UK surgeons report that EU directive has cut training time
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《英国医生杂志》
Surgical training in the United Kingdom and the Republic of Ireland has been adversely affected by the introduction of the European working time directive in August 2004, an online survey of trainee surgeons shows.
The survey found that nearly 90% of SHOs (senior house officers) considered that revised working patterns resulting from the directive had adversely affected their training by reducing their time in the operating theatre, contact with surgeon trainers, and/or time in outpatient clinics. The directive limits the working week for junior doctors to a maximum of 58 hours, with a reduction to 56 hours in 2007. Eighty two per cent of survey respondents said that their training time in theatre had decreased, and almost three quarters considered that direct contact time with their trainer(s) had decreased. More than half (58%) said that training time in outpatient clinics had also decreased.
The results came from a recent online survey of trainee surgeons registered with the Royal College of Surgeons, the Association of Surgeons in Training, and the British Orthopaedic Trainees Association. A total of 1323 responses were returned, although about 4000 people potentially would have had access to the survey; 577 responses came from specialist registrars, 681 from SHOs, and 65 from doctors in other categories such as clinical fellows and research fellows.
Professor John Lowry, chairman of the Royal College of Surgeons?working party on the European Working Time Directive, said: "Surgery is a craft specialty, and, while the Royal College of Surgeons supports the need for team working, the skills that ensure patient safety cannot be acquired without a long period of experience and one to one teaching from consultants."
He added: "This survey suggests that even the first stage of implementation of has reduced trainees?contact time with their trainers to a very significant degree. Training a surgeon takes time, and that time must be spent in theatre, in outpatient clinics, and on the ward."
He estimated that surgeons who trained several years ago would have typically had a total of around 32 000 hours of training before becoming a consultant but that this had now fallen to as low as 6000 hours.
Most (84%) respondents to the survey, which was conducted over a period of five weeks in December 2004 and January 2005, were working in England, with 5% in Wales, 8% in Scotland, and 3% in Ireland (including Northern Ireland).
In addition to effects on training, 58% of those taking part in the survey said that the quality of patient care had worsened as a result of the directive, with 84% judging that continuity of care had deteriorated. Paradoxically, 47% felt that their quality of life had decreased.
Before the introduction of the directive, most SHOs were either "resident on-call" (living at the hospital and potentially able to rest between periods of activity) or "non-resident on-call" (on call from home and being called to the hospital for emergencies only). The survey showed that 57% were now working shifts of up to 13 hours, followed by 11 hours?continuous rest in every 24 hour period.
Professor Lowry explained that this working pattern meant that many SHOs were largely providing service work in hospitals rather than receiving direct training. He said: "Little surgical activity takes place at night, and so SHOs working full shifts may lack training opportunities. In addition, they miss out on daytime training—when most surgery is carried out—because they have to take compensatory rest after night work. This results in them spending less time with their trainers and having less training time in theatre." The shift pattern could also be responsible for some respondents reporting a reduction in quality of life—with more junior doctors working at night on a regular basis, he suggested.
Current surgical training in the United Kingdom takes at least 12 years, on average. After medical school and one year as a preregistration house officer, a surgical trainee becomes a an SHO, receiving basic surgical training for an average of five years before becoming a specialist registrar and receiving six years of higher surgical training.
SHOs must do a minimum of two years?basic surgical training. Their working week should include two to three operating sessions, two outpatient sessions, two to three ward rounds, sessions for administration, teaching, and personal study, as well as contributing to the emergency on-call rota. They must also complete a logbook to record their clinical, surgical, and education experience, the contents of which must be authenticated regularly by the trainee抯 consultant and their overall training supervisor.(London Susan Mayor)
The survey found that nearly 90% of SHOs (senior house officers) considered that revised working patterns resulting from the directive had adversely affected their training by reducing their time in the operating theatre, contact with surgeon trainers, and/or time in outpatient clinics. The directive limits the working week for junior doctors to a maximum of 58 hours, with a reduction to 56 hours in 2007. Eighty two per cent of survey respondents said that their training time in theatre had decreased, and almost three quarters considered that direct contact time with their trainer(s) had decreased. More than half (58%) said that training time in outpatient clinics had also decreased.
The results came from a recent online survey of trainee surgeons registered with the Royal College of Surgeons, the Association of Surgeons in Training, and the British Orthopaedic Trainees Association. A total of 1323 responses were returned, although about 4000 people potentially would have had access to the survey; 577 responses came from specialist registrars, 681 from SHOs, and 65 from doctors in other categories such as clinical fellows and research fellows.
Professor John Lowry, chairman of the Royal College of Surgeons?working party on the European Working Time Directive, said: "Surgery is a craft specialty, and, while the Royal College of Surgeons supports the need for team working, the skills that ensure patient safety cannot be acquired without a long period of experience and one to one teaching from consultants."
He added: "This survey suggests that even the first stage of implementation of has reduced trainees?contact time with their trainers to a very significant degree. Training a surgeon takes time, and that time must be spent in theatre, in outpatient clinics, and on the ward."
He estimated that surgeons who trained several years ago would have typically had a total of around 32 000 hours of training before becoming a consultant but that this had now fallen to as low as 6000 hours.
Most (84%) respondents to the survey, which was conducted over a period of five weeks in December 2004 and January 2005, were working in England, with 5% in Wales, 8% in Scotland, and 3% in Ireland (including Northern Ireland).
In addition to effects on training, 58% of those taking part in the survey said that the quality of patient care had worsened as a result of the directive, with 84% judging that continuity of care had deteriorated. Paradoxically, 47% felt that their quality of life had decreased.
Before the introduction of the directive, most SHOs were either "resident on-call" (living at the hospital and potentially able to rest between periods of activity) or "non-resident on-call" (on call from home and being called to the hospital for emergencies only). The survey showed that 57% were now working shifts of up to 13 hours, followed by 11 hours?continuous rest in every 24 hour period.
Professor Lowry explained that this working pattern meant that many SHOs were largely providing service work in hospitals rather than receiving direct training. He said: "Little surgical activity takes place at night, and so SHOs working full shifts may lack training opportunities. In addition, they miss out on daytime training—when most surgery is carried out—because they have to take compensatory rest after night work. This results in them spending less time with their trainers and having less training time in theatre." The shift pattern could also be responsible for some respondents reporting a reduction in quality of life—with more junior doctors working at night on a regular basis, he suggested.
Current surgical training in the United Kingdom takes at least 12 years, on average. After medical school and one year as a preregistration house officer, a surgical trainee becomes a an SHO, receiving basic surgical training for an average of five years before becoming a specialist registrar and receiving six years of higher surgical training.
SHOs must do a minimum of two years?basic surgical training. Their working week should include two to three operating sessions, two outpatient sessions, two to three ward rounds, sessions for administration, teaching, and personal study, as well as contributing to the emergency on-call rota. They must also complete a logbook to record their clinical, surgical, and education experience, the contents of which must be authenticated regularly by the trainee抯 consultant and their overall training supervisor.(London Susan Mayor)