General Surgery 

Specialty Champions

2024-2025: Aaliyah Qadir & Cara Pirie

2025-2026: x

An Introduction to General Surgery

General surgery is a versatile and dynamic specialty that focuses on the diagnosis, treatment and management of a broad range of conditions. It includes surgical care for the gastrointestinal tract, breast, and endocrine systems, as well as oncological surgery, transplantation, and general pediatric cases.

 As one of the largest surgical specialties in the UK, general surgeons are vital in emergency departments, providing emergency surgical care when needed. They also play a key role in rural and remote areas, where their broad skill set is essential to address diverse patient needs when access to specialists may be limited.

 General surgeons are often the first responders to emergencies like acute appendicitis, trauma, and bowel obstructions. In addition to handling these urgent cases, they perform elective procedures such as hernia repairs and gallbladder surgeries. The specialty demands a mix of technical skills, strong clinical reasoning, and adaptability to manage a wide variety of patients effectively.

What are some of the sub-specialties of General Surgery?

• Upper and Lower Gastrointestinal Surgery

• Colorectal Surgery

• Hepatopancreatobiliary (HPB) Surgery

• Trauma and Emergency Surgery

• Transplant Surgery – Kidney, Liver and Pancreas

• Endocrine Surgery

• Breast Surgery

• Vascular Surgery

What are some of the common conditions seen and procedures performed in General Surgery?

Common Conditions

• Appendicitis

• Acute cholecystitis

• Hernias (Umbilical, inguinal, femoral)

• Malignancy (e.g., Oesophageal, stomach, colorectal cancers)

• Acute Pancreatitis

• Diverticulitis

Common Procedures

• Laparoscopic appendectomy

• Cholecystectomy

• Hernia repairs

• Bowel resections

• Endoscopic procedures (e.g., gastroscopy, colonoscopy)

Why General Surgery?

Benefits:

• Wide variety of clinical presentations and surgical procedures

• Opportunity to make an impact on patient outcomes

• Availability of subspecialty pathways to suit diverse interests

• Mix of elective and emergency cases

 Drawbacks:

• Competitive training pathway with intense workloads. In 2024, the competition ratios for surgical training were 5.25 for core surgical training (CT1) followed by 3.76 for general surgical training (ST3)

• Physically and mentally demanding

• On-call commitments can affect work-life balance

What is the training pathway?

• Like most surgical specialties, general surgery is generally NOT a run-through program. A run-through program for general surgery was piloted in England, Scotland and Wales, referred to as The Improving Surgical Training (IST). However, as of 2022, Health Education England has paused the IST pilot in England. The IST program continues to operate in Wales and Scotland, where run-through surgical training posts for general surgery are still available.

• The CST pathway involves applicants first applying for core surgical training, then general surgical training once completed.

• To apply for CST:

  • Applicants must meet the eligibility criteria - https://www.rcseng.ac.uk/careers-in-surgery/careers-support/what-is-surgery-like-as-a-career/entry-requirements-and-training/

  • Take the Multi-Specialty Recruitment Assessment (MSRA) which will be used to shortlist applicants for interview - https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/multi-specialty-recruitment-assessment-msra/taking-the-msra/overview-of-the-msra

  • Complete a portfolio which will be assessed during interview - https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/surgery/core-surgery/core-surgical-training-self-assessment-scoring-guidance-for-candidates

 Core Surgical Training (CT1 – CT2)

• Core training lasts for two years and provides broad exposure to different surgical specialties, allowing trainees to develop foundational surgical skills.

• During this phase, trainees must pass the MRCS (Membership of the Royal College of Surgeons) exams

 Specialty Training (ST3 – ST8)

• Upon completing core training, trainees apply for specialty training posts in General Surgery.

• Specialty training typically lasts six

• Trainees must pass the FRCS (Fellowship of the Royal College of Surgeons) exams, a rigorous assessment of their readiness for independent practice

Consultancy and Fellowships

• After completing specialty training and obtaining the FRCS, trainees can apply for consultant posts in General Surgery

• Many general surgeons pursue additional training in areas of interest

 Other Opportunities

• SAS Grade Positions: Some surgeons may choose to work as Specialty and Associate Specialist (SAS) grade doctors instead of pursuing consultancy.

• Locum Opportunities: Trainees may undertake locum posts within surgical specialties after CT2 or during training transitions.

Essential Learning

• Key aspects of the MLA content map which relate to general surgery – there may be overlap with other surgical specialties

MLA Presentations

• Abdominal distention

• Abdominal mass

• Acute abdominal pain

• Acute and chronic pain management

• Ascites

• Bleeding from lower GI tract

• Bleeding from upper GI tract

• Breast lump

• Breast tenderness/pain

• Change in bowel habit

• Change in stool colour

• Chronic abdominal pain

• Constipation

• Decreased appetite

• Diarrhoea

• Fatigue

• Fever

• Jaundice

• Lump in groin

• Massive haemorrhage

• Melaena

• Nausea

• Perianal symptoms

• Post-surgical care and complications

• Pruritus

• Rectal prolapse

• Swallowing problems

• Trauma

• Vomiting

• Weight Loss

Possible OSCE Stations Related to General Surgery

• Altered bowel habit history - Patient with a history of rectal bleeding

• Thyroid history

• Breast lump history

• Abdominal examination

• Breast examination

• Thyroid examination

• Hernia examination

• Abdominal X-ray - Interpretation, diagnosis and management

• Suturing

Recommended resources for students relevant to General Surgery

• Textbooks:

  • Essential Surgery: problems, diagnosis and management

  • McLeod’s Clinical Examination

  • Moore’s Clinical Anatomy

• Websites:

  • Zero to Finals

  • Teach Me Surgery

  • Geeky Medics

  • OSCE Stop

  • BMJ Best Practice

Relevant Professional Organisations and Academic Literature

Relevant Organisations

• Royal College of Surgeons of England/Edinburgh/Ireland

• Association of Surgeons in Training (ASiT)

• Surgical Specialty Associations – e.g., Association of Upper GI Surgeons (AUGIS)

 Journals

• British Journal of Surgery (BJS)

• Journal of the American College of Surgeons (JACS)

• The Lancet

• https://www.rcseng.ac.uk/library-and-publications/library/guide-to-services/online-journals/

 Examples of Literature

• Heywood, N. et al. (2021) The laparoscopy in emergency general surgery (LEGS) study: A questionnaire survey of UK practice, Annals of the Royal College of Surgeons of England.

•  Morris, M.X. et al. (2024) Current and future applications of Artificial Intelligence in surgery: Implications for clinical practice and research, Frontiers in surgery.

•  Please, H. et al. (2024) Virtual Reality Technology for Surgical Learning: Qualitative outcomes of the first virtual reality training course for emergency and essential surgery delivered by a UK–uganda partnership, BMJ Open Quality.

Signposting for Opportunities Relevant to General Surgery

Conferences

• SCRUBS Surgical Conference

• ASiT

• Association of Surgeons of Great Britain and Ireland Annual Congress

• Other general surgery conferences can be found at: https://www.yorksandhumberdeanery.nhs.uk/surgery/general_surgery/trainee_area/courses_and_conferences

 Competitions

• ASiT – ‘Medical Student Prize session’

• Annual Association of Surgeons of Great Britain and Ireland Annual Congress Undergraduate Essay Prize Competition

• National Intercollegiate Surgical Skills Competition

 QUB Final Year Prizes

• Sinclair Medal

• O'Connell Prize

 Grants and Funding

• Magrath Clinical Scholarships

 Relevant QUB SSCs

• Year 3

  • Neuroendocrine tumours

  • POCUS (Point of Care Ultrasound)

Relevant Intercalation Opportunities

• MSc Clinical Anatomy – QUB, University of Edinburgh, University of Birmingham, Hull York Medical School

• MSc Laparoscopic Surgery and Surgical Skills - Barts and The London School of Medicine and Dentistry

Elective Opportunities

• General surgery electives are available for application in NI – relevant application forms/details are available on individual trust websites

• It is also possible to plan a general surgery elective abroad

  • For countries like Australia, Canada and the United States, electives are available through other universities or may be possible to plan through a contact

  • Electives can also be planned via. Organisations with a focus on surgery – However, it may not always be possible to solely focus on general surgery, some electives may include 2 or more surgical specialties

Past Summer Studentships

• The Patrick G Johnston Centre for Cancer Research (PGJCCR) have previously offered studentships in Gastro-intestinal cancers

• Wellcome-Wolfson Institute for Experimental Medicine:

  • Identifying the mechanisms of Gremlin1 signalling in colorectal cancer

• Centre for Public Health

  • Using early Health Technology Assessment to assess the potential value of an innovative diagnostic test for pancreatic cancer