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Effect of the 48‐hour week on training in anaesthesia

Al-Rawi and Spargo [1] present data on the effect of the European Working Time Directive compliant rotas on trainee case numbers in the Wessex region. We commend their efforts, believing this to be a key issue currently facing anaesthesia. The authors allocated trainees to two groups based on rota pattern but do not report the total average number of hours that the groups worked. This may not have been different, explaining the apparent lack of change in caseload. In our opinion the reduction in hours trainees can legally work is the salient issue, rather than rota pattern. Our major teaching hospital recently changed from a 56-h (2B) rota to a 48-h (1A) rota, allowing the opportunity to study the impact of the European Working Time Directive. We audited theatre allocations for ST3–ST7 trainees over two 12-week periods before and after the introduction of the 48-h week. Data was taken from finalised rotas for each week, recording each 4-h session as either training (accompanied) or solo (unaccompanied). On call sessions were not included. Leave allocations were similar in both periods as were the number of trainees allocated to each rota. Our data showed an average overall reduction of 0.6 sessions each week per trainee. This reduction occurred mainly in the allocation to solo lists. Previously published data regarding the change to rotas of < 56 h per week [2] in 2004 cloncludes that reducing hours reduces session availability. The Royal College of Anaesthetists stipulates a minimum of three training sessions each week. With the total number of sessions approaching three there is inevitably a reduction in unaccompanied experience. Whilst proponents of competency based training may argue that this is no loss, in our department there is undoubtedly a reduction in overall experience being offered to trainees. One solution is to reduce the time trainees spend on call and may be achieved through service provision by non-training grades or consultants. However, the resulting effect on training through reduction in experience gained during on-call sessions is difficult to quantify and may well be negative. Alternatively training could be recouped by lengthening training programs. An analogy to this currently exists in less than full time training where program times are extended in order to attain an equivalent time spent in training. Extending current programs by 1 year would roughly approximate to the hours lost in the change to the 48-h week. The final option would be to opt-out of the European Working Time Directive and revert to a 56-h week. This approach is favoured by our surgical colleagues who advocate a 60 h week to maximise training. It would be legally and politically difficult to implement such a change without the widespread support of all stakeholders.