Impact of reduced working time on surgical training in the United Kingdom and Ireland.
ABSTRACT The European Working Time Directive (EWTD) 48 h working week has been law in European countries since 1998. A phased approach to implementation was agreed for doctors in training, which steadily brought down working hours to 58 in 2004, 56 in 2007 and 48 in 2009. Medical trainees can "opt out" to a 54 h working week but this has to be voluntary and rotas cannot be constructed that assume an opt out is taking place. A key component of the working week arrangements is that the maximum period of work for a resident doctor without rest is 13 h. Shorter sessions of work have led to complex rotas, frequent handovers with difficulties maintaining continuity of care with implications for patient safety. Although there has been over 10 years notice of the changes to the working week and progress has up to now been reasonable (helped, in part by a steady increase in consultant numbers) this latest reduction from 56 h to 48 h seems to have been the most difficult to manage.
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ABSTRACT: Neurosurgery remains among the highest malpractice risk specialties. This study aimed to identify areas in neurosurgery associated with litigation, attendant causes and costs. Retrospective analysis was conducted of 42 closed litigation cases treated by neurosurgeons at one hospital between March 2004 and March 2013. Data included clinical event, timing and reason for claim, operative course and legal outcome. Twenty-nine claims were defended out of court and twelve were settled out of court. One case required court attendance and was defended. Of the 42 claims, 28, 13 and 1 related to spinal (0.3% of caseload), cranial (0.1% of caseload) and peripheral nerve (0.07% of caseload) surgery respectively. The most common causes of claims were faulty surgical technique (43%), delayed diagnosis/misdiagnosis (17%), lack of information (14%) and delayed treatment (12%), with a likelihood of success of 39%, 29%, 17% and 20% respectively. The highest median payouts were for claims against faulty surgical technique (£230,000) and delayed diagnosis/misdiagnosis (£212,650). The mean delay between clinical event and claim was 664 days. Spinal surgery carries the highest litigation risk versus cranial and peripheral nerve surgery. Claims are most commonly against faulty surgical technique and delayed diagnosis/misdiagnosis, which have the highest success rates and payouts. In spinal surgery, the most common cause of claims is faulty surgical technique. In cranial surgery, the most common cause is lack of information. Claims may occur years after the clinical event, necessitating thorough contemporaneous documentation for adequate future defence. We emphasise thorough patient consultation and meticulous surgical technique to minimise litigation in neurosurgical practice.Annals of The Royal College of Surgeons of England 05/2014; 96(4):266-270. DOI:10.1308/003588414X13814021679834 · 1.22 Impact Factor
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ABSTRACT: Background: There is a disproportionate number of female and male surgeons in Zimbabwe. Factors determining the post-graduate career choice of female doctors in Zimbabwe have not been documented. The main objective of this study was to determine factors deterring women in Zimbabwe from choosing surgery as a lifetime specialty of choice. Methods: A convenience sample of 161 doctors and medical students were recruited. A questionnaire covering a broad range of topics was administered and collected anonymously. Undergraduate and post-graduate enrolment figures and information on registered surgeons was obtained from the respective authorities. Results: A total of 159 questionnaires were assessable, with a slight male dominance. The majority (60%) was below the age of 30 years. The vast majority were within 5 years of graduating from Medical School. Surgery was selected as the specialty of choice by 40% of the respondents with only 25% of them being women. A female enrolment figure for the University of Zimbabwe, College of Health Sciences, was 34% in 2010, an increase from 13% in 1995. Female surgeons comprise 8% of the Surgical Society of Zimbabwe. Women selecting surgery responded that surgery was dynamic, exciting and a good challenge. However, they admitted that other women would not choose it as it was too demanding. Women choosing Surgery were consistently found to have been leaders at some point in their life. Women selecting other specialties re-iterated that their surgical rotations were too tough and iron ruled, making it an unwelcome environment for women; in addition, they sited that the lack of female role models in the department was a deterrent. Lack of time with family by being in a surgical specialty was cited by only 5% of the study population. Males choosing Surgery as a specialty, at all levels, encouraged women to join the specialty, however, they cited work disruptions when female colleagues were pregnant. Conclusion: In this qualitative study, we have found that there are fewer women choosing Surgery as a specialty. It is clear that achieving gender balance in the Department of Surgery will continue to be a challenge. This balance is further compounded by the significantly low proportion of female medical students enrolled to the UZ-CHS each year, and the lack of appropriate female role models in the Department.
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ABSTRACT: In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.Surgery 02/2015; DOI:10.1016/j.surg.2014.09.025 · 3.37 Impact Factor