Canadian Surgery Measured by British Standards

From a visit to 10 centres in England, Scotland and Ireland, the author assesses Canadian surgery by British Standards. Canadian manpower and British manpower in general surgery are similar in number when British registrars are included. However, in Britain, manpower is distributed uniformly as hospital-based firms, vertically structured from houseman to registrar to consultant. Apart from teaching centres, the structure in Canada is horizontal. Most general surgeons are not hospital-based. They work independently and have no help from interns or residents. Canadian training is of short duration, highly co-ordinated and noncompetitive, and learning is focused to a large extent by a tough final examination. In contrast British training is long, not co-ordinated, competitive, and learning is focused by clinical experience and research as there is no final examination. Research in general surgery in Canada seems to be more difficult to generate and support than in Britain. Factors that stimulate research in Britain and do not exist in Canada are the professorial unit concept, the longer training and competition for positions, and possibly greater funding by government and private industry