RxPG News XML Feed for RxPG News   Add RxPG News Headlines to My Yahoo!  

Medical Research Health Special Topics World
 
  Home
 
   Health
 Aging
 Asian Health
 Events
 Fitness
 Food & Nutrition
 Happiness
 Men's Health
 Mental Health
 Occupational Health
 Parenting
 Sleep Hygiene
 Women's Health
 Public Health
 
   Careers
 Dental
 Medical
  Australia
  ECFMG
  India
  United Kingdom
   PLAB
   PRHO
  United States
 Nursing
 
   DocIndia
 Overseas Indian Doctor
 Reservation Issue
 
   Healthcare
 Africa
 Australia
 Canada Healthcare
 China Healthcare
 India Healthcare
 New Zealand
 South Africa
 UK
 USA
 World Healthcare
 
   Latest Research
 Aging
 Alternative Medicine
 Anaethesia
 Biochemistry
 Biotechnology
 Cancer
 Cardiology
 Clinical Trials
 Cytology
 Dental
 Dermatology
 Embryology
 Endocrinology
 ENT
 Environment
 Epidemiology
 Gastroenterology
 Genetics
 Gynaecology
 Haematology
 Immunology
 Infectious Diseases
 Medicine
 Metabolism
 Microbiology
 Musculoskeletal
 Nephrology
 Neurosciences
 Obstetrics
 Ophthalmology
 Orthopedics
 Paediatrics
 Pathology
 Pharmacology
 Physiology
 Psychiatry
 Radiology
 Rheumatology
 Sports Medicine
 Surgery
 Toxicology
 Urology
 
   Medical News
 Awards & Prizes
 Epidemics
 Launch
 Opinion
 Professionals
 
   Special Topics
 Ethics
 Euthanasia
 Evolution
 Feature
 Odd Medical News
 Climate

Last Updated: May 21, 2007 - 4:00:57 AM
United Kingdom Channel

subscribe to United Kingdom newsletter
Careers : Medical : United Kingdom

   EMAIL   |   PRINT
Surgical Training in UK seriously compromised by EWTD
Feb 25, 2005 - 5:15:00 PM
Although the RCS and the Academy of Medical Royal Colleges recommend that a 1:8 rota should be the minimum, ie a trainee surgeon should not be on call more than one block of nights in eight (including working a full day either side), 45% of SHO respondents were working full shifts on a 1:7 rota or more frequently. Only 5.3% of SpRs were working a 1:9 shift or less frequently - for most of them the frequency of the shift pattern was between 1:5 and 1:8.

Article options
 Email to a Friend
 Printer friendly version
 United Kingdom channel RSS
 More United Kingdom news
[RxPG] The findings of a survey of trainee surgeons carried out by the Royal College of Surgeons (RCSEng), in collaboration with sister surgical Royal Colleges, the Association of Surgeons in Training (AsiT) and the British Orthopaedic Trainees’ Association (BOTA) to find out the effect the European Working Time Directive (EWTD) has had on their training, their care of patients and the quality of their own lives reveals that the introduction of the European Working Time Directive has seriously compromised surgical training. The implementation of shorter hours has meant that training time in the operating theatre and contact with surgeon trainers have both diminished significantly.

Nearly 90% of SHOs felt that the revised working patterns had diminished their training; 84% felt that continuity of care had suffered; 58% considered that the quality of care had worsened; and 47% felt that their quality of life had deteriorated. Almost 75% considered that their direct contact time with their trainer(s) had decreased; 82% felt that their theatre training time had decreased; and 58% felt that out-patient clinic training time had also decreased.

‘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,’ said Professor John Lowry, chairman of the Royal College of Surgeons’ EWTD Working Party. ‘This survey suggests that even the first stage of implementation of EWTD has reduced trainees’ contact time with their trainers to a significant degree. The situation will be exacerbated unless training is properly funded. Training a surgeon takes time and that time must be spent in theatre, in out-patient clinics and on the ward.’

The survey was carried out on-line over a period of five weeks in December 2004/January 2005. 1323 responses were received, of whom 577 (44%) were SpRs, 681 (51%) were SHOs and 65 (5%) were ‘other’, comprising clinical fellows, PRHOs and research fellows. 84% of them were working in England, 8% in Scotland, 3% in Ireland and 5% in Wales.

The European Working Time Directive (EWTD) became law for junior doctors in August 2004. It reduced the working week to a maximum of 58 hours. In 2007 the working week will be further reduced to 56 hours, and possibly to 48 hours by 2009 (this could be extended to 2012).

Before the introduction of the EWTD, most SHOs were either resident on-call (ie they could rest at the hospital in between periods of activity) or non-resident on-call (ie on call from home and only called in to the hospital for emergencies). Now, more than half of them (57%) are working shifts of up to 13 hours, followed by 11 hours’ continuous rest in every 24-hour period. Of those, almost half are working one week in seven (1:7) in this pattern, or more frequently.

In this working period, SHOs are largely providing service work in hospitals rather than receiving the direct training which is vital to their career progression. Little surgical activity takes place at night and so SHOs working full shifts 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 trainer(s) and having less training time in theatre. Many Trusts use their SHOs for service work, especially at night.

Although the RCS and the Academy of Medical Royal Colleges recommend that a 1:8 rota should be the minimum, ie a trainee surgeon should not be on call more than one block of nights in eight (including working a full day either side), 45% of SHO respondents were working full shifts on a 1:7 rota or more frequently. Only 5.3% of SpRs were working a 1:9 shift or less frequently - for most of them the frequency of the shift pattern was between 1:5 and 1:8. Nearly 90% of SHOs felt that the revised working pattern had diminished their training time and almost 75% of them felt they had less direct time with their trainer(s). Just over half of the SpRs reported that the quality of their training had ‘severely or slightly worsened’.

In July 2003, the RCS said that additional funding was required to increase the number of doctors in higher specialist training, and pointed out to the Department of Health that the EWTD would require more consultant surgeons to provide a safe and effective acute service. Last March, the College said that the job plans of consultant surgeons had to allow protected teaching time – in out-patient departments, at the bedside, and in the operating theatre.*

Last week, Mr Hugh Phillips, the President of the RCS, drew attention to the shortfall of surgeons and the need for more consultant posts to carry out the necessary surgical work and to train their successors. ‘Surgical trainees are working to keep hospitals safe at night but are not getting enough training because of shift work. Trainees should not be used to provide service cover unsupervised, particularly at night, to the detriment of their training,’ Mr Phillips said.

‘Trusts must fund and resource training,’ said Mr Phillips. ‘Surgical trainees must insist on being trained. Trainers must insist on the opportunity to train. Surgery is a craft that is learned at the elbow of the trainer, not by doing unsupervised service work.’

Through its EWTD Working Party, chaired by Professor John Lowry, the RCS will continue to lobby the government and the Department of Health to ensure that Trusts adequately resource and protect surgical training time and maximise training opportunities for junior surgeons.




Publication: The Royal College of Surgeons of England
On the web: Full details of the survey can be found on the College web area dedicated to EWDT 

Related United Kingdom News
MTAS will cause irreparable harm to 10,000 junior doctors
BMA welcomes abandonment of MTAS
The Royal College of Psychiatrists welcomes the Government’s decision to abandon the MTAS process
BMA Junior doctors Committee left the MTAS review group in protest
Review says junior doctors should get guaranteed interviews
The Academy of Medical Royal Colleges say on MTAS
Royal College Concerned About Impact of MTAS on Mental Health of Trainee Doctors
BMA calls for delay to MTAS recruitment system
BMA responds to High Court ruling on visa restrictions for overseas doctors
UK - No more a land of Equal Opportunities?

Subscribe to United Kingdom Newsletter
E-mail Address:

 Additional information about the news article
Current surgical training takes on average at least 12 years. Following medical school, and one year as a Pre-registration House Officer (PRHO), a surgical trainee becomes a Senior House Officer (SHO) undergoing basic surgical training for an average of five years before becoming a Specialist Registrar (SpR) and undergoing six years of higher surgical training.

Currently, SHOs must undertake a minimum of two years’ basic surgical training. Their working week should include 2-3 operating sessions, 2 out-patient sessions, 2-3 ward rounds, sessions for administration, teaching, and personal study, as well as contributing to the emergency on-call rota. SHOs must complete a logbook to record their clinical, surgical and education experience, the contents of which must be authenticated regularly by the trainee’s consultant and their overall training supervisor. The logbook must be brought to both the clinical and viva voce examinations at the RCS.

Currently, an SpR’s weekly timetable must include 2-3 operating sessions, 2-3 out-patient clinics, 1-2 pre- and post-operative ward rounds, and sessions of academic study, formal education and administration in addition to emergency on-call commitments.
 Feedback
For any corrections of factual information, to contact the editors or to send any medical news or health news press releases, use feedback form

Top of Page

 
© All rights reserved 2004 onwards by RxPG Medical Solutions Private Limited
Contact Us