Over the limit?

The final phase of the European Working Time Directive came into force on 1 August. The BMJ reports from some of the affected countries

Resident duty hours in American neurosurgery

The unexpected death of Libby Zion, at New York Hospital in 1984, led to a series of investigations that recently resulted in profound changes in resident duty hours. On July 1, 2003, the Accreditation Council for Graduate Medical Education (the governing body of all residency programs in the United States) mandated the following work hours rules: no more than 80 hours per week, no more than 24 hours of continuous patient care (with an added 6-hour transition period), 1 day in 7 free of patient care responsibilities, and a minimum of 10 rest hours between duty periods. These rules are based on a considerable body of scientific study indicating that sleep loss affects cognitive performance and, possibly, patient care. The new work hours have stimulated vigorous debate, both pro and con. Those arguments are reviewed.

Effects of the European Working Time Directive on anaesthetic training in the United Kingdom

Decreases in the hours worked by trainee anaesthetists are being brought about by both the New Deal for Trainees and the European Working Time Directive. Anticipated improvements in health and safety achieved by a decrease in hours will be at the expense of training time if the amount of night-time work remains constant. This audit examined the effects of a change from a partial to a full shift system on a cohort of trainee anaesthetists working in a large district general hospital in the South-west of England. Logbook and list analyses were performed for two 10-week periods: one before and one after the decrease in hours. An 18% decrease in the number of cases done and an 11% decrease in the number of weekly training lists were found for specialist registrars. A 22% decrease in the number of cases done and a 14% decrease in the number of weekly training lists were found for senior house officers. Furthermore, a decrease of one service list per specialist registrar per week was seen, which will have implications for consultant manpower requirements.

Clinical management. Where medicine meets management. Reduced circumstances

The development of effective clinical teams is vital to the delivery of quality clinical care and reducing clinical errors. Implementation of the European working-time directive will disrupt team dynamics and reduce the training opportunities for junior doctors. Funding is needed to increase further the number of doctors if the directive is not to be at the expense of patient care.

The European Working Time Directive: a survey of surgical specialist registrars

On 1 August 2004 junior doctors in the Irish health care system and other healthcare systems throughout Europe will no longer be excluded from the provisions of the European Working Time Directive. Their working hours will then be limited by law, first to 58 hours a week and then, by 2009, to 48 hours. This will demand even more profound changes for the Irish health care system than seen so far. This survey was undertaken to elicit the opinions and first-hand experiences of surgical specialist registrars (SpRs) throughout Ireland on different working patterns, and the impact of being on-call on their surgical training and lives. The working time directive will undoubtedly shake the foundations of surgery in Ireland and Europe, and meeting the directive by 2009 will require fundamental change if both it and the challenge of providing first class surgical training and safe patient care are to be met.

Political issues in emergency medicine: The United States

The format of the paper is to allow three authors to discuss what they believe are the most significant political issues facing emergency medicine (EM) in their country or region. Each author writes independently and does not see any other contributing author's work, therefore potential overlap of subject matter is inevitable. However, we were soliciting their individual opinions about the serious issues confronting us today, rather than a consensus. An additional author, well familiar with the topics being discussed, wrote the Commentary from an overview perspective on the writings of the other authors. This supplemental opinion was offered as a method for enhanced cohesiveness in describing the political situations impacting the specialty of emergency medicine. The three authors for the United States are James Hoekstra, Professor and Chair, Wake Forest University Health Sciences; Robert McNamara, Professor and Chair, Temple University School of Medicine, and Robert Schafermeyer, Associate Chair, Department of Emergency Medicine, North Carolina School of Medicine. Between them, they represent more than 50 years experience in clinical and academic emergency medicine. They write from a personal perspective. Their views are their own, and do not represent any organization(s) with which they may have or had affiliations.