{
  "abstract": "Objectives The study aimed to explore why trauma and orthopaedic registrars decide to discontinue surgical training. Understanding the factors that influence a decision to leave may help to inform changes which enhance the experiences of surgeons and retention of the future workforce.Design Qualitative study using semi-structured interviews.Setting Between October 2022 and March 2026, interviews were conducted with participants who had left the UK National Health Service (NHS) trauma and orthopaedic specialty training before completion. Reflexive thematic analysis was performed on 1727 min of interview data.Results 23 respondents were interviewed. Most respondents exited specialty training in the middle years (ST5 and 6). 13 retrained in the NHS and 10 left the NHS entirely. Three overarching themes were identified: (1) ‘The Hidden Curriculum’ describes the presence of unwritten rules, attributes and behaviours which must be met to succeed in training (2) ‘Flawless Care in a Flawed System’ describes surgeons’ responsibility for delivering faultless care while lacking agency to address system failures and (3) ‘Interchangeable and Underappreciated’ depicts the dissonance between trainees’ professional status and their perceptions of being interchangeable.Conclusions The loss of surgical registrars from training programmes comes at a high cost to the healthcare system and society as well as to the individual. Understanding what triggers surgeons to leave training allows consideration of how challenges can be modified to prevent further attrition and ensure sustainability of the profession.",
  "authors": [
    {
      "affiliations": [
        "Royal Devon and Exeter Hospital, Exeter, UK"
      ],
      "name": "Joanna Maggs"
    },
    {
      "affiliations": [
        "University of Warwick, Coventry, UK"
      ],
      "name": "Hannah James"
    },
    {
      "affiliations": [
        "Centre for Evidence and Implementation Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Julia Gauly"
    },
    {
      "affiliations": [
        "Northumbria NHS Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Helen Vint"
    },
    {
      "affiliations": [
        "Barts Bone and Joint Health, Barts and The London School of Medicine and Dentistry, London, UK"
      ],
      "name": "Homa Arshad"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK"
      ],
      "name": "Sarah McMahon"
    },
    {
      "affiliations": [
        "Centre for Evidence and Implementation Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Arabella Scantlebury"
    },
    {
      "affiliations": [
        "Centre for Evidence and Implementation Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Amy Grove"
    }
  ],
  "title": "Leaving orthopaedic surgical training: the LOST surgeons – a qualitative study exploring why UK trauma and orthopaedic registrars discontinue surgical training",
  "uid": "2e8129b4-fe6b-5a31-892a-bd2e6dbe980f"
}