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Does the Implementation of European Working Time Directive (EWTD) Have an Effect on Surgical Training in a Flemish Teaching Hospital Network ?

Abstract Background: Surgical residents used to work many hours. The European working time directive (EWTD) 2003/88/EG was created to protect young doctors from working too many hours. EWTD was implemented in Belgium on February 1st 2011. A decrease in working hours and improvement of surgical education was expected. Methods: Every resident was requested by the Faculty of Medicine to answer an ACC (Activities Coaching Context) questionnaire about his/her teaching hospital. The answers of surgical residents in all teaching hospitals, during the academic years before, during and after the implementation of the EWTD were used. Statistical analysis was performed with SPSS 20. Results: Since implementation we noted a significant decrease in mean daily working time (MDWT) (p < 0,001). However, this MDWT stayed significantly longer in university hospitals (UH), even after implementation of EWTD (p = 0,024). Non-medical administrative workload (AW) did not change significantly (p = 0,531), but medical AW increased significantly after implementation (p = 0,050). Non-medical and medical AW were significantly higher in UH after implementation (p = 0,002 and p < 0,001). The opportunity to practice skills and also the perception of a good balance between working and learning did not change significantly after implementation (p = 0,200 and p = 0,819), but both were scored significantly better in non-UH (p < 0,001 and p = 0,052) regardless implementation of EWTD. Conclusions: Since implementation of EWTD there is a significant decrease in MDWT. However, AW has not decreased and is higher in UH. The main challenge for future surgical education will be to reduce AW in order to give surgical residents enough opportunities to practice their surgical skills without prolonging training time.