Abstract
Background
Every trainee in Trauma and Orthopaedics (T&O) in the UK and Ireland records their operative experience via the Faculty of Health Informatics eLogbook. Since August 2009, all doctors were subject to the full European Working Time Directive (EWTD) restrictions of 48 hours of work per week. We have previously shown that the implementation of shift working patterns in some units in preparation for these restrictions reduced training opportunities by 50% (elective surgical exposure). We have now analysed the national data to establish whether operative experience has fallen since August 2009.
Methods
All operative data recorded nationally by trainees (all years, all supervision levels) between the 3 months of August to October 2007, 2008 and 2009 were compared. Data were available for 1091 ‘validated’ training grade surgeons (ST3-8 or equivalent) in 2007, 1103 in 2008 and 767 in 2009. Mean operative figures were calculated per trainee for each of the 3-month time periods.
Results
During the three study periods trainees performed an average of 63 (2007), 62 (2008) and 65 (2009) operations, and total operative exposure was 102, 101 and 107 respectively. There was an increase in operative exposure of 5% from 2007 to 2009. Trauma represented 44% (2007), 41% (2008) and 42% (2009) of total exposure.
Conclusion
This national data shows that, in the 3 months following implementation of the 48-hours EWTD restrictions, the expected decrease in operative exposure did not occur. This may be a result of the introduction of rotas to maximise theatre exposure, whilst minimising other commitments, such as outpatient experience. Alternatively, there may be widespread disregard for shift working and hours restrictions in order to maintain adequate operative exposure. Despite the implementation of the full EWTD restrictions, it appears that T&O trainee operative exposure in the first three months has not fallen.
