Transition from surgical trainee to consultant practice: a scoping review of non-clinical deficiencies in higher surgical training

Background

The transition from higher surgical training to consultant practice involves significant non-clinical challenges that can contribute to burnout and compromise patient safety. Despite these recognized issues, comprehensive understanding of non-clinical deficiencies in surgical training remains limited. This scoping review systematically examines the research landscape to identify specific non-clinical gaps, evaluate existing interventions, and inform evidence-based solutions for supporting surgical trainees’ transition to consultant practice.

Methods

Following PRISMA-P guidelines, we searched MEDLINE, HMIC, PubMed, and Google Scholar through May 2024. From 527 initially identified studies, 56 met inclusion criteria focusing on trainee-to-consultant transitions. Due to limited surgery-specific research, the scope was expanded to include medical specialties while maintaining focus on non-clinical competencies.

Results

Research was predominantly medical-focused (42/56 studies) with only 9 surgery-specific studies, revealing a critical evidence gap. Most studies employed qualitative methodologies (33/56), particularly narrative approaches and semi-structured interviews. Three key non-clinical deficiencies emerged across all specialties: management skills (29 studies), leadership capabilities (27 studies), and supervision/training competencies (20 studies). Surgery-specific gaps included financial management, medicolegal knowledge, and business planning. Only 11 interventions were identified, with merely 3 targeting surgical trainees—predominantly short-course formats (1–4 days) with limited long-term evaluation. The majority assessed impact only through pre-/post-course questionnaires, with just 6 studies examining sustained outcomes.

Conclusion

This review exposes a significant research deficit in surgical transition studies compared to medicine, hindering development of targeted interventions. The predominance of generic, short-term solutions inadequately addresses surgery-specific challenges such as high-stakes decision-making, complex procedural management, and multidisciplinary team leadership. Current evidence suggests that management, leadership, and supervision represent universal training gaps, but surgery-specific deficiencies remain poorly characterized. There is urgent need for mixed-methods research to comprehensively understand surgical transition challenges and develop specialty-specific, longitudinally-evaluated interventions. Addressing these gaps is essential for improving new consultant preparedness, reducing burnout, and enhancing patient safety in surgical services.