Surgical training should be provided in a 48 hour week, says surgery college president

Surgical training should be provided within a 48 hour week, Ian Ritchie, president of the Royal College of Surgeons of Edinburgh, has said.

Ritchie said that surgical trainees should not have to opt out of the working time regulations to receive enough training. Earlier this year the government said that it would consider how to encourage more doctors to opt out of working time restrictions established to comply with the European Working Time Directive.1

Speaking to BMJ Careers, Ritchie said, “If the legal situation is [that doctors can work a maximum of] 48 hours a week, I don’t think we should be suggesting to our members and fellows that they derogate or go away from what is a legally established situation, which, after all, has been put there for the benefit of the doctors and the patients.”

Ritchie said that it was up to the health service to find a way to accommodate the changes introduced by the working time regulations and ensure that trainees were being trained as well as working. “The difficulty for medicine is that it’s a 24 hour job, in terms of providing cover for sick people. The question for me is whether the time trainees spend working overnight is actually training.”

He added, “There is a big difference between providing service and being trained, and overnight it is not training, its service delivery. And, under the current arrangements, if [trainees] work during the night they can’t be around during the day, which is when most of the good quality training happens.”

Ritchie said it was important that, if trainees did work overnight, they were supervised by a consultant who could provide training. “But to justify having the consultant there working overnight you’d probably have to have a large volume of work going through. The volume of working going through at night is actually very low.”

He said that the health service therefore needed to go “back to basics” and work out how it could deliver a service without using doctors in training. “You might get a position where trainees were inserted into the health service and received very high quality training, but if you took the trainees away for whatever reason, the service wouldn’t fall down,” he said.

Consultants also needed to get involved in redesigning service delivery, Ritchie said. “Fundamentally, I think there needs to be more engagement by consultant staff. When I say engagement, I mean engagement in thinking about how they deliver the service and how they can create an environment that is conducive to good training and that looks after the trainees.”