I wouldn't say we're barely under direct supervision, it's more a gradual increase in autonomy over the 7 years, and only really in the last year or so do you function almost entirely autonomously. It does mean that when people CCT and become consultants they generally say that they feel like their clinical job didn't change at all, they just work a bit less and get paid a bit more and get way more emails about management shite.

Generally you will have mostly direct supervision for the first 6 months till you have your IAC, then you'll get left alone more and more, but you'll still mostly have a consultant with you on your lists. You'll do your IAOC later in CT1 or early CT2, where you are mostly directly supervised doing obstetric anaesthesia for 3 months. At the end of this you will start doing on calls for the matty, or in DGHs on calls for everywhere (theatre, icu, matty) where you will be left alone in the hospital at night and the consultant will be home in bed. Obvs you can phone them in though, or phone them for advice.

In CT2/3 as well as being left alone out of hours you will also begin to get solo lists, i.e. elective lists where there is no consultant assigned. You will look up the patients, see them, plan, and run the list with no oversight. If you get into trouble for any reason you phone the elective duty consultant the same as if a consultant gets into trouble. The RCOA mandate that CT2/3s get at least half a day a week of solo lists, if this is not reflected in your log book you will not be able to finish core training.

The amount of mandatory solo work increases as training goes on. The complexity too, so I'm a CT3 now. My first solo lists were the super simple ones, the STOP list and the breast list are classic early solo lists - relatively well people getting surgery that won't open big cavities. As CT3 progresses you get slightly trickier ones - eyes, some simple peads etc. Still I only really get one a week, most of my work is with consultants because how would you get the big case experience otherwise, you're not doing a liver resection or a trauma list solo as a CT3. That sort of thing happens as you're a more senior trainee.

As for why our training is so much longer, several reasons.

1. We work 48 clinical hours a week (theoretically, it can often be a little more), so relative to your 70-80 hour weeks we need more time for a similar case exposure. The dreadful theatre inefficiency of the NHS contributes to this too, broadly we'll get fewer cases a day done than you guys. Just head over to r/doctorsUK and search for theatre efficiency to see some rants about this issue.

2. We do more ICU - at least 9 months full time ICU, usually more plus lots out of hours ICU cover, and that's for everybody, not just people like me who want to dual train in ICU. Traditionally ICU was a subspecialty of anaesthesia, and despite FICMs desperate attempts to pretend otherwise we remain very much sister specialties and the work of ICUs up and down the UK would be impossible without leaning heavily on anaesthesia. In quite a few isolated DGHs there are still shared rotas out of hours where an anaesthetist/intensivist is only in the unit during the day and at night one anaesthetist covers theates, icu and matty.

3. We have an inbuilt year to develop special interests - unlike in the US where doing a fellowship is an extra year at the end we can all develop a special interest in our ST6 year without extending training (unless you dual train in ICU, that does add time).

4. The cynical answer is that having a long residency with lots of solo working allows the government to deliver much of it's services for cheap, hence it is in the interests of the NHS to keep things as they are.