The effect of the EWTD on training in general surgery: an analysis of electronic logbook records

Abstract

The introduction of time-limited surgical training in the UK in 1994 following the Calman report raised concerns over the hands-on experience of trainees, heightened by the hours reduction demanded by the New Deal. From 1994, junior doctors' on-duty hours of work for hard-pressed posts were targeted to a limit of 56 hours but SpRs were allowed a voluntary extension from 73 on-duty hours to a maximum of 83 hours per week. By 1995 concern was being expressed at the reduction in training time and continuity of patient care and although calls for more targeted training were made, evidence of a negative impact on training has continued to surface.

Analysing the operative experience of basic surgical trainees in Ireland using a web-based logbook

“…Recent data from the United States has shown concerning deficiencies in the operative exposure of general surgical trainees upon the completion of training [18]. Similar trends have recently emerged for senior trainees in general surgery [6,7] and orthopaedics [8-11] from the United Kingdom. We have now shown that operative exposure during basic surgical training is sub-optimal.…”

Validation of an oncoplastic breast simulator for assessment of technical skills in wide local excision

“…The model was found to have good overall anatomical realism, and the simulated tissues were found to handle in a similar fashion to real breast tissues. Of the assessment methods employed, procedure‐specific global rating scales were found to be construct valid and to have excellent inter‐rater reliability, sufficient for high‐stakes examinations. End‐product assessments in the form of a margin width deviation score were able to differentiate surgeons based on high‐ and low‐volume operative experience.…”

“…Skills training in the operating theatre is undeniably superior to other forms of training. However, several factors, including the dilution of exposure to core oncological procedures as a result of working time restrictions, shifts to competency‐based curricula and the potential for bias in assessments by trainers, have led to increasing interest in simulation. Moreover, with the publication of surgeon‐specific outcomes, the public are becoming increasingly aware of variability associated with procedural learning curves, and training opportunities outside the operating room may help to reduce such performance variability.…”

General medical training in gastroenterology: views from specialist trainees on the challenges of dual accreditation

“…Increasing demand on medical registrars' time, both during periods on call and while attempting to attain focused competencies, have been further challenged by a reduction in training time available following the introduction of the European Working Time Directive (EWTD). 1,2 …”