Updates to the General Surgery Curriculum

The General Medical Council (GMC) has approved the updated General Surgery Curriculum, introducing several important changes to the Phase 3 competencies for breast surgery declared trainees. 
These revisions are the result of the extensive work undertaken by the Mammary Fold, with the support of the Association of Breast Surgery (ABS), informed by a comprehensive review of breast surgery trainees' experiences, challenges, and training needs across the UK and Ireland. The full curriculum, together with the Summary of Changes and Change Mapping Proforma, can be accessed via the ISCP website.

The most significant changes for breast surgery trainees relate to the indicative operative numbers required for Certificate of Completion of Training (CCT) sign-off. These have been revised to better reflect current training opportunities and contemporary practice:

• Implant-based breast reconstruction: reduced from 40 to 30 indicative cases.
• Local perforator flap: reduced from 25 to 15 indicative cases.

In addition to the important syllabus revisions that reflect contemporary surgical practice, as outlined in the Summary of changes and Change mapping proforma, the updated curriculum introduces new introductory generic content (Section 3.5.1) on Genomics, Clinical Informatics, and Sustainability. These emerging areas are increasingly relevant to surgical practice and are intended to support adaptability, innovation, and continued professional development. As access to training in these areas varies across the UK and Ireland, they are not yet fully embedded into the syllabus but engagement is encouraged. However, we do not expect trainees to produce comprehensive portfolio evidence in these domains at this stage.

While these changes represent significant progress, we recognise that there is still considerable work to do to ensure equitable access to high-quality training opportunities across all regions and to support trainers in delivering robust breast surgery training programmes. 
We hope these revisions mark an important step towards a more balanced and sustainable training programme, reinforcing the principle that excellence in surgical training should be measured by the quality and breadth of learning experiences.  

The Mammary Fold and ABS would like to thank everyone who contributed to this work, particularly the many trainees and trainers whose feedback helped shape these changes. We all remain committed to continuing this work to improve breast surgical training for future generations.