The detrimental impact of the implementation of the European working time directive (EWTD) on surgical senior house officer (SHO) operative experience
- 257 Downloads
Concerns have been voiced regarding the impact of the European Working Time Directive (EWTD) on surgical training. Following its introduction (August 2009) in Wexford General Hospital, Ireland Surgical Senior House Officers (SSHOs) are required to leave the hospital at 10 a.m. the morning after on-call duty. This study investigates the consequences of this practice on operative experience gained by six SSHOs in comparison to their predecessors.
A prospectively maintained database of surgical procedures was interrogated. Operative experience of SSHOs over a 5-month period (August–December 2009) was compared with that of colleagues 1 year earlier. The primary endpoint was overall operative volume of SSHOs. Subgroup analysis was performed of cases by primary operator versus assistant, intermediate versus minor procedures and by team. Comparison was made of operative volume between Group 1 (pre-EWTD) and Group 2 (post-EWTD).
Operative volume for Group 1 (pre-EWTD) was 461 cases. Group 2 (post-EWTD) was involved in a total of 349 operations, showing a decrease of 24 % (P = 0.006). SSHOs in Group 1 (pre-EWTD) had been the primary operator in 109 cases compared to 87 in Group 2 (post-EWTD), demonstrating a reduction of 20 % (P = 0.06). Most worryingly, there was a reduction of 63 % (P = 0.04) in the intermediate cases performed as operating surgeon in Group 2 (post-EWTD).
The present data set demonstrates a significant reduction in operative experience gained by SSHOs after local implementation of the EWTD. A major challenge facing Irish surgical training over the next decade is reduced operative exposure in the clinical setting.
KeywordsEuropean working time directive, EWTD Surgical training Senior house officer, SHO
Conflict of interest
- 1.EUR-Lex (1993) Council Directive 93/104/EC of 23 November 1993 concerning certain aspects of the organisation of working timeGoogle Scholar
- 2.European Communities (2004) (Organisation of Working Time) (Activities of Doctors in Training) Regulations 2004 (S.I. No. 494 of 2004)Google Scholar
- 3.Case C-303/98 Sindicato de Medicos de Asistencia Publica (SiMAP) v Conselleria de Sanidad y Consumo de la Generalidad Valenciana (2000) ECR 1-7963Google Scholar
- 4.Andeshaupstadt Kiel v Norbert Jaeger (2003) “The Jaeger judgement”, C-152/02Google Scholar
- 5.Optimising Working Hours to Provide Quality in Training and Patient Safety; a position statement by the Association of Surgeons in Training 2009. http://www.asit.org/assets/documents/ASiT_EWTD_Position_Statement.pdf
- 6.CD/09/378 Recommendation No. LCR19559 Parties: health Service Executive and Approx. 4800 doctors (represented by Irish Medical Organisation)Google Scholar
- 7.Benes V (2006) The European working time directive and the effects on training of surgical specialists (doctors in training)—a position paper of the surgical disciplines of the countries of the EU. Acta Neurochir (Wien) 148:1227–12233Google Scholar