Surgical training “should be provided in 48 hour week”

TRAINEE surgeons should not have to opt out of the European Working Time Directive to receive enough training, according to the president of the Royal College of Surgeons of Edinburgh.

Ian Ritchie told BMJ Careers that sufficient surgical training should be delivered within the average working week of 48 hours.

In July, the Department of Health revealed plans to encourage trainee doctors to increase their training time by voluntarily opting-out of the EWTD. They said opting out could benefit junior doctors in specialties such as surgery where “overly rigid shift patterns” have reduced training opportunities.

But Mr Ritchie told BMJ Careers: "If the legal situation is [that doctors can work a maximum of] 48 hours a week, I don’t think we should be suggesting to our members and fellows that they derogate or go away from what is a legally established situation, which, after all, has been put there for the benefit of the doctors and the patients.”

He said it was up to the health service to find a way to accommodate the changes brought in by working time regulations and ensure that trainees were being trained as well as working.

“The difficulty for medicine is that it’s a 24 hour job, in terms of providing cover for sick people. The question for me is whether the time trainees spend working overnight is actually training.”

He added: “There is a big difference between providing service and being trained, and overnight it is not training, it’s service delivery. And, under the current arrangements, if [trainees] work during the night they can’t be around during the day, which is when most of the good quality training happens.”

Mr Ritchie said that trainees who did work overnight should be supervised by a consultant who could provide training. “But to justify having the consultant there working overnight you’d probably have to have a large volume of work going through. The volume of working going through at night is actually very low.”

He called on the health service to go “back to basics” and devise a plan to deliver a service without using trainees. “You might get a position where trainees were inserted into the health service and received very high quality training, but if you took the trainees away for whatever reason, the service wouldn’t fall down,” he said.

Consultants, he said, need to be “more engaged” in thinking about how they deliver the service and how to create an environment that is conducive to quality training.

Source: BMJ Careers