Original Research

Remote and rural surgery training and recruitment: a national attitudinal survey of Scottish surgical trainees


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Stuart J Fergusson1
BSc (Med Sci), MBChB, ChM, FRCS, DRCOG, PGCAP, FHEA, Rural Surgical Fellow *

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Ella Teasdale2
BSc, MBChB, MRCS, Specialist Registrar in General Surgery


1 Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN, UK

2 Department of General Surgery, Royal United Hospital, Bath, UK

ACCEPTED: 27 April 2022

early abstract:

Introduction: Scotland’s healthcare system includes six Rural General Hospitals (RGHs) which provide a full surgical service to the most remote and rural populations. Constraints of geography, finance and population need means that local delivery of surgical services will be required for the foreseeable future. These RGHs face difficulties in recruiting suitably trained general surgeons. We aimed to describe Scottish surgical trainees’ attitudes towards training and working in remote and rural surgery, perceived barriers to recruitment and potential solutions.
Methods: A survey was distributed in paper and electronic forms to all Scottish trainees in core surgery (early stage trainees) and general surgery (later stage trainees). The survey collected data describing demographics, life and career experiences, and attitudes towards training in remote and rural environments. Univariate and multivariate analysis of influences on interest in rural training and recruitment was carried out, and thematic analysis of free text responses.
Results: There were 152 respondents (response rate 59%). Most (81%) felt that surgical training should be offered in rural environments and 43% were personally interested in some rural training.  On multivariate analysis, interest in rural training was associated with being a core trainee (odds ratio (OR) 7.54, 95% confidence interval (CI) 2.79-22.76), and rural work experience following graduation (OR 5.12, 95% CI 1.85-15.39). Respondents stating that they were likely to work in a rural environment (9.2%), were more likely on multivariate analysis to be core trainees (OR 5.70, 95% CI 1.37-28.99) and have previously lived in a rural location (OR 5.49, 95% CI 1.33-25.93). When trainees were asked for their views on how RGH jobs could be made more attractive, themes identified were as follows: increasing and improving training opportunities in RGHs; increasing the breadth of surgical training; optimising links with referral centres; improving pay and conditions.
Conclusions: This is the first study in a UK setting which has described the views of surgical trainees towards training and working in rural environments. There is substantial support and interest for rural surgical training amongst Scottish surgical trainees.  A minority are interested in a rural surgical career, with interest more likely in core trainees and in those who have lived rurally.  Increasing surgical training opportunities in rural environments and maximising medical school intake from rural areas may be important in addressing recruitment concerns.