Sir, we write further to the paper by S. Koshal (BDJ 2012; 213: 73–76). We agree on the importance of compulsory and thorough induction training of all DF2/DF3 maxillofacial surgery trainees/SHOs. Our induction process this year involved a one-week crossover period between the previous DFY2/SHOs and the new cohort. This allowed all the on-call services to be provided safely whilst the induction went ahead and also allowed opportunities for (paid) shadowing of the on-call SHO. Based upon the guide of Bridging the gap by Stark and Mitchell, the induction comprised four full days of training incorporating generic Trust induction, and local inductions in both maxillofacial surgery and ear nose and throat. Six clinical skill stations were used covering medical scenarios, ATLS and various practical skills such as systematic examination and venous cannulation. These were combined with seminars and lectures based upon case scenarios, trauma and administration/paperwork. Again a handbook was given, covering most aspects of on-call and also outpatient work.

The original Bridging the gap training was reliant on deanery funding and also upon the trainees having time off work from their vocational training (DFY1) posts. This inevitably has proven difficult, and has been met with resistance from vocational trainers for the leave required. Hence we believe that having the induction in the first week of starting is more practicable for all involved. This creates a massive burden for those secondary care trainers involved and who are already under incredible pressures from the 'target' culture within hospitals. We continue, despite these pressures, to believe this process is vital in developing trainees who are confident and able to carry out their role safely and effectively.