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LETTERS: David T Reilly No time to train the surgeons: Golden age of surgical training didn't exist BMJ 2004; 328: 1133-c-1134-c [Full text]

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Changes in junior surgeon's working hours - Are there lessons to be learnt from the airline industry?

Peter U. Kalu, Peter E. Butler   (28 April 2005)

Changes in junior surgeon's working hours - Are there lessons to be learnt from the airline industry? 28 April 2005
Peter U. Kalu, Plastic Surgery Research Fellow Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, NW3 2QG, Peter E. Butler Send response to journal: Re: Changes in junior surgeon's working hours - Are there lessons to be learnt from the airline industry?	Dear Editor, The training of surgeons and commercial airline pilots has often been seen as comparable. Both in their own way are trained to be familiar with the management of unusual situations which may arise due to technical difficulties. Adequate experience and training are seen as key and so we read with interest the employment tribunal ruling in favour of the pilot Jessica Starmer against British Airways (BA)(1). The case highlights some fundamental concerns pertaining to how much training is required to be proficient at one’s job. Starmer was successfully able to argue that the company had unfairly refused to let her halve her hours in order to look after her one-year-old daughter. The airline felt only pilots with more than 2,000 flying hours experience (around three years of full time flying) should work at 50 per cent levels. Crucially the tribunal concluded B.A.‘had not given any cogent evidence as to why it would be unsafe or in any way unsuitable for the claimant, or any other pilot, to fly at 50% of full time’. Reviewing the case and wishing to learn lessons for surgical training we wonder if there are a crucial number of hours training required to be proficient? In the light of further planned reductions in working hours(2), will surgical trainees achieve this? We think that the solution may lie in pilot training. Pilots have to pass a specialist examination termed the Airline Transport Pilot’s Licence (ATPL) before they can practice. Similarly, surgeons must pass their specialist examination called the Membership of the Royal College of Surgeons (MRCS) but after this the surgeon is only required to demonstrate his/her surgical knowledge in an exit specialist examination. The continued situation for pilots is very different, they undergo rigorous continual assessments of competence which include medical checks every year until they are 40 and then every six months until 65 in addition to biannual technical assessments of ability in simulators that result in certificates of Line Proficiency Check (LPC) and Operational Proficiency Check (OPC). Are patients any less deserving of safety than commercial passengers? Is regular assessment of a surgeon’s ability not desirable? The advent of revalidation may force views to change. We believe the time has come for the surgical profession to develop a regular assessment of surgical ability analogous to the LPC and OPC. We feel that surgical knowledge is currently well examined with present examination methods but we would suggest that assessments of technical competence become more objective and validated using technical assessment tools such as global rating scales and checklists(3). Our final request would be for closer scrutiny of the effects that change in a junior surgeon’s training will have on competency and whether there is a critical number of hours beyond which even surgeons must not go. Reference List (1) Andrew C. BA ordered to let pilot halve hours for her child. Guardian 2005 Apr 23. (2) Pickersgill T. The European working time directive for doctors in training. BMJ 2001 December 1;323(7324):1266. (3) Kalu PU, Atkins J, Baker D, Green CJ, Butler PE. How do we assess microsurgical skill? Microsurgery 2005;25(1):25-9. Competing interests: None declared