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The detrimental impact of the implementation of the European working time directive (EWTD) on surgical senior house officer (SHO) operative experience

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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.

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Correspondence to K. J. Breen.

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Breen, K.J., Hogan, A.M. & Mealy, K. The detrimental impact of the implementation of the European working time directive (EWTD) on surgical senior house officer (SHO) operative experience. Ir J Med Sci 182, 383–387 (2013).

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