The surgeon of today is witness to unprecedented change in the delivery of healthcare. Our populations are ageing and the available options for treatment are expanding. Surgeons are becoming increasingly specialist and patients in hospital are sicker than ever before. Pressures on trainees include a shorter working week and there is an emphasis on operating theatre efficiency, which reduces opportunity for supervised trainee operating. Add to this the increasing scrutiny of an individual surgeon's outcomes that can act to limit a trainee's exposure to operative experience. Traditional team structures of surgical firms and the apprentice-style training have been consigned to history.

Over recent years, the examination process in surgery has also changed and the Intercollegiate Surgical Curriculum Project now emphasizes the different domains of surgical practice, based on the Can-MEDS framework and underpinned by the principles of Good Medical Practice. As well as becoming a surgical expert, with the appropriate knowledge, clinical skills, technical skills and professional attitudes, a surgeon must develop skills as a Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. These are admirable goals and the examination system is indeed evolving to assess the full range of these qualities.

This new edition of Fundamentals of Surgical Practice is aimed at the surgeon in training preparing for the Intercollegiate MRCS Examination. The book follows the syllabus for the examination, which has been agreed by, and is common to, the Surgical Royal Colleges of Great Britain and Ireland.