New deal not satisfactory for cardiothoracic surgery

The European working time directive: implications for subspecialty acute care

The requirements of the new deal for junior doctors' hours has meant that many smaller trusts are unable to provide adequate cover on-call for medical and surgical subspecialties. The care of the acute subspecialty patients has, therefore, shifted to general teams in many trusts. We assessed what impact this had upon the outcome of acute urological cases in our district general hospital by prospectively monitoring acute renal colic admissions over a 12-month period and surveyed the provision of services in other regional hospitals. The shift in care of the acute urological patient was associated with considerable morbidity for patients admitted in our hospital. The additional financial burden due to this morbidity was estimated to be 33000 pounds/annum. The implementation of the new deal must be achieved with every care to minimise the clinical and financial costs of withdrawing acute subspecialty services.

The European Working Time Directive: One for all and all for one?

BACKGROUND

The European Working Time Directive (EWTD) became law in Britain on October 1, 1998. As a result, the maximum period that may be spent as a resident in hospitals is 56 hours per week and after August 2009, 48 hours per week. The aim of this study was to determine the views of senior house officers (SHOs), specialist registrars (SpRs), and general consultant surgeons (CONs) in Wales on the influence of the EWTD on surgical training and clinical experience.

METHODS

In this cohort study, a postal questionnaire was sent to 150 SHOs in surgical specialties, 50 general surgical SpRs, and all 84 CONs in the Welsh Deanery.

RESULTS

The response rates were 81%, 78%, and 71% for SHOs, SpRs, and CONs, respectively. The vast majorities at all grades (88% SHOs, 100% SpRs, and 96% CONs) were unhappy with the introduction of EWTD legislation to clinical medicine. Most felt that EWTD legislation will have a negative effect on clinical experience (96% SHOs, 97% SpRs, 96% CONs); patient care (83% SHOs, 85% SpRs, 96% CONs); and training (94% SHOs, 100% SpRs, 93% CONs). Furthermore, a large proportion felt surgical training should be exempt from EWTD regulations (76% SHOs, 87% SpRs, 89% CONs). A significant proportion at each grade was opposed to the introduction of shifts in order to comply with regulations (78% SHOs, 87% SpRs, 89% CONs), and an alarming number have considered leaving the National Health Service when the regulations are enforced (29% SHOs, 41% SpRs, 33% CONs).

CONCLUSION

This study shows that, in Wales at least, a vast majority of surgical trainees and consultants alike are opposed to the introduction of the EWTD and believe it will have a detrimental effect on training, patient care, and doctors' lives outside of medicine.

Special features topic: the effects of limited work hours on surgical training in otolaryngology-head and neck surgery

PURPOSE OF REVIEW

This paper reviews the historic events that culminated in the development of duty hour regulations, and then discusses many of the problems being encountered as the regulations are implemented.

RECENT FINDINGS

On July 3, 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted duty hour requirements for residency training programs in the United States. Although these regulations should have come as no surprise to graduate medical education programs, many were nevertheless unprepared for their implementation. In comparison to duty hour restrictions currently in place in European countries, those being implemented in this country are much more lenient. Both the fiscal and the educational impact of these requirements on graduate medical education are substantial. Recent accreditation actions taken against a training program at Johns Hopkins University clearly demonstrates that the ACGME is prepared to strictly enforce these standards.

SUMMARY

The impact of the new duty-hour requirements on residency training and education will be a matter of great interest as they are implemented throughout the graduate education system in the United States.