{'fraction_non_alphanumeric': 0.020791683326669332, 'fraction_numerical': 0.012794882047181128, 'mean_word_length': 4.8870588235294115, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Current neurosurgical trainees' perception of the European Working Time Directive and shift work

This paper by Tait et al. is a stimulating and provocative paper on the controversial topic of the European Working Time Directive (EWTD). The introduction of the European Working Time Directive (EWTD) in 1993 and its consequent implementation in the NHS from 2004 onwards has had a significant impact on the quality of patient’s care, surgical training and the quality of life for surgical trainees. It is instructive and almost despairing to observe that legislation introduced to improve junior doctors working conditions (including training) and patient safety has in reality led to a system ‘‘less safe, harmful to training and worse in terms of work/life balance’’. The EWTD was introduced to improve both junior doctor working conditions and patient safety. The legislation required a progressive reduction of the weekly working hours from 58 hours in August 2004, to 56 hours in August 2007 and finally to the target of 48 hours a week in August 2009. Moreover there are also strict requirements in relation to rest periods. To allow for peaks and troughs in activity calculations are based on a 26 week reference period (Table I). Thus the current evidence of the working of the system is based on the interim target of 58 hours – the effect of a further 20% reduction of hours has yet to be evaluated. With the restrictions of the EWTD the traditional firm structure of trainees and trainers, which for several decades has been the cornerstone of the hospital practice in the United Kingdom is no longer feasible. The firm system guaranteed continuity of care for patients from admission to discharge including outpatient care and enabled the development of multidisciplinary teams. Several systems have been devised to substitute the firm system and soften the transition from the old on call-firm base structure to the shift-based EWTD system; these are generally very complex and difficult to implement. More complex systems are likely to generate more errors and in medicine errors lead to morbidity and mortality. In a shift based EWTD-compliant system more than one team (and more than one speciality) will be involved in a patient’s treatment with discontinuity of care and heavy reliance on an effective handover system which in itself is time-consuming. The response of the Department of Health (DoH) to the introduction of the EWTD has been the so called ‘‘Hospital at Night’’ (HAN):