At a presentation to be delivered at the British International Congress of Obstetrics and Gynaecology in Belfast today, a survey of trainees will highlight how the European Working Time Directive (EWTD) has had a negative impact on junior doctor training.
The Royal College of Obstetricians and Gynaecologists (RCOG) 5th Trainees’ Survey shows how the EWTD, six months after its implementation, has in some instances been detrimental to postgraduate medical training.
The survey was sent to all individual O&G trainees on the RCOG’s register and 964 responses were received. Trainees were asked a range of questions including pay bands, the types of rota patterns used in their trusts and the effect of the EWTD on their training and work.
The key findings are:
- 90% of trainees had to cover rota gaps during day (ie. posts were unfilled)
- While most trainees do the standard eight-hour shift, 20% mentioned they work on shifts that lasted between 13 to 24 hours in a day. 10% of trainees mentioned doing seven continuous nights of shift work
- 49% of trainees said that trusts expected them to cover rota gaps during evenings and weekends. 36% were expected by their trusts to cover rota gaps at night
- 16% of respondents mentioned that their rotas were not EWTD compliant (ie. 48hours/week). The main reason for non-compliance in the majority of cases (90%) was because there was not enough staff.
- The vast majority of ST2 trainees (>80%) did not feel competent to take independent ST3/2nd on-call duties by the end of the training year.
- For trainees at ST3 level, 72% took on 2nd on call duties at the start of their training year. Of the 28% who required extra support, 6.5% had the support of a consultant, 48% had a senior trainee covering while 45% had no cover at all during out-of-hours on-call.
- 30% of trainees felt that there had been an overall decrease in training sessions (50% were unsure).
Survey results show that the rota gaps are having a negative impact on training. Respondents felt that achieving competence and the confidence to do independent 2nd on-call duties may be an issue at ST2/3 levels. More alarmingly, those on subspecialty and advanced training felt that obstetric on-call cover impacted negatively on their training. ST5 trainees feel less confident to do independent out-of-hours acute gynaecology.
The purpose of the EWTD was to reduce the number of working hours for trainee doctors. This move was meant to improve safety. However, the majority of trainees in this survey stated that the ETWD made no real difference in patient safety, their work-life balance and levels of job satisfaction. In fact, trainees were not getting enough time to train because many of them were on enforced time off in-lieu after they had been on-call. 74% of those surveyed returned to work voluntarily on their days off to take advantage of training opportunities they were missing.
However, it was not all bad news. Trainees mentioned that it was because of the EWTD that supervision by senior staff has improved. Another positive knock-on effect was increased consultant presence in the labour ward.
Dr Jayanta Chatterjee, Chair of the RCOG Trainees’ Committee said, “Our survey has revealed the main pressure points in O&G services provided by trainees with the introduction of the European Working Time Directive. The picture isn’t all bad, indeed, many trainees noted that their labour ward experience and supervision on labour ward was ‘good’ or ‘very good’.
“We now need to look at ways to ensure that we continue to provide safe and good quality services, alongside ample training opportunities for junior doctors. O&G trainees are enthusiastic and hard-working and many are very keen to learn more. We must find ways to make O&G a rewarding career option for our junior doctors.”
Dr Maggie Blott, RCOG Vice President (Education) said, “The results of this survey will help us to focus on the weak areas in specialty training. It has raised issues which we are particularly concerned about, such as the knowledge gaps and the lack of opportunities to train, which this survey has identified.
“What we need to remember is that O&G is a high-intensity discipline and long shifts where trainees have little rest will compromise safety. We must strike a balance between what trainees can achieve within the confines of a normal working day with the demands of work. We will work with the trainees and trusts to ensure that our trainees receive adequate training and don’t burn-out at the same time.”
The RCOG Trainees’ Committee will continue to monitor the situation periodically and review these survey findings in a year’s time.
Ends
To speak to Dr Blott or Dr Chatterjee, please call 020 7772 6446.
Notes
Other findings from the survey:
- There are more female (73%) than male (27%) trainees in O&G.
- 49.2% were from the UK, 5.5% from the EU and 45.3% were from outside the EU.
