It is doubtful whether training programs in either Wellington or Riyadh will enable greater operative experience in the future, because the limitations identified in this study are primarily determined by the incidence of disease in the community. Whether an overseas component of training is either necessary or justified under these circumstances can be questioned. Whether the Saudi Board should accept Saudi training without an extra overseas portion, being that it is more relevant to the population served, remains to be determined. It is often argued that surgical training is for the most part based on an apprenticeship system 6 in which graded supervision, as described in this study, ensures that patients come to no harm. Consultants often allow a good and competent trainee to gain operative experience as a reward for good patient care outside of the operating room.
Training is thus in major part determined by the trainee and has to be earned.
Experience without training increases confidence but not competence. 8 Training in surgery is thus not simply a question of teaching operative techniques. Most problems with trainees occur in relation to attitudes and behavior. These problems themselves, if present, may have a major impact on the gaining of operative experience. Colorectal cancer patients, primary treatment and number of patients per year.