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How long does it take to train a surgeon?

BMJ 2009; 339 doi: (Published 05 November 2009) Cite this as: BMJ 2009;339:b4260

This article has a correction. Please see:

  1. Gretchen Purcell Jackson, assistant professor of surgery and biomedical informatics,
  2. John L Tarpley, professor of surgery and anaesthesiology
  1. 1Vanderbilt Children’s Hospital, 220 Children’s Way, Nashville TN 37232, USA
  1. gretchen.jackson{at}

    Restrictions on the working hours of doctors may be compromising surgical education and patient care. Gretchen Purcell Jackson and John Tarpley argue that greater flexibility is needed in applying regulations

    The time required to train a competent surgeon is a hotly debated topic as working hours for medical trainees are increasingly restricted worldwide. Surgical disciplines are unique in that surgeons must not only acquire medical knowledge but also develop the manual dexterity and, sometimes, the strength and endurance to perform procedures. We examine the evidence from the United States on the effects of duty hour legislation on surgeons’ training.

    Regulations on working hours

    Not all countries regulate working hours, but in those that do, the maximum hours per week for a doctor in training can range from as little as 37 hours in Denmark to 80 hours in the United States. The European Working Time Directive decreased the weekly hours for trainees to 48 in August 2009.1 In the United States, the Accreditation Council for Graduate Medical Education (ACGME) imposed a national limit of 80 hours weekly for all medical trainees in 2003. The Institute of Medicine has just called for greater restrictions, suggesting a five hour “nap” between 10 pm and 8 am for extended shifts and more time off after working periods—from 10 hours after a day shift to 48 hours after three nights of consecutive duty.2

    Sleep researchers applaud these efforts. Heavy night call, defined as every fourth or fifth night, has been shown to compromise attention and vigilance as much as alcohol intoxication,3 and sleep deprived surgeons have exhibited impaired psychomotor performance with laparoscopic simulators.4 As ludicrous as taking a nap while on call may seem, late evening and early morning hours are associated with low temperature and cortisol levels and, in turn, low arousal states, …

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