Head To Head

Can doctors be trained in a 48 hour working week?

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7323 (Published 10 December 2014) Cite this as: BMJ 2014;349:g7323
  1. Andrew Hartle, president, Association of Anaesthetists of Great Britain and Ireland, London W1B 1PY,
  2. Sarah Gibb, chair, Group of Anaesthetists in Training, Association of Anaesthetists of Great Britain and Ireland,
  3. Andrew Goddard, registrar, Royal College of Physicians, London NW1 4LE
  1. Correspondence to: A Hartle president{at}aagbi.org, A Goddard andrew.goddard{at}rcplondon.ac.uk

Andrew Hartle and Sarah Gibb find no evidence that implementation of the European Working Time Directive has led to a decline in the quality of training. But Andrew Goddard thinks that 48 hours doesn’t give sufficient time for some specialties and notes trainees’ dissatisfaction

Yes—Andrew Hartle and Sarah Gibb

Since August 2009 all UK trainee doctors have been restricted to a 48 hour week (averaged over 26 weeks). The purpose of the European Working Time Directive, implemented into UK law as the working time regulations, is to encourage the safety and health of workers by enforcing periods of rest and annual leave, as well as the maximum working week.

No one could wish a return to the unregulated 100 hour or more weeks of former generations. However, a constant concern with the regulations has been the potential negative effect on the quantity and quality of medical training—and, by extension, patient care. Is there any evidence to substantiate these fears? Is quantity any substitute for quality?

Catalyst for redesign

In his 2010 review on the effect of the working time regulations on the quality of medical training John Temple stated that “high quality training can be delivered in 48 hours [a week].” However, he emphasised that barriers to such high quality training would continue if trainees had a major role in out of hours service, were poorly supervised, or had limited access to learning.1 He argued that the regulations should be a catalyst for redesigning service and training. The traditional model of experiential learning, where trainees spend long periods delivering service and acquiring skills and knowledge should be replaced by a consultant delivered service and high quality training within a service environment with appropriate supervision.

A review commissioned by the General Medical Council in 2012 concluded that although the quality of the literature varied, the balance of evidence …

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