Two thirds of surgical trainees believe their training has deteriorated since the Working Time Directive was implemented in August, research reveals.
The survey of over 1,600 surgeons in training also reveals that two thirds are attending work while off-duty in order to gain adequate experience of operating. These additional hours will result in many trainees exceeding the 48-hour limit.
But, it is not just the training of surgeons that is being compromised - quality and continuity of care are also being threatened.
The survey, by the Association of Surgeons in Training and the British Orthopaedic Trainee Association (BOTA), shows that 84% of surgical trainees are working in excess of their rostered hours to maintain the quality of the service and ensure patient care is unaffected.
Furthermore, 17% of trainees were aware of formally reported adverse critical incidents, using established hospital reporting systems, directly arising from reduced working hours or increased frequency of handovers associated with WTD implementation.
Nearly half of surgical trainees have no specific time allocated in their rota for the dedicated handover of patient care, contrary to professional guidelines; three quarters hand over care to other surgical teams twice or more during each 24-hour period.
Mr Benjamin Caesar, president of BOTA, said: “The effect of the EWTD on the craft specialities, such as surgery, has been devastating, with deterioration in both surgical training and patient care.”
Paradoxically, the work-life balance of surgeons has not been improved. Nine out of ten say theirs has remained the same or deteriorated.
Caesar said: “This survey demonstrates that the shift patterns being imposed as a result of the WTD are having exactly the opposite effect on surgical trainees to those it proposes. They are more fatigued, less well trained and have a poorer work-life balance.
“The methods of training safe, competent and confident consultant surgeons for the future need to be significantly reviewed to accommodate any changes in working patterns. The government needs to listen to the surgical leadership in presenting a compromise solution to the hours required to train surgeons and to deliver a safe service.”
Fifteen percent of trainees have opted out of the WTD. A further two thirds would like to do so, but 10% have been prevented by their trusts.
The Royal College of Surgeons has campaigned for a 56-hour week for surgeons in training.
Lesley Bentley, demitting lay chair of the Patient Liaison Group at the Royal College of Surgeons of England, said: “It would be of concern to patients if changes in working hours were to compromise training, continuity of care and high quality outcomes, all crucially important for patients, now and in the future.”
Last month, more rotas for junior doctors were granted a two-year delay from full implementation of the WTD, taking the number of officially non-compliant rotas to 273.
In September, another survey revealed that nearly half of trainees felt their rotas weren’t compliant in reality.
Read an ASiT blog on the issue.
