A similar framework of stages and levels is used by all the specialties. Trainees progress through the curriculum by demonstrating competence to the required standard for the stage of training. Within this framework each specialty has defined its structure and indicative length of training. Each individual specialty syllabus provides details of how the curriculum is shaped to the stages of training.

In general terms, by the end of training, surgeons have to demonstrate:

• theoretical and practical knowledge related to surgery in general and to their specialty practice
• technical and operative skills
• clinical skills and judgement
• generic professional and leadership skills
• an understanding of the values that underpin the profession of surgery and the responsibilities that come with being a member of the profession
• the special attributes needed to be a surgeon
• a commitment to their ongoing personal and professional development and practice using reflective practice and other educational processes
• an understanding and respect for the multi-professional nature of healthcare and their role in it
• an understanding of the responsibilities of being an employee in the UK and/or Republic of Ireland health systems and/or a private practitioner.

In the final stage of training, when the trainee has attained the knowledge and skills required for the essential aspects of the curriculum in their chosen specialty, there will be the opportunity to extend his/her skills and competences in one or two specific fields. The final stage of the syllabus covers the major areas of specialised practice. The syllabuses are intended to allow the future certification/CESR-CP (UK) or CSCST (Ireland) holder to develop a particular area of clinical interest and expertise prior to appointment to a consultant post. Some will require further post-certification training in order to achieve the competences necessary for some of the rarer complex procedures. In some specialties, interface posts provide this training in complex areas pre-certification.

Acting up as a consultant (AUC)

'Acting up' under supervision provides final year trainees with experience to help them make the transition from trainee to consultant. A period of acting up offers trainees an opportunity to get a feel for the consultant role while still being under a level of supervision.

The post must be defined as acting up for an absent consultant, and cannot be used to fill a new locum consultant post or to fill service needs.

The trainee acting up will be carrying out a consultant’s tasks but with the understanding that they will have a named supervisor at the hosting hospital and that the designated supervisor will always be available for support, including out of hours or during on-call work.

Specialty Advisory Committee (SAC) support is required and must be sought prospectively through an application to the JCST. Further GMC prospective approval is not required unless the acting up post is outside the home Deanery/Local Offices. If accepted, the AUC will be able to count towards certification/CESR-CP (UK) or CSCST (Ireland). Trainees will need to follow the guidance on acting up as a consultant which can be found on the JCST website.