P Malone, Z Zaidi,
M Baguneid.
University Hospital South Manchester.
The surgical profession is calling for endorsement of a 65 hour working week as an immediate remedy amid substantial concerns about European Working Time Directive (EWTD) 2009 implementation.
Aside from this, the Association of Surgeons in Training and other organisations have also been calling for improvements in surgical training to be delivered for many years.
So far little action has been taken on both these issues. A major apprehension is that EWTD will impede training in the craft specialties as they depend on adequate exposure to interventional procedures. If this is compromised, ultimately it may have a negative effect on standards of patient care delivered. With the final countdown to August 2009 ever looming, there must be further widespread recognition that the time to direct more resources towards improving surgical training is long overdue.
There is a widespread will to focus on improving the intensity of surgical training in recognition of a large amount of time spent at work without training purpose. Individual hospital trusts must, in particular, address the imbalance between meeting political targets and investing in the training of the surgeons of tomorrow. Improved resources should be directed to specific training needs and targets. More time must be allocated to dedicated 'teaching' operating lists, outpatient clinics and tutorials. In the recent House of Commons debate on EWTD, Alan Johnson MP, secretary of state for health, referenced good access to virtual reality surgical simulators as a way in which surgical training has apparently already been improved. However, this is not yet a reality because of both a widespread absence in provision of simulators and also crucially, a lack of opportunity during the working week to use them.
Therefore in addition to courses, improvements in study leave funding, computer training rooms and better access to anatomy demonstration rooms, we advocate improved provision of surgical simulators within skills labs based in the theatre complex.
In North West England we are currently piloting a surgical skills lab within the operating theatres aimed to suit both core and higher surgical trainees. It provides a range of resources including laparoscopic, arthroscopic, microscopic and endovascular simulators, sawbone models to practice orthopaedic plating, artificial vessels for anastomosis, models to simulate open surgery, basic surgical skills trainers, anatomical models, written materials and computers preloaded with links to journals and operative demonstration videos. The setup cost is no more than £100,000 and the key benefit within the operating theatre complex is that it will also allow surgical trainees to better utilise what is commonly regarded as 'lost' training time between operations.
This is when the surgeon is confined to the theatre corridor waiting for the next patient to be anaesthetised and may take as much as 25% of a typical day's operating time. Frequently the consultant is also present in theatre at these times and so this concept lends itself to increased one on one consultant tuition.
The learning and teaching experience for surgery is certainly a multifaceted process that needs to be embraced by national bodies, hospital trusts, trainers and trainees alike in a coordinated manner. Trainees are calling for improved resources to be made available to improve their training and we advocate a shift in focus to develop better policies that allow this. Amongst other improvements, dry skills labs within the operating theatre corridor could go a long way to instigate improvements and lessen the feared impact of the EWTD on training to ultimately uphold surgical standards and maintain the quality of the surgical CCT.
Working Time Directive 2009 
