Barriers to operative exposure in foundation training

BACKGROUND: Early exposure to the operating theatre is a key determinant of surgical career interest and technical skills development. Despite this, contemporary data describing barriers to theatre access for UK foundation doctors are limited. This study characterises perceived barriers to operative exposure within a large regional cohort. METHODS: Foundation doctors (FY1, FY2 or equivalent) across the South West of England completed a 41-item online survey following a surgical rotation (22nd July-16th August 2025). The survey included multiple-choice and Likert-scale questions assessing career intentions, operative exposure, and perceived barriers, alongside free-text questions exploring contextual factors. Quantitative data were analysed using Microsoft Excel and IBM SPSS® Statistics. Qualitative data were analysed using the constant comparative method within NVivo 15. RESULTS: A total of 296 doctors responded (20.5%). Of these, 69.3% were FY1 and 28.7% FY2; 27.4% intended to apply for core surgical training (CST). Ward workload was the most frequently cited barrier to theatre attendance (57.6%), followed by rota inflexibility or absence of protected time (25.5%) and surgical culture (7.4%). Qualitative analysis identified four overarching themes: heavy ward dependency, inflexible rota structures, competition for limited operative opportunities, and cultural pressures, including peer resentment and reluctance from theatre teams to extend operating lists. Most respondents obtained their primary theatre exposure through rostered clinical hours (68.0%), with 11.7% relying predominantly on unpaid time. Only 50% of CST-intending trainees felt on track to achieve the required 40 logged cases. CONCLUSION: Foundation doctors face substantial structural and cultural barriers to accessing the operating theatre. Mandated protected theatre time, improved ward staffing, and structured early surgical skills teaching may mitigate these constraints and support equitable preparation for CST.