scholarly journals Universal SHO and SpR shift rotas adversely influence SHO operative experience

2006 ◽  
Vol 88 (7) ◽  
pp. 244-246 ◽  
Author(s):  
C Beaton ◽  
MR Stephens ◽  
AN Hopper ◽  
WG Lewis
Keyword(s):  
General Hospital ◽  
Shift Work ◽  
Clinical Experience ◽  
Surgical Training ◽  
General Surgery ◽  
District General Hospital ◽  
European Working ◽  
Training Post ◽  
Operative Experience ◽  
Working Time Directive

The European Working Time Directive (EWTD) will reduce the clinical experience obtained by surgeons prior to attaining consultant status from 21,000 surgical hours to 7,640 hours, 1 with shift work obligatory for compliance. We have shown previously that the operative experience of SHOs in general surgery is on the wane in our own hospital, varies with subspecialty interest 2 and has witnessed further erosion by the introduction of the EWTD. 3 The aim of this study was to assess the influence of an all tier shift rota on the emergency and elective operative experience of SHOs in a category 1 general surgical training post working in a large district general hospital serving a population of 600,000.

The Lost Generation: Impact of the 56-hour EWTD on Current Surgical Training

2010 ◽  
Vol 92 (3) ◽  
pp. 102-106 ◽  
Author(s):  
CR Chalmers ◽  
S Joshi ◽  
PG Bentley ◽  
NH Boyle
Keyword(s):  
Shift Work ◽  
Surgical Training ◽  
New Deal ◽  
Working Hours ◽  
Lost Generation ◽  
Surgical Trainees ◽  
European Working ◽  
Working Time Directive ◽  
Training Opportunities ◽  
The New Deal

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.

scholarly journals Future of Vascular Surgical Training: The Trainees' Views

2008 ◽  
Vol 90 (2) ◽  
pp. 96-99 ◽  
Author(s):  
Toby Richards ◽  
Keith Jones
Keyword(s):  
Vascular Surgery ◽  
Surgical Training ◽  
General Surgery ◽  
Endovascular Aneurysm Repair ◽  
Endovascular Techniques ◽  
European Working ◽  
The Uk ◽  
Aneurysm Repair ◽  
Working Time Directive ◽  
Future Work

INTRODUCTION In the UK, surgical training includes all aspects of general surgery. Vascular surgery is not an independent specialty. We wished to assess the views of vascular trainees in UK on the future of vascular surgery and training. MATERIALS AND METHODS Trainees were surveyed in 2003, 2004 (after introduction of the European Working Time Directive) and 2005, concentrating on four areas – future practise of vascular surgery, role of endovascular training, vascular specialisation and future training. RESULTS The majority of trainees want to practise vascular surgery alone. In 2003, 80% thought training should include endovascular techniques. By 2005, all trainees regarded training as mandatory as endovascular techniques would represent a significant part of their future work. Opinion changed on training; from 4 years general then 2 years vascular surgery (qualification in general surgery) to 2 years general and 4 years vascular surgery (specialist qualification in vascular surgery; P < 0.0001). Opinion also changed, that vascular surgery should spilt from general surgery to form its own speciality (P < 0.0007). CONCLUSIONS Trainees now regard training in endovascular techniques and endovascular aneurysm repair as mandatory. The majority wish to specialise from general surgery and achieve a separate qualification in vascular surgery.

scholarly journals Hospital at Night and the surgical middle grade: An Observational Study from a District General Hospital

2006 ◽  
Vol 88 (1) ◽  
pp. 24-26 ◽  
Author(s):  
SR Aspinall ◽  
DM Bradburn ◽  
SJ Mills
Keyword(s):  
Observational Study ◽  
General Hospital ◽  
New Deal ◽  
Emergency Surgery ◽  
Cumulative Effect ◽  
District General Hospital ◽  
Middle Grade ◽  
European Working ◽  
Working Time Directive ◽  
The New Deal

The cumulative effect of Calmanisation, the New Deal, the European Working Time Directive (EWTD) and the Jaeger and SiMAP rulings has been to reduce trainees' exposure to emergency surgery. The Hospital at Night project has been designed to create a generic team of doctors to maximise the number of doctors available for any task by removing boundaries between teams. This project is currently being piloted in a number of centres around the country, including Wansbeck General Hospital (WGH) a 323-bed district general hospital (DGH) serving a population of 240,000 in Northumberland.

Changing times? Doctors' sick leave in a district general hospital

2008 ◽  
Vol 90 (4) ◽  
pp. 130-132
Author(s):  
DJ Duffy ◽  
L Jeys ◽  
NJ London
Keyword(s):  
General Hospital ◽  
Medical Staff ◽  
Career Guidance ◽  
District General Hospital ◽  
Junior Doctors ◽  
Firm Structure ◽  
Junior Staff ◽  
European Working ◽  
Changing Times ◽  
Working Time Directive

Most junior doctors now work shifts to comply with the European Working Time Directive (EWTD) and the New Deal. Increasingly there has been general concern among senior medical staff that this has undermined the traditional medical team or 'firm' structure. The effect of this has been witnessed most acutely with the fragmentation of many units, with lead clinicians often struggling to develop and foster a working relationship with their junior staff. The net effect has been a loss of clear line management, team support and in some cases, career guidance. As a result an increase in absenteeism in junior doctors has been perceived to occur. This study set out to investigate the rates of such absenteeism among medical staff in a district general hospital.

scholarly journals Near-misses and Missed Opportunities: Poor Patient Handover In General Surgery

2008 ◽  
Vol 90 (3) ◽  
pp. 96-98 ◽  
Author(s):  
M Tokode ◽  
L Barthelmes ◽  
B O'Riordan
Keyword(s):  
General Surgery ◽  
Working Hours ◽  
Junior Doctors ◽  
Learning Potential ◽  
Missed Opportunities ◽  
Near Misses ◽  
Medical Careers ◽  
European Working ◽  
Working Time Directive ◽  
Patient Handover

Since the introduction of shift systems for junior doctors as part of the European Working Time Directive, different teams of doctors look after patients over the course of a day. This requires ro bust handover mechanisms to pass on inf ormation between differ ent teams of doctors to avoid misses and near-misses in patients' care. Modernising Medical Careers shortens the placements of doctors in foundation programmes in general surgery to four months compared with six-month placements as pre-registration house officers in the past. The reduction in working hours will therefore adv ersely aff ect exposur e and experience of junior doctors in general surg ery unless the learning potential of time spent at work is maximised.

Surgical assistance - who can help?

2014 ◽  
Vol 96 (7) ◽  
pp. 244-246 ◽  
Author(s):  
Susan Hall ◽  
Julie Quick ◽  
Andrew Hall ◽  
Adrian Jones
Keyword(s):  
Patient Care ◽  
Surgical Training ◽  
Perioperative Care ◽  
Working Time ◽  
European Working Time Directive ◽  
Surgical Assistance ◽  
European Working ◽  
High Standards ◽  
Working Time Directive

Changes affecting surgical training, together with the implementation of the European Working Time Directive, have necessitated increased reliance on non-medically qualified assistants. Such assistance must be performed by suitably educated personnel. The RCS, The Perioperative Care Collaborative (PCC) and The Association for Perioperative Practice (AfPP) all play a role in ensuring high standards of patient care. In so doing, they have determined the circumstances and the level at which such assistance may be given by three grades of perioperative personnel. It is essential that surgeons understand and support such non-medically qualified colleagues in adhering to these standards.

scholarly journals Surgical anatomy in the age of EWTD and ISCP

2008 ◽  
Vol 90 (7) ◽  
pp. 245-245
Author(s):  
Vishy Mahadevan
Keyword(s):  
Surgical Training ◽  
Surgical Anatomy ◽  
Working Time ◽  
European Working Time Directive ◽  
Medical Careers ◽  
European Working ◽  
The Face ◽  
Considerable Impact ◽  
The Uk ◽  
Working Time Directive

Four major new initiatives being implemented nationally are set to have a considerable impact on the nature of surgical training in the UK. When fully operational, these developments will alter the face of surgical training: the European Working Time Directive (EWTD), Modernising Medical Careers (MMC), the Intercollegiate Surgical Curriculum Programme (ISCP) and the new MRCS examination.

scholarly journals Introducing a reserve waiting list initiative for elective general surgery at a District General Hospital

2019 ◽  
Vol 8 (3) ◽  
pp. e000745 ◽  
Author(s):  
Vaki Antoniou ◽  
Olivia Burke ◽  
Roland Fernandes
Keyword(s):  
General Hospital ◽  
General Surgery ◽  
Fast Track ◽  
Operating Time ◽  
District General Hospital ◽  
Waiting List ◽  
Related Factors ◽  
Simple Protocol ◽  
Significant Burden ◽  
Training Opportunities

Cancelled operations represent a significant burden on the National Health Service in terms of theatre efficiency, financial implications and lost training opportunities. Moreover, they carry considerable physical and psychological effects to patients and their relatives. Evidence has shown that up to 93% of cancelled operations are due to patient-related factors. An analysis at our District General Hospital revealed that approximately 18 operations are cancelled on the day of surgery each month. This equates to 27 hours of allocated operating time valued by the trust as £67 500, not being used effectively. This retrospective quality improvement report aims to reduce unused theatre time due to cancelled elective operations in general surgery theatres—thereby improving theatre efficiency and patient care. To ascertain the baseline number of cancelled operations, an initial review of theatre cases was undertaken. Further review was then completed after implementation of two improvements—a short notice surgical waiting list and fast track pre-assessment clinics. The results showed that implementation of the reserve surgical waiting list reduced unused operating time by an average of 2.25 hours per month. By further adding in the fast track preassessment clinic, these figures increased to an average of 11.5 hours over the next 3 months. This precipitated a reutilisation of otherwise wasted theatre time. Economic impact of this time amounts around £28 750 a month, after implementation of both improvements. Simple protocol changes can lead to large improvements in the efficient running of theatres. The resultant change has improved patient satisfaction, led to greater training opportunities and improved theatre efficiency. Extrapolation of our results show better usage of previously underused theatre time, to the equivalent worth of £345 000. Further implementation of these improvements in other surgical specialities and hospitals would be beneficial.

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