The perceived effects of the European working time directive upon training opportunities for specialist registrars in general surgery in the West Midlands

Padwick, R. and Markham, D. and Johnson, N. (2013) The perceived effects of the European working time directive upon training opportunities for specialist registrars in general surgery in the West Midlands. British Journal of Surgery, 100 (Suppl.). p. 152. ISSN 0007-1323

Abstract

Background: There is concern in the medical literature that reduced work hours as a result of the European Working Time Directive (EWTD) is detrimental to surgical training due to reduction in workplace-based training opportunities. This is supported by literature suggesting that learning theories applicable to surgical training include social learning and constructivism, and that surgeons are ‘hands-on’, practical learners. However, there is no conclusive evidence that reduced hours is detrimental to surgical training, and this study aims to explore whether this is indeed the case. Methods: A series of one-to-one semi-structured interviews were performed with Year 5 and 6 Specialist Registrars in General Surgery on the West Midlands Higher Surgical Training scheme. Nine interviews were performed before thematic saturation was reached. Interview transcripts were then thematically analysed in NVivo 9. Results: Participants perceive the EWTD to have reduced training opportunities due to reduced hours, a change to working shifts as opposed to 24-hour on-calls and the introduction of timetabled days off into on-call rotas in order to make them EWTD-compliant, which is largely being used in order to gain further training opportunities. Trainees are attending courses and going on Fellowships in order to augment training. There is a difference in opinion as to what constitutes training and what constitutes service provision. Trainees perceive that shift-working leads to increased fatigue and a disruption to life outside of work. Conclusion: Overall perceptions are of a detrimental effect upon training opportunities for a variety of reasons, which is consistent with the current literature. New theory has been generated regarding the perceptions of service and training activities, and the differences between 24-hour on-calls and shifts upon fatigue, which could be explored further with quantitative methodologies.