Abstract
Since August 2009, the National Health Service of the United Kingdom has faced the challenge of delivering training for junior doctors within a 48-hour working week, as stipulated by the European Working Time Directive and legislated in the UK by the Working Time Regulations 1998. Since that time, widespread concern has been expressed about the impact of restricted duty hours on the quality of postgraduate medical training in the UK, particularly in the “craft” specialties – that is, those disciplines in which trainees develop practical skills that are best learned through direct experience with patients. At the same time, specialist training in the UK has experienced considerable change since 2007 with the introduction of competency-based specialty curricula, workplace-based assessment, and the annual review of competency progression. The challenges presented by the reduction of duty hours include increased pressure on doctors-in-training to provide service during evening and overnight hours, reduced interaction with supervisors, and reduced opportunities for learning. This paper explores these challenges and proposes potential responses with respect to the reorganization of training and service provision.
Highlights
The European Working Time Directive (EWTD), issued in 1993 by the European Union with the intention of protecting the health and safety of workers, sets out minimum requirements in relation to work hours, rest periods, and annual leave
Since August 2009, the National Health Service of the United Kingdom has faced the challenge of delivering training for junior doctors within a 48-hour working week, as stipulated by the European Working Time Directive and legislated in the UK by the Working Time Regulations 1998
This paper explores these challenges and proposes potential responses with respect to the reorganization of training and service provision
Summary
The European Working Time Directive (EWTD), issued in 1993 by the European Union with the intention of protecting the health and safety of workers, sets out minimum requirements in relation to work hours, rest periods, and annual leave. 2. Redesigning rotas Changes to achieve EWTD compliance require more doctors per weekly rota, increasing the pressure on junior doctors to work fewer daytime hours in favour of providing coverage during overnight shifts. Redesigning rotas Changes to achieve EWTD compliance require more doctors per weekly rota, increasing the pressure on junior doctors to work fewer daytime hours in favour of providing coverage during overnight shifts This has had the effect of reducing trainer–trainee interactions, impeding continuity of care, and increasing the number of handovers required [20]. Given that the numbers of doctors-in-training is controlled and the number of hours worked is reduced, it is important that specialist capacity be expanded to manage the service, provide time for high-quality training, and potentially develop new ways to deliver care. Annual UK-wide trainee questionnaires, regular inspection visits, and monitoring of the ARCP reports and of outcomes of specialist training should provide robust information about the quality of training under the EWTD
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