Educational framework

The educational framework is built on three key foundations that are interlinked:

• Stages in the development of competent practice
• Standards in the areas of specialty-based knowledge, clinical judgement, technical and operative skills, and professional behaviour and leadership
• Framework for appraisal, feedback and assessment.

The modular surgical curriculum framework has been designed to define stages in the development of competent surgical practice, with each stage underpinned by explicit outcome standards. This provides a means of charting progress through the various stages of surgical training in the domains of specialty-based knowledge, clinical and technical skills and professional behaviour and leadership (including judgement).

Each surgical specialty has adapted this approach to reflect their training pathway. Therefore, although the educational concept is the same for all specialties the composition of the stages will differ.

UK only

The core (or initial stage for run-through training) reflects the early years of surgical training and the need for surgeons to gain competence in a range of knowledge and skills many of which will not be specialty-specific. A syllabus, which is common to all the surgical specialties (the common component of the syllabus, which is founded in the applied surgical sciences) has been written for this stage. This is supplemented by the topics from the appropriate surgical specialty syllabus as defined in each training programme (the specialty-specific component of the syllabus).

UK and Republic of Ireland

During the intermediate and final stages the scope of specialty practice increases with the expansion in case mix and case load and this is accompanied by the need for greater depth of knowledge and increasing skills and judgement. The content is therefore based on progression, increasing in both depth and complexity through to the completion of training.

Surgeons need to be able to perform in differing conditions and circumstances, respond to the unpredictable, and make decisions under pressure, frequently in the absence of all the desirable data. They use professional judgement, insight and leadership in everyday practice, working within multi-professional teams. Their conduct is guided by professional values and standards against which they are judged. These values and standards are laid down in the General Medical Council’s Good Medical Practice in the UK and the Medical Council of Ireland’s Guide to Professional Conduct and Ethics.

The Professional Behaviour and Leadership Skills syllabus is mapped to the Leadership framework as laid out by the Academy of Medical Royal Colleges and derived from Good Medical Practice. The Professional Behaviour and Leadership skills section of the syllabus is common to all surgical specialties and is based on Good Medical Practice.

The syllabus lays down the standards of specialty-based knowledge, clinical judgement, technical and operative skills and professional skills and behaviour that must be acquired at each stage in order to progress. The syllabus comprises the following components:

• A specialty overview which describes the following:
• details of the specialty as it is practised in the UK and the Republic of Ireland
• the scope of practice within the specialty
• the key topics that a trainee will cover by the end of training
• an overview of how, in general terms, training is shaped.


• Key topics that all trainees will cover by certification and will be able to manage independently, including complications. These are also referred to as essential topics.


• Index procedures that refer to some of the more commonly performed clinical interventions and operations in the specialty. They represent evidence of technical competence across the whole range of specialty procedures in supervised settings, ensuring that the required elements of specialty practice are acquired and adequately assessed. Direct Observation of Procedural Skills (DOPS) and Procedure Based Assessments (PBAs) assess trainees carrying out index procedures (whole procedures or specific sections) to evidence learning.


• The stages of training, which comprise a number of topics to be completed during a notional period of training. Within each stage there is the syllabus content which contains the specialty topics that must be covered. Each of these topics includes one or more learning objectives and the level of performance/competence to be achieved at completion in the domains of:
• specialty-based knowledge
• clinical skills and judgement
• technical and operative skills.

Standards for depth of knowledge during early years surgical training (UK only)

In the early years of training, the appropriate depth and level of knowledge required can be found in exemplar texts tabulated below. We expect trainees to gain knowledge from these texts in the context of surgical practice defined in the core surgical component of the curriculum above.

The curriculum requires a professional approach from surgical trainees who will be expected to have a deep understanding of the subjects, to the minimum standard laid out below. It is expected that trainees will read beyond the texts below and will be able to make critical use, where appropriate of original literature and peer-scrutinised review articles in the related scientific and clinical literature such that they can aspire to an excellent standard in surgical practice.

The texts are not recommended as the sole source within their subject matter and there are alternative textbooks and web information that may better suit an individual’s learning style. Over time it will be important for associated curriculum management systems to provide an expanded and critically reviewed list of supporting educational material.

In addition to these standard texts, sample MRCS MCQ examination questions are also available at www.intercollegiatemrcs.org.uk, which will demonstrate the level of knowledge required to be able to successfully pass the MRCS examination.

Standards for depth of knowledge during intermediate and final years surgical training

In the intermediate and final stages of surgical training the following methodology is used to define the relevant depth of knowledge required of the surgical trainee. Each topic within a stage has a competence level ascribed to it for knowledge ranging from 1 to 4 which indicates the depth of knowledge required:

• knows of
• knows basic concepts
• knows generally
• knows specifically and broadly.

Standards for clinical and technical skills

The practical application of knowledge is evidenced through clinical and technical skills. Each topic within a stage has a competence level ascribed to it in the areas of clinical and technical skills ranging from 1 to 4:

1. Has observed

Exit descriptor; at this level the trainee:

• has adequate knowledge of the steps through direct observation
• demonstrates that he/she can handle instruments relevant to the procedure appropriately and safely
• can perform some parts of the procedure with reasonable fluency.

2. Can do with assistance

Exit descriptor; at this level the trainee:

• knows all the steps - and the reasons that lie behind the methodology
• can carry out a straightforward procedure fluently from start to finish
• knows and demonstrates when to call for assistance/advice from the supervisor (knows personal limitations).

3. Can do whole but may need assistance

Exit descriptor; at this level the trainee:

• can adapt to well-known variations in the procedure encountered, without direct input from the trainer
• recognises and makes a correct assessment of common problems that are encountered
• is able to deal with most of the common problems
• knows and demonstrates when he/she needs help
• requires advice rather than help that requires the trainer to scrub.

4. Competent to do without assistance, including complications

Exit descriptor, at this level the trainee:

• with regard to the common clinical situations in the specialty, can deal with straightforward and difficult cases to a satisfactory level and without the requirement for external input
• is at the level at which one would expect a UK consultant surgeon to function
• is capable of supervising trainees.

The explicit standards form the basis for:

• specifying the syllabus content;
• organising workplace (on-the-job) training in terms of appropriate case mix and case load
• providing the basis for identifying relevant teaching and learning opportunities that are needed to support trainees’ development at each particular stage of progress
• informing competence-based assessment to provide evidence of what trainees know and can do.

Standards for the professional skills and leadership syllabus

The methodology used to define the standards for this component of the syllabus is through a series of descriptors that indicate the sorts of activities that trainees should be able to successfully undertake at two specific time points, namely the end of 'early years' training (i.e. entry into ST3, or ST4 in Neurosurgery) and the end of surgical training (i.e. CCT).

The framework for appraisal, feedback and assessment

The curriculum is consistent with the four Good Medical Practice domains contained in the GMC’s framework for appraisal and assessment:

• knowledge skills and performance
• safety and quality
• communication, partnership and team working
• maintaining trust.

The knowledge, skills and performance aspects are primarily found within the specialty-specific syllabus. All domains are reflected within the professional behaviour and leadership syllabus, which also reflect the Academy’s common competence and leadership competence frameworks.