries in bridging this gap.