Well, trainees cannot be trained in a 48 hour week, if they are doing nothing but service work for 48 hours. That seems unarguable. If you require your trainees to do service work for 48 hours, and you want to train them as well, then they have to work more than 48 hours. The price is that their ability to learn will fall, steeply, as they get more and more tired, and so will their ability to provide safe patient care.
The implication is that, if you are serious about patient safety, staff well-being, or even the European Working Time Directive, you *must* restructure your training. If you want to move away from a trainee delivered service, which is, to a fair extent, what you have, and even more, what we have in Ireland, then you have to restructure your staffing levels, and the roles of fully trained staff.
This can be done cleverly, or poorly. Largely, in the UK and Ireland, it seems to have been done rather poorly. However some specialties, including anaesthetics, amd my own former specialty, paediatrics, show that it can be done right.
You can look, carefully, at what doctors actually do and see are they the best, most effective, most economical staff to do it. Expanded roles for nursing staff, smarter use of ICT, and better use of administrative staff, can all help to make the transisiton to decent safe working lives for trainees much less painful. You have to want to change.
Regards,
Anthony Staines
PS The NCHD strike in Ireland in 1988 was aboout overitme rates (http://www.medicalindependent.ie/27327/the_ethics_of_taking_strike_actio...) . We wanted to make ourselves expensive, so that managers would have an incentive to make more effective use of our time. What happened instead was that our salaries rocketed, (as we were paid time and a half, instead of one-third time, for every hour of overtime), but our working hours did not fall. Never underestimate the willingness of mangers to find the easiest option for them :-)
Rapid Response:
Well, trainees cannot be trained in a 48 hour week, if they are doing nothing but service work for 48 hours. That seems unarguable. If you require your trainees to do service work for 48 hours, and you want to train them as well, then they have to work more than 48 hours. The price is that their ability to learn will fall, steeply, as they get more and more tired, and so will their ability to provide safe patient care.
The implication is that, if you are serious about patient safety, staff well-being, or even the European Working Time Directive, you *must* restructure your training. If you want to move away from a trainee delivered service, which is, to a fair extent, what you have, and even more, what we have in Ireland, then you have to restructure your staffing levels, and the roles of fully trained staff.
This can be done cleverly, or poorly. Largely, in the UK and Ireland, it seems to have been done rather poorly. However some specialties, including anaesthetics, amd my own former specialty, paediatrics, show that it can be done right.
You can look, carefully, at what doctors actually do and see are they the best, most effective, most economical staff to do it. Expanded roles for nursing staff, smarter use of ICT, and better use of administrative staff, can all help to make the transisiton to decent safe working lives for trainees much less painful. You have to want to change.
Regards,
Anthony Staines
PS The NCHD strike in Ireland in 1988 was aboout overitme rates (http://www.medicalindependent.ie/27327/the_ethics_of_taking_strike_actio...) . We wanted to make ourselves expensive, so that managers would have an incentive to make more effective use of our time. What happened instead was that our salaries rocketed, (as we were paid time and a half, instead of one-third time, for every hour of overtime), but our working hours did not fall. Never underestimate the willingness of mangers to find the easiest option for them :-)
Competing interests: No competing interests