Another year and another outcome 51 in my ARCP2 to crown one of my hardest but also fulfilling years as a Surgical Trainee. My transition into becoming a Vascular Registrar was as equally humbling as it was exciting. This post highlights my key experiences and takeaways:
1. Did I choose the Right Specialty?
- This year reinforced my decision to pursue vascular surgery. Despite the challenges, I really enjoyed my time in vascular surgery.
- My weekly rota involved: outpatient clinic, angio/ endovascular list, elective theatre, EVAR3, veins list, renal access list, MDT, Ultrasound and SPA4.
- I am also a tech guy and vascular surgery if full of new tech. I enjoyed going on courses and conferences and learning all the cutting-edge tech and procedures in vascular surgery.
- The reassurance of “I picked the right field” was a major source of motivation.
2. Transition Challenges
- New environments: NHS training can be exhausting, it involves moving to new hospital every 6-12 months or to a new city entirely. I moved to Cardiff this year, and had to learn a working in a different hospital systems with new people. This somehow proved harder than expected. Even small things like finding theatre lockers, a private toilet, or a quiet spot for reading was not easy.
- Additionally, Vascular in the NHS is organised in a hub-spoke manner, meaning you have one central hospital that does the major operating but your service covers all hospitals in the surrounding region. This meant I had to travel to a different hospital ever so often to run a clinic or perform day case procedures. Not to mention learn to pronounce Welsh names like Llanelli, Bronglais, and Glangwili.
- Loss of confidence: Coming from General Surgery, where I felt relatively capable and confident, to being “the new Vascular ST4” with no prior Vascular surgery experience was humbling.
- Electronic systems: Adjusting to unfamiliar software systems just added another layer of complexity.
3. Learning Curve in Vascular Surgery
- The shift from general surgery to vascular felt like “starting over”—especially in endovascular techniques.
- Surgical skills: Suturing vessels felt completely different from suturing bowel. Vascular suturing is very fine and meticulous.
- Endovascular skills: Learning wires, catheters, and devices was one of the steepest challenges.
- Confidence: The early months were marked by feeling like an intern again, often relying on consultants, more experienced registrars, and reps for guidance.
4. The Role of General Surgery Training
- General surgery provided a strong foundation in:
- Managing acutely unwell patients.
- CCRISP5 instincts.
- Managing a team.
- Open surgical exposures, dissection planes, and NOTSS6 in the operating theatre.
- On the other hand, laparoscopic skills had little carry-over into vascular practice.
5. Building Relationships
- Earning trust from new colleagues and theatre staff was essential.
- Senior registrars, nurses, and company reps proved invaluable for practical guidance and learning.
- Reps, in particular, played a surprisingly big role in teaching about devices and sizing strategies.
6. Work-Life Balance & Call
- My year was split into General surgery on-calls every 2 weeks with day-time regular vascular rota in-between, and a vascular 5-day on-call week every 6 weeks. I felt like I was on-call all the time.
- However, when I was off my on-call and on regular vascular surgery duties, it was wonderful. The operating is fine and meticulous, how can anyone not love it?
7. Emotional & Personal Adjustments
- Moving to the UK for me meant leaving behind support systems, long-time friends, and family. The transition brought loneliness and, at times, anxiety.
- Moving around different cities and hospitals within the UK doesn’t help you build any long-lasting relationships either. I was moving to my 3rd city in 2 years.
- Additionally, as surgeons we like to be perfectionists and often don’t extend ourselves much grace. This ends up placing undue pressure and stress, making the learning curve feel heavier than it needs to be.
- Rebuilding identity outside of the hospital environment was an unexpected but important process.
8. Growth & Small Wins
- Through the year I recognised my growth and improvement.
- These improvements, even though small, improve your confidence and slowly you are trusted with more autonomy.
- You can gain a lot of improvement in the span of 1 year.
9. Looking Ahead
- I aspire to gain greater autonomy and confidence as I continue to my ST5 year.
- I hope to emulate the senior registrars, who seem far more polished and comfortable.
10. Advice for new Registrars
- Embrace discomfort—you will feel like an intern again, and that’s normal.
- Build strong relationships with the consultants, other clinical staff, juniors, and reps.
- Take advantage of your general surgery experience, operate as much as you can, and preserve those skills.
- Use resources wisely: reps, senior registrars, and consultants can accelerate your learning.
- Attend courses and conferences, ask all the dumb questions, and be vulnerable enough to learn.
- Above all: don’t stress too much, remember that all your trainers wants you to succeed.
This reflection from my first year as a Vascular Registrar highlighted just how demanding surgery is both technically, emotionally, and personally; but also deeply rewarding. The growth is undeniable, even if at times it feels slow. Trust the process, be patient with yourself, and give yourself grace.
Reference Key:
- Outcome 5- refers to incomplete evidence provided i.e. the trainee failed to submit the full required documentation for the review. You are given more time 2-4 weeks to provide further evidence as requested by the ARCP panel.
- ARCP- Annual Review of Competence Progression. It is a mandatory, annual assessment process for NHS/ UK doctors in postgraduate training to evaluate their progress against the standards of their training program, determine their readiness to advance to the next stage.
- EVAR- Endovascular aneurysm repair
- SPA- Supporting Professional Activities also known as EDT (Educational Development Time) – which are allocated hours within a doctor’s job plan for non-clinical responsibilities like Continuing Professional Development (CPD), teaching, audit, research, and clinical governance.
- CCRISP- Care of the Critically Ill Surgical Patient
- NOTSS- Non-Technical Skills for Surgeons