Background: There is concern in the medical literature that reduced work
hours as a result of the European Working Time Directive (EWTD) is
detrimental to surgical training due to reduction in workplace-based training
opportunities. This is supported by literature suggesting that learning theories
applicable to surgical training include social learning and constructivism, and
that surgeons are ‘hands-on’, practical learners. However, there is no conclusive
evidence that reduced hours is detrimental to surgical training, and this study
aims to explore whether this is indeed the case.
Methods: A series of one-to-one semi-structured interviews were performed
with Year 5 and 6 Specialist Registrars in General Surgery on the West Midlands
Higher Surgical Training scheme. Nine interviews were performed before
thematic saturation was reached. Interview transcripts were then thematically
analysed in NVivo 9.
Results: Participants perceive the EWTD to have reduced training
opportunities due to reduced hours, a change to working shifts as opposed
to 24-hour on-calls and the introduction of timetabled days off into on-call
rotas in order to make them EWTD-compliant, which is largely being used
in order to gain further training opportunities. Trainees are attending courses
and going on Fellowships in order to augment training. There is a difference in
opinion as to what constitutes training and what constitutes service provision.
Trainees perceive that shift-working leads to increased fatigue and a disruption
to life outside of work.
Conclusion: Overall perceptions are of a detrimental effect upon training
opportunities for a variety of reasons, which is consistent with the current
literature. New theory has been generated regarding the perceptions of service
and training activities, and the differences between 24-hour on-calls and shifts
upon fatigue, which could be explored further with quantitative methodologies.