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The European Working Time Directive and training

Felix Chua
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DOI: https://doi.org/10.7861/clinmedicine.11-1-98a
Clin Med February 2011
Felix Chua
Consultant respiratory physician, St George's Healthcare NHS Trust London
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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.

The European Working Time Directive and training

I agree with Dr Chua's comments. The data presented were based on a survey of consultants completing their training in the past 10 years and as such were subject to recall bias. Usually, unless detailed records have been kept, individuals over-estimate how many procedures they have done. Since that study we have started an annual survey of trainees obtaining a certificate of completion of training in the previous 12 months. This survey includes collecting procedural numbers during training. Data from the 2009 survey show that numbers have fallen in all the procedures compared with the data I presented. The numbers for colonoscopy, endoscopic retrograde cholangiopancreatography, angiography, echocardiography, chest drains and bronchoscopy were 607, 186, 907, 780, 52 and 68 respectively. These data were not available when I wrote the editorial but certainly give good weight to the concerns many consultants, including myself, have about the quality and quantity of training in a 48-hour week.

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • Royal College of Physicians

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • Royal College of Physicians
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The European Working Time Directive and training
Felix Chua
Clinical Medicine Feb 2011, 11 (1) 98; DOI: 10.7861/clinmedicine.11-1-98a

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The European Working Time Directive and training
Felix Chua
Clinical Medicine Feb 2011, 11 (1) 98; DOI: 10.7861/clinmedicine.11-1-98a
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