scholarly journals Teaching and Assessing Surgical Competence

2006 ◽  
Vol 88 (5) ◽  
pp. 429-432 ◽  
Author(s):  
WEG Thomas

Surgical competence and its assessment is one of the most hotly debated topics engaging the profession. In the current climate of diminishing working hours and shorter training, the surgical profession is having to address the complex issue as to how surgery as a craft specialty should be taught, and how to assess when an individual is competent within their chosen sphere as well as how that competence should be maintained. Internationally, there is political pressure upon the professional to achieve contracted activity to comply with political imperatives and, at the same time, to achieve a greater degree of specialisation. Within Europe, the working time directive has led to a shift system of rotas and this, along with a shorter overall period of training, has led to reduced time available to surgical trainees in which to learn their craft.

2008 ◽  
Vol 90 (2) ◽  
pp. 60-63 ◽  
Author(s):  
N Kara ◽  
PV Patil ◽  
SM Shimi

The last decade has seen major changes in the working pattern of surgical trainees. This commenced with the introduction of the maximum 72-hour working week in 1991. The European Working Time Directive reduced the working hours to a maximum of 56 hours, with the intention to reduce it further to 48 hours by 2009. This is additionally affected by compliance with the SiMAP and Jaeger Rulings. The results of the Calman report coupled with those of the Confidential Enquiry into Perioperative Deaths (CEPOD) report have also had a significant effect on the amount and level of experience obtained during surgical training.


2010 ◽  
Vol 92 (3) ◽  
pp. 102-106 ◽  
Author(s):  
CR Chalmers ◽  
S Joshi ◽  
PG Bentley ◽  
NH Boyle

The reform of specialist surgical training – the New Deal (1991), the Calman report (1993) and the implementation of the European Working Time Directive (EWTD, 1998) – has resulted in shorter training periods with reduced working hours. The Calman reform aimed to improve and structure training with regular assessment and supervision whereas the New Deal and the EWTD have concentrated predominantly on a reduction in hours. The adoption of full or partial shift work to provide surgical cover at night compliant to a 56-hour working week, as stipulated by phase one of the EWTD, has resulted in daytime hospital attendance for surgical trainees of an average three days per week despite almost universal acknowledgement of the limited training opportunities available at night.


2009 ◽  
Vol 91 (1) ◽  
pp. 14-15
Author(s):  
Matthew Worrall

Is your hospital ready for the 48-hour week? Do you think your rota as it stands is going to cope? If every member of your clinical team lost eight hours a week from tomorrow, do you think you could continue to offer patients a proper service? At present, for many fellows and members the answer to these questions is probably no. Over half of respondents to a survey undertaken by this College, alongside the Royal College of Anaesthetists, declared they were unprepared for the European Working Time Directive (EWTD) August 2009 deadline of 48 hours per week.


2009 ◽  
Vol 91 (4) ◽  
pp. 132-134 ◽  
Author(s):  
Ryckie G Wade ◽  
James Henderson

Doctors have historically worked long hours to provide patient care but also to gain experience. Over the last decade, working hours have decreased significantly, and the introduction of the European Working Time Directive (EWTD) has formalised this. In August 2009, junior doctors (but not consultants) will be limited to a 48-hour working week (see http://www.dh.gov.uk/en/Managingyourorganisation/Huma nresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/index.htm). There are concerns at all levels of the profession that doctors will not be adequately trained to function at the standard of a current NHS consultant. Doctors with the least experience make the most errors and familiarity with situations and equipment is directly related to competency.


2021 ◽  
pp. 203195252199085
Author(s):  
Merle Erikson

In 2018, the Estonian Ministry of Social Affairs came up with idea of introducing a new category of employee – the autonomous employee – in Estonia. This concept is based on Article 17(1) of the Working Time Directive, which allows derogations from the scope of the Directive for managing executives or other persons with autonomous decision-taking powers. The implementation of the concept of the autonomous employee has been seen as a panacea that makes the organisation of working time more flexible and the regulation relevant to practical needs. However, according to the case law of the European Court of Justice, the scope of Article 17(1) is very narrow. The article examines the concept of the autonomous employee, the nature and organisation of autonomous work, mainly based on EU law, as well as the Finnish Working Hours Act and amendments to the Estonian Sports Act, both of which entered into force in 2020.


2014 ◽  
Vol 96 (9) ◽  
pp. 304-307 ◽  
Author(s):  
PM Brennan ◽  
JJM Loan ◽  
MA Hughes ◽  
IAM Hennessey ◽  
RW Partridge

In parallel with the introduction of working time regulations that have led to changes in working patterns, surgical trainees are taking longer to achieve operative competencies and logging fewer surgical cases. 1–3 The existing style of surgical training appears to provide insufficient operative exposure in limited working hours.


2019 ◽  
Vol 10 (1) ◽  
pp. 17-42
Author(s):  
Sharona Aharoni-Goldenberg

The 2003/88/EC Working Time Directive limits maximum weekly working time to 48 hours per week and establishes minimum daily rest periods of 11 hours. Article 22 thereof allows Member States to opt-out of the 48-hours limitation, thus limiting daily working hours to 13, subject to the respect of the general principles of the protection of the health and safety of workers and to employees’ consent. This article attaches great weight to Member States’ obligations to respect the General Principles, which include, inter alia, the protection of workers’ health and safety; workers’ right to reasonable working hours and to dignity; and the notion of adapting work to workers. It refers to empirical research exposing the distinctly negative implications of work lasting more the 12 daily hours on both workers’ health and safety. It suggests that the limitation of working hours should be treated as equivalent to the supplying of employees in industrial plants with protective equipment. It regards employers’ duty to adapt work to workers as having double meaning: first, longitude of hours worked should fit the physical and mental limitations characterising the human body; second, workload should be adapted to employees’ physical and psychological limitations vis-à-vis work hours. The article concludes that it is doubtful whether allowing regular working hours of up to 13 hours complies with the General Principles; proposes to interpret the derogation as limiting regular daily working hours to 12; and to amend the derogation accordingly. It further concludes that the Directive rightly prioritises workers’ health and safety over economic considerations. Indeed, workers are not a means to achieve employers’ goals; rather, they are human beings whose physical and psychological well-being must be respected in the context of working hours and must prevail over commercial interests. Further, commercial interests actually call for the limitation of working hours to up to 12 on a regular basis. The derogation is also subject to workers’ consent and thus reflects their rights to autonomy in the workplace and to free choice of occupation. Hence, employees should be treated as (part) authors of their own work environments and should therefore have the power to shape the length of their overtime. However, their right to autonomy may be hindered by direct or indirect pressures, especially as they have little bargaining powers and alternatives. In order to achieve actual autonomy in the workplace, this article suggests that: employers inform employees as to their freedom to choose whether or not to opt-out and of the risks to health and safety emanating from overtime; consent be written; and that overtime performed beyond 48 weekly hours without free and informed consent be regarded as unconsenting and deserving of reparation.


2008 ◽  
Vol 90 (2) ◽  
pp. 68-70 ◽  
Author(s):  
K Grover ◽  
M Gatt ◽  
J MacFie

The implementation of the European Working Time Directive (EWTD) has changed the way surgical training is delivered in the European Union. The Jaeger ruling by the European Court of Justice states that health service employers must guarantee an 11-hour rest period within any 24-hour time period, while the SiMAP ruling has enshrined the concept of all time spent at work being classified as working time. To comply with these rulings, as of August 2004 most NHS Trusts across the UK have implemented shift systems for junior doctors. Numerous factors influence an individual's ability to adapt to working shifts and this has major implications both for patients and for surgical trainees.


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