The effect of reconfiguration

High-quality care of acute surgical patients depends on excellent clinical judgement, technical ability and experience. Clinical judgement and technical ability are developed throughout a surgeon's career by effective supervision combined with adequate operative exposure. A number of changes to working practice, such as the European Working Time Directive (EWTD) and to surgical training (eg Calman) have resulted in a significant reduction in emergency operative exposure for surgical trainees over the last ten years. The additional impact on operative exposure of recent changes in NHS structure and postgraduate training, such as the reconfiguration of emergency ser vices, independent treatment centres and Modernising Medical Careers, is unknown. The principal aims of this study were to report the volume of emergency surgery in a single centre and to evaluate the impact of reconfiguration on exposure of surgical trainees to emergency surgery.