higher surgical training A structured, formalised 6-year period of training, which follows 4 years of related general medicine (in A&E and ITU/ICU), including two and a half to three years of basic surgical training. The first 3 years of higher surgical training are often taken in district general hospitals where trainees gain a wide spectrum of experience covering a number of the different sub-specialty disciplines, including breast, endocrine, vascular, upper GI (stomach, small bowel, liver and pancreas), or lower GI (large bowel, cancer, inflammatory bowel disease and the rectum and anus) surgery. One of the 6 years is designated for research which may have already been fulfilled before gaining a national training number. The final two years of higher surgical training are usually spent in the sub-specialty of the trainee’s choice. During the final year, the trainee takes the intercollegiate specialty examination. The trainee can choose whether he or she is examined in his or her nominated sub-specialty or in the generality of, for example, general surgery. Surgical trainees can take higher surgical training in neurosurgery, cardiac surgery, ear, nose and throat (ENT), trauma and orthopaedics, paediatric surgery, urology, or oral and maxillofacial surgery.