The needs of surgical training in the era of the European Working Time Directive

Dear Sir

In the era post the implementation of the European Working Time Directive (EWTD) has had a significant impact on surgical training. The previous reliance on volume of training to ensure exposure to the breadth and depth of the speciality prior to completion of training is proving to be impractical. There remains significant anxiety pertaining to the final quality of trainees at the end of the program, both within the trainee body and the Royal Colleges of Surgeons, which has not declined over time (Anwar et al 2005; Fitzgerald & Caesar 2012) due to a perception that reduced working hours will lead to a decline in the quality of training and ultimately, a decline in patient care. The implementation of the EWTD also clashed with the National Health Service rota and medical training systems and resulted in a radical redesign in medical staffing.

The Temple report highlighted that the EWTD has had the greatest impact on doctors in training within secondary care, with the surgical specialties being particularly affected. It is however, important to note that no trainee in surgery has conducted their entire postgraduate training under the EWTD, making full evaluation difficult. It is worth noting that general practice as a speciality has had trainees begin and finish their higher training under the EWTD and is currently in the process of extending the length of postgraduate training by 25%.

The introduction of EWTD-compliant on-call rotas did result in lost training opportunities, as the cohesive relationship between individual trainers and the trainees was, if not broken, then strained. This is much more marked in surgical specialities, where the unplanned care divides the direct relationship between trainers and trainees. This pressure is exacerbated by the training model still relying on “learning by osmosis” where the sheer volume of experience allows all aspects of training to be addressed, a model that is not practicable under the EWTD. This represents an excellent opportunity for redesigning the training system to take into account the new working culture. It is possible to deduce that a more supervised training environment, with directed teaching and structured learning. However, this would require an ideological and culture shift to implement, but do point the way to a more effective restricting of hospital training program.

Declaration of interest: The author reports no conflicts of interest.