The European Working Time Directive: Will Modern Surgical Training in the United Kingdom Be Sufficient?

Matthew G Wyman,Roy Huynh,Corinne Owers

doi:10.7759/cureus.21797

Abstract

PurposeThe introduction of the European Working Time Directive in 2009 limits doctors in the United Kingdom to a 48-hour working week. The reduction in surgical training time raises concern over the ability of future surgeons to deliver safe and effective care.MethodsThis interview-based qualitative study was conducted within a tertiary referral centre in the United Kingdom. Nine consultant general surgeons were interviewed with the aim of investigating how surgical trainees can comply with the European Working Time Directive whilst gaining sufficient knowledge, skill and experience to be safe surgeons.ResultsConsultants felt that the European Working Time Directive has impacted surgical training, patient care, service provision, and the professional attitudes of trainees. They felt that current surgical trainees have a relative lack of experience compared to previous generations, which has impacted their ability to manage complex patients. The consultant-trainee relationship was felt to have suffered due to shorter working hours. Furthermore, the move towards shift work has resulted in a lack of continuity of care for patients. Consultants suggested reconfiguring theatre lists to maximise opportunities for trainees. They also recommended that trainees seek out alternative learning methodologies such as simulation, and consider clinical fellowships at the completion of their training to maximise their experience and surgical skills prior to consultancy.ConclusionThis study highlights the concerns that senior surgeons working in a busy tertiary referral centre have towards the European Working Time Directive and modern surgical training. The authors recommend that both trainees and consultants have a responsibility to maximize opportunities during training, and that mentorship will need to continue at the consultant level. Further research in other centres can determine whether these sentiments are widespread, and whether institutional steps should be taken to change the way that modern surgeons are trained.

Highlights

The European Working Time Directive (EWTD) provides legislation for employers regarding minimum health and safety requirements for employee working hours, time off, breaks, and minimum rest periods
Consultants felt that the European Working Time Directive has impacted surgical training, patient care, service provision, and the professional attitudes of trainees
There is evidence that the increased frequency of handovers and staffing changes limits continuity of care, and increases the likelihood of medical errors [3]. Professional associations such as the British Medical Association (BMA), the General Medical Council (GMC), and the Association of Surgeons in Training (ASiT) have argued that modern medical and surgical trainees are exposed to fewer cases, gain less clinical knowledge, and have less ability to perform complex procedures

Summary

Introduction

The European Working Time Directive (EWTD) provides legislation for employers regarding minimum health and safety requirements for employee working hours, time off, breaks, and minimum rest periods. The EWTD was fully implemented for doctors in the United Kingdom in 2009 and mandates that junior doctors are unable to work more than a 48 hour week when averaged over a 26-week period, or a maximum of 56 hours after signing an opt-out clause [1]. It is unclear whether the strict limits stipulated by the EWTD have improved patient safety. There is evidence that the increased frequency of handovers and staffing changes limits continuity of care, and increases the likelihood of medical errors [3]. The Accreditation Council for Graduate Medical Education (ACGME) demonstrated a significant decrease in

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