Editor – Goddard presented important preliminary findings in his editorial on the impact of the European Working Time Directive on training (Clin Med Aug 2010 pp 317–18). However, his conclusion that conversion to a 56-hour working week has not significantly impacted on the quality of training of physicians is unsupported by data. Admittedly, he concedes that the measurement of such impact is difficult due to the lack of validated quality measures of training. While the table he presented may not demonstrate a statistical difference in numbers of procedures performed by trainees between the two periods assessed (1998–2002 and 2003–7), procedural competency in the ‘craft medical specialties’ is nevertheless influenced by absolute numbers of procedures undertaken. Of the procedures listed in the table, only trainee-performed angiography and echocardiography increased in numbers between the two periods. This may be a cardiology-specific characteristic; indeed, in the same article, Goddard comments on the longer hours that cardiology specialist registrars (SpRs) work in comparison to another specialty. Perhaps something useful may be learned from our cardiology trainers in this regard. With respect to the numbers of bronchoscopies performed pre- and post-2003, while the comparison may not be p-value significant, it is undeniable that a mean difference of over 60 procedures performed by the end of training is likely to be qualitatively significant in distinguishing a skilled and procedurally-confident late-stage SpR or new consultant from a merely competent one.

• Royal College of Physicians