How to manage surgeon training amid new work-hour restrictions

Last month amid much controversy, the new European Union rules on junior doctors’ working hours went into effect, lowering the cap from 56 hours to no more than 48 in 1 week. Among the many challenges facing the medical industry in the wake of this most recent ruling is how to maintain appropriate levels of surgeon training in an environment of increasingly stringent constraints on time spent at work.

When the new rules went into effect on August 1, a number of organizations and associations that have long been critical of the European Union’s Working Time Directive came out with studies or commentary warnings of the negative impact the directive might have on medical practice and patient outcomes. Most of those pieces focused on the short-term effects such as the costs associated with the enforcement of the new rules or the physician access issues that could arise if an H1N1 pandemic emerges in the fall.

While those are both important issues that need to be considered by the medical community, many of us in the industry are even more concerned by the long-term impact the new rules may have on young doctors’ ability to advance their skills through ongoing training and education. Surgeons are also worried. The Royal Academy of Surgeons, which opposes the rules, has publicly stated that the shorter work week could “ruin the training” of junior doctors and Dr. Andy Thornley, Chairman of the British Medical Association's junior doctors' committee, told the BBC that British Medical Association members are worried about their training and long-term status. He said, “The future of the NHS depends on the production of the high-quality consultants of tomorrow. This cannot be done if standards of training are allowed to slide.”

At Stryker, our international surgeons have been telling us that this issue presents enormous challenges to resident institutions as well as to industry in general. At a recent panel discussion we organized, participating surgeons told us that industry as a whole must continue to focus on surgeon education and its delivery locally and regionally.

In addition to asking for continued action on the issue, the surgeons also maintained the Web-based learning may present new opportunities to bridge the growing gaps between what surgeons want to invest in ongoing training and what the rules will permit them to do time-wise. Web-based learning, done well, not only helps us to deliver education at the moment of need, but also in a highly time-efficient manner. Web-based learning also removes much of the time and travel costs associated with training. The panel also noted that residents, who are likely to be more familiar and comfortable with Web technologies than older doctors, are more likely to review and perform simulated techniques online.

So, on behalf of our surgeon partners, it is clear that industry must continue to devote time and resources to the development of innovative training programs that will enable young doctors to participate in all the training and education programs they need to maintain the highest standards of care.

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Laura Piccinini is vice president and general manager of orthopaedics for Stryker Europe.