Surgery in London and the Royal College of Surgeons of England: Opportunities and Pitfalls (EPUB)

The Evolution of Surgical Training and Practice: London and the Royal College of Surgeons of England

Introspective Outlook at Historical Developments

In the realm of medicine, the post-World War II era heralded a profound transformation, characterized by remarkable advancements in medical sciences, engineering, high technology, and surgical techniques. These innovations broadened the horizons of surgical treatment, offering hope to patients facing a wider range of medical conditions.

London, an epicenter of medical education and research, witnessed a disproportionate concentration of teaching hospitals, medical schools, specialist hospitals, and research institutes. The city became a crucible for innovation in surgical practice, but also a stage for ongoing debates about the optimal organization of care for increasingly complex patients.

The Royal Commission on Medical Education (the Todd Report in 1968) and the Flowers Report in 1980 advocated major reforms in undergraduate and postgraduate medical education. These reports recognized the need for a harmonized approach to specialist training in line with EU directives, a change that culminated in a revolution in surgical training and practice.

The Royal College of Surgeons and Its Troubled Legacy

Throughout history, the relationship between the Royal College of Surgeons of England and its diplomates has been marked by both collaboration and contention. While the college has played a pivotal role in advancing surgical knowledge and setting standards for practice, it has also faced criticism for perceived exclusionary policies and a slow response to societal changes.

Diversity and Inclusion: A Call to Reckoning

In 2020, Professor Neil Mortensen, President of the Royal College of Surgeons of England, commissioned Baroness Helena Kennedy, QC, to conduct a comprehensive review of diversity and inclusion within the college and the profession. The resulting report, published in 2021, painted a stark picture of systemic sexism, racism, and homophobia.

The college has responded with an ambitious Diversity, Equity, and Inclusion (DEI) Action Plan, acknowledging the need for fundamental change. This plan represents an opportunity for the college to align itself with the values of a society that demands equal opportunities and representation for all.

Historical Context: 700 Years of Surgical Evolution

To fully understand the present state of surgical training and practice, it is essential to delve into the historical context that has shaped its evolution. This mini-monograph provides a comprehensive overview of more than 700 years of recorded surgical history, tracing the milestones, controversies, and innovations that have brought us to where we are today.

Current Controversies and Future Directions

The ongoing debate about the optimal organization of operative and postoperative care for elderly and comorbid patients underscores the complexity of modern surgical practice. As the population ages and the prevalence of chronic conditions increases, the need for tailored approaches to surgical care becomes paramount.

Furthermore, the issue of diversity and inclusion remains a pressing concern for the surgical profession. The college’s DEI Action Plan sets a clear path forward, but it will require sustained commitment and a willingness to address unconscious biases and institutional barriers.

Conclusion

The evolution of surgical training and practice in London and the role of the Royal College of Surgeons of England have been intertwined for centuries. By examining the historical foundations, addressing ongoing controversies, and embracing the imperative for diversity and inclusion, the college can continue to play a vital role in shaping the future of surgery and ensuring equitable access to high-quality care for all patients.