Worlds apart: training in rural South Africa.

Background: Reforms in the delivery of surgical and anaesthetic services in the UK have reduced the opportunity for trainees to acquire 'hands-on' training. These problems are seen in other European countries and in North America.

Context: Surgical and anaesthetic services within developed health care systems tend to be specialised, and are often consultant led. In rural South Africa there is a shortage of surgeons and anaesthetists to service the population, and the public health care system is vastly over-burdened. Trauma accounts for a large percentage of the surgical and anaesthetic workload.

Innovation: This report compares the anaesthetic and surgical training experience of two first-year registrars during a 6-month training period in rural South Africa and a 6-month training period in the UK.

Implications: Surgical and anaesthetic trainees from countries such as the UK can spend an out-of-programme training period in rural South Africa, thereby broadening their experience and exposure to trauma. They have the opportunity to take on a higher level of responsibility at an earlier stage of training, gaining 'hands-on' experience. Similarly, South African anaesthetic and surgical trainees can spend an out-of-programme training period in the UK, where they can learn the specialist procedures needed in their home country.