Surgical training initially began as an apprentice-style model with no specific duration of or defined career progression [
1]. The Calman training system reforms implemented in 1996 by Chief Medical Officer Sir Kenneth Calman introduced a focused training system with structured teaching, specified competencies and supervised learning as a cost-neutral initiative [
2]. As a result of these changes, the overall time spent in training, both day to day and also in cumulative years, has steadily reduced, but this has also caused a perceived reduced flexibility of career choices for the so-called pluripotent surgical trainee [
3]. These changes were focused on developing a specialist workforce leading on to ‘Specialist Registrar’ posts to replace the previous ‘Senior Registrar’. A maximum of seven years was required to progress as a consultant. However, no changes were made for the training needs of Senior House Officers (SHO) giving rise to a so-called lost tribe [
4]. In 2002, two documents entitled ‘Unfinished Business’ and ‘Choice and Opportunity’ were published with the aim of improving training requirements and progression for SHO, Non-Consultant Career grade (NCCG) and overseas doctors [
5]. In 2005, this directly led to the launch of the reform programme ‘Modernising Medical Careers’ (MMC) and ‘Medical Training Application System’ (MTAS), offering structured, yet flexible, training opportunities. However, the MMC programme seriously failed to establish a streamlined framework for speciality training and led to several corrective actions and, ultimately, the restructuring of speciality training [
6]. ‘Core Surgical training’ and ‘Speciality training’ posts were then introduced with competitive selection processes in place. Trainees received a certificate for completion of training (CCT) within surgery and entered the specialist register held by the General Medical Council (GMC). Introduction of consultant-led service and the European Working Time Directive (EWTD) resulted in 48 h of working time for trainee doctors. The 2013 ‘Shape of Training’ review [
7] further emphasised the need for a shift from service provision to structured training. In an attempt to rectify this, the latest ‘Improving Surgical Training’ (IST) pilot was designed by the Royal College of Surgeons and Health Education England (HEE) [
8]. This re-introduced the concept of ‘run-through’ specialties. The pilot aimed to redress the balance between training and service provision, particularly focusing on more in-hours training, establishing cross-specialty and cross-professional competencies, improving the role of trainers by increasing their dedicated training time, investing in focused training opportunities including simulation strategies and expanding the surgical team. In March 2020, when elective operating was largely suspended due to the COVID-19 pandemic, trainees lost a significant amount of operating experience and this has further highlighted the importance of training ‘tomorrow’s surgeons’[
9] The detailed framework for specialty training programmes has been agreed by the four UK health departments and has been published in the eighth edition of the Reference Guide for Postgraduate Foundation and Specialty Training in the UK (also known as the Gold Guide) [
10].