Surgical training in the United Kingdom has gone through numerous reforms over the past few decades. Whilst the European Working Time Directive (EWTD) brought restrictions on the number of hours worked per week, it is incorrect to assume its introduction has been the cause of diminished training quality. Whilst many will associate the pre-EWTD era with “better” training, this type of cognitive dissonance is both regressive and harmful to the necessary reform required nationwide.
Surgical trainees increasingly feel disenchanted with their training, not because they wish they spent additional hours in the hospital, but because they wish that these hours were filled with a greater proportion of high quality supervised learning events, rather than activities providing minimal training value.
Junior surgeons today spend the majority of their time either on call or covering the wards. During a normal working day, they will be required to perform simple tasks on the ward, such as phlebotomy, rewriting charts or writing discharge summaries. These tasks are of minimal educational value. Reversing the EWTD hours restrictions would not ensure that the opportunities for supervised learning events are improved.
The UK aspires to practice a competency based training system; The CanMED model of training applied recently to surgical training, increased number of hours spent performing training activities by 15-fold, with a 3-fold increase in cost. Focusing on quality and frequency of training activities should be a priority, rather than a poorly thought out nostalgic return to surgical training in the late 20th century. Patients, surgical procedures, and the NHS have all moved on. It is time that surgical training moves forward, and ensures that changes truly enhance training opportunities. Within a competency-based system, time does not equal competency. Time does not equal training.
The elusive ’10,000 hours’ has been referenced time and again, however, it is not evidence-based. Popularised by the author Malcolm Gladwell, based on musings from Ericsson and colleagues, he admits that to suggest spending this much time performing a complex task to become an expert is an ‘oversimplification’, and recognises that ‘practice isn’t a condition for success’.
Finally, as we have yet to hear any reassurances as to whether EU healthcare workers will have automatic right to remain in the UK, BOTA wishes to extend our sincere appreciation to them for their contribution to the NHS, and medical education. We hope that a post-Brexit UK will remain united, to ensure the NHS and its many multinational and multitalented staff continue to provide world class healthcare.
The BOTA Committee