Researchers have produced the first objective evidence to show that training opportunities and operative experience are being lost in trauma and orthopaedics following implementation of the European Working Time Regulations (EWTR).
The study confirms fears that the introduction of the 48-hour working week has impacted on the ability of the NHS to deliver a safe service and high quality training and surgical experience for trainees.
Data was obtained from the electronic logbooks of 35 specialist registrars and fellows working in trauma and orthopaedic training posts at Nottingham University Hospitals Trust for one year before and one year after the EWTR were introduced in August 2009. This change reduced the maximum hours worked by doctors from 56 to 48.
The number of orthopaedic operations carried out by the trainees reduced from 3,859 pre-EWTR to 3,349 post-EWTR. Trainee involvement in operating procedures was reduced by 13.2% and their exposure to elective operations was cut by 17.8%.
The mean operating experience of trainees during six month posts before and after the EWTR changes reduced from 227 to 197.
Although there was no significant reduction in the total number of trauma operations performed before and after the change in work pattern there was a significant decrease in those that trainees performed independently: a drop from a mean of 38 to 28 operations per trainee per six month period following the introduction of the EWTR.
Also fewer extracapsular neck of femur fixations and knee arthroscopies were performed independently by the trainees.
Trainees in all years (1-6) performed less operations.
The authors, three senior surgeons from Nottingham University Hospitals Trust, suggest that their study may underestimate the full impact of the EWTR as it did not include changes that reduced the working week to 56 hours prior to 2009. A study in 2006 reported that the reduction in working hours to 56 hours a week resulted in a 20% decrease in exposure to operative cases.
They conclude that their study demonstrates there has been a “significant” reduction in total operating and elective procedures in orthopaedic surgery and the involvement of trainee surgeons in these procedures since the introduction of the EWTR.
“These findings have significant implications for patient safety and the provision of quality training for the next generation of orthopaedic surgeons,” they warn.
Read the report.