Intended for healthcare professionals


Working time directive has had little negative effect on anaesthetists’ training

BMJ 2012; 345 doi: (Published 06 October 2012) Cite this as: BMJ 2012;345:e6785
  1. Caroline White
  1. 1BMJ
  1. cwhite{at}

Legal limits on the number of hours doctors can work instigated by the European Working Time Directive seem to have had little negative effect on anaesthetists’ specialist training, research published in Anaesthesia indicates.1

The study, conducted in one anaesthetic department of a London teaching hospital, found that years 1 and 2 specialty trainees spent more time in theatre and being supervised by consultants than before the directive was introduced, whereas those in years 3-7 had fewer theatre sessions overall but more supervised sessions.

The findings run counter to the widely held view that the directive has curbed the amount of time available for and the quality of specialist medical training.2

The researchers analysed working patterns during two identical six month periods, one in 1999, before the directive was in force, and the other a decade later in 2009, after it had been introduced.

They analysed the total number of weekly (10 of five hours) theatre sessions attended by trainees, the number of those sessions supervised by a consultant, and the amount of leave taken in the two six month periods. In all, just under 6000 theatre sessions were analysed: 2353 in 2009 and 3572 in 2009.

The results showed that the total number of theatre sessions attended by specialist trainee years 1 and 2, which included obstetrics but excluded intensive care, rose by 37%, while the number supervised by consultants rose by 77% between 1999 and 2009. This was achieved by cutting the number of night shifts worked by each trainee; dispensing with the duty senior house officer role; providing on-call ward and emergency cover; and ensuring that specialty trainees years 1 and 2 didn’t do on-call duties during their initial three month assessment period.

Trainees in years 3-7 attended 27% fewer sessions, but this was largely because of a decrease in the number of solo sessions; their supervised sessions rose by 11% over the same timeframe.

But the authors pointed out, “The issue for debate is whether or not the needs of senior trainees should be regarded as different from those of junior trainees and that, in fact, they need more independent than supervised practice.”

Overall training time did not reduce in either group, because staffing levels expanded in the department for each grade of staff by between 60% and 70%, prompting a 52% rise in the total number of theatre sessions provided.

The amount of sick leave at all levels of training also fell, possibly because compliant rotas are healthier rotas, the authors suggested.

The amount of study leave almost halved over the decade, which may have been because trainees didn’t much care for classroom based training or that the increased number of days off after being on call as part of compliance with the directive avoided the need to apply for it during their working week, the authors said.

Shortly after the directive was introduced the Royal College of Anaesthetists voiced concerns about the effect that the reductions in daytime training lists was having on trainees gaining the required competencies.

Their concerns were echoed by a survey of strategic health authorities in England, 15% of which reported some level of trainee opt out from the working time restrictions,3 and successive surveys from the Group of Anaesthetists in Training,4 the Association of Surgeons in Training,5 and the BMA.6

But the researchers insisted: “High quality training is still possible in the UK, despite reductions in junior doctors’ hours.”

And they concluded: “Our data contradict the hypothesis that the European Working Time Directive has reduced access to training, or suggest that if it has, other factors, such as improved trainee rostering, have overridden its effect.”


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