The National Non-deanery Training Initiative: A National Needs Assessment and Roadmap for Improving the Training of Trauma and Orthopaedic Non-deanery Trainees.

The UK trauma and orthopaedic (T&O) workforce increasingly relies on non-deanery doctors, including international medical graduates (IMGs), Specialist and Associate Specialist (SAS) doctors, and locally employed doctors, who contribute substantially to service delivery across elective and trauma care. Despite their important role, there remains no nationally standardised training pathway to support competency development and progression through the Portfolio Pathway towards specialist registration. This technical report proposes a structured, curriculum-aligned framework for non-deanery T&O registrars that integrates educational supervision, workplace-based assessments, mentorship, operative competency monitoring, portfolio development, leadership activities, and protected educational time within existing NHS infrastructure. The proposed model aims to convert routine clinical service into documented educational progression while providing a framework that may support greater consistency in training, improve educational equity, and strengthen workforce retention. Further evaluation is required to determine its impact on educational and patient outcomes. A phased implementation strategy incorporating national governance, local supervision, and quality assurance mechanisms is described. Adoption of such a framework could provide a practical and scalable solution to support consultant-level competency development and strengthen the long-term sustainability of the UK T&O workforce.