The WTD was a long time coming. Together with MMC it is completely changing the lives and working patterns of junior doctors. Yet, as 1 August implementation date recedes into the past, we still feel strangely unprepared.
Meeting after meeting about the WTD ended with shaking of heads and shrugged shoulders. How can we provide a service to patients under these conditions? How can we train doctors in such a short period?
The answers to both of these questions are fairly simple and are interlinked. It would be easy to provide training under the new regime if only there were no requirement to provide service. And it would be easy to provide service if there were no requirement to train.
At this point in the argument someone invariably points out that service and training are inextricably linked. Well, to a point. Most specialties now have introduced the concept of a curriculum; a series of clinical cases and experiences that the doctor-in-training needs to see and gain experience of. But the curriculum does not mirror service requirements.
For example, a surgeon-in-training may need to do ten cases of operation X and ten cases of operation Y to satisfy the curriculum. But operation X may be twice as common as operation Y, and he may end up doing too many of these cases. I think it becomes helpful to talk of intra-curricular training and extra-curricular training to distinguish the two situations.
So, we could devise schemes whereby trainees would only spend time getting the experiences that were necessary for the curriculum. This would allow us to reduce their hours-in-training considerably.
Who, then, would do the work necessary to run the service? Would this work fall to staff grades, consultants, sub-consultants or nurses? Would hospitals that cannot deliver the relevant parts of the curriculum still get trainees?
Questions like this provoke apoplexy amongst junior and senior doctors and to the various groups and corporate bodies across medicine, and discussions hit a brick wall. None of these options are remotely palatable to large parts of the profession, and none of the groundwork has been done to enable any of these to take place.
But until the question of the extra-curricular work has been addressed then there can be no progress. So the question I am left puzzling over is why we find ourselves ten years down the line unable to solve this dilemma.
Is it because nobody in medicine has the leadership or authority to reach a decision? Is it because none of these alternatives are acceptable and we all have our heads buried in the sand?
Something is going to have to give way soon. We cannot spend the next ten years playing a game of chicken.
An excellent ‘article’. You have hit the nail on the head!
There are two main problems - service and training. The EWTD does not apply to ‘education’ so, if one could separate the ‘training’ from the ’service’ things might be more manageable. The second is really down to the profession; ’seniors’ have always expected the ‘juniors’ to ‘cover’ the emergencies though, in fact Consultants’ also have to be ‘on call’ to cover their juniors. So, if one could design ‘cover’ for ‘out of hours’ emergencies as a seperate entity, this might help (in fact I understand that consultants have to ‘come in’ more often at night because of the inexperience of juniors); and juniors should only be doing ‘nights and weekends’ if it benefits their training UNDER SUPERVISION!
Finally, many consultants do not think that the EWTD applies to them - but it does! As I have said before, the EWTD was not designed for the professions; hence the inherant problems. Certainly juniors hours needed to come down from previous levels; but I know of no one who is successful in any walk of life who has not had to work long hours on their ‘way up’!
Retired Orthopod