Nine out of ten O&G trainees have had to cover daytime rota gaps since the Working Time Directive was introduced, a survey reveals.
The rise in unfilled posts, following the implementation of a 48-hour week, also resulted in 49% of trainees covering gaps during evenings and weekends and 36% at night.
Over 950 trainees responded to the Royal College of Obstetricians and Gynaecologists’ survey.
It also reveals that 16% of trainees believe their rotas were not WTD compliant at the time of the survey, and nearly all blamed insufficient staff numbers.
Nearly a third of O&G trainees felt that there had been an overall decrease in training sessions.
Respondents felt that achieving competence and the confidence to do independent 2nd on-call duties may be an issue at ST2/3 levels. More alarmingly, those on sub-specialty and advanced training felt that obstetric on-call cover impacted negatively on their training. ST5 trainees feel less confident to do independent out-of-hours acute gynaecology.
Dr Maggie Blott, the college’s vice president (education) said: “The results of this survey will help us to focus on the weak areas in specialty training. It has raised issues which we are particularly concerned about, such as the knowledge gaps and the lack of opportunities to train, which this survey has identified.
“What we need to remember is that O&G is a high-intensity discipline and long shifts where trainees have little rest will compromise safety. We must strike a balance between what trainees can achieve within the confines of a normal working day with the demands of work. We will work with the trainees and trusts to ensure that our trainees receive adequate training and don’t burn-out at the same time.”
On the positive side, trainees mentioned that it was because of the WTD that supervision by senior staff has improved. And it had also resulted in greater consultant presence in the labour ward.
The government-commissioned Temple review recently acknowledged that the WTD had damaged training but suggested the solution lay in truly consultant-delivered services rather than an extension to the 48-hour week for trainees.
I remember long hours in O+G with affection. If all doctors are doing longer hours and there are more doctors on site, being on call bcomes a learning experience. Senior doctors can supervise and teach more junior doctors and more than one doctor can benefit from the learning opportunities. Obs and Gynae is still largely a pattern recognition speciality. The complicated obstetric emergencies occur infrequently and so to get any exposure to them we still need to spend a lot of time on labour ward. Relatively senior trainees are not comfortable managing relatively common conditions. I see in the future a need for a resident junior consultant supervised by a senior consultant.