Impact of reduced working time on surgical training in the United Kingdom and Ireland

Schools of Surgery, United Kingdom.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland (Impact Factor: 2.18). 12/2011; 9 Suppl 1:S6-7. DOI: 10.1016/j.surge.2010.11.020
Source: PubMed


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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    • "Without compensating for residents' working hours, a new 'resident law' cannot be stabilized soon. Besides compensating for working hours, reduced working time for surgical training in the United Kingdom and Ireland may have negative effects on the continuous observation and consistent care of surgical patients[5]. Training quality is another point to consider when residents' on-duty hours are reduced. "

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