Abstract:

Prior to institution of the European Working Time Directive (EWTD), junior doctors commonly worked in excess of 8 hours per week. This was associated with a high frequency of fatal incidents which were attributed to exhaustion and impaired concentration (e.g. prescribing fatal doses of morphine). The EWTD, which was enacted in 2003, limits doctors in training to a maximum 48-hour week, averaged over a six month period. It lays down minimum requirements in relation to working hours, rest periods and annual leave. There have been concerns that such time limitations reduce clinical exposure and lead to a poorer standard of medical education. In response to these concerns, we have conducted a small-scale study designed to elicit opinions of the EWTD across the UK junior doctor workforce.

Aim:
To canvas opinions regarding the impact of the European Working Time Directive (EWTD) on Junior Doctors working in England.

Methodology:
A five-minute online structured survey sent to junior doctors across several educational regions within England. Likert scales were used to quantify responses. 164 junior doctors completed the survey during October 2012.

Summary of Results:
- 57% felt that the 48 hour week restriction has had a detrimental effect on the quality of their training
- More than 60% believed that EWTD has led to declines in patient safety.
- 71% reported feeling pressurised to document that they had complied with EWTD during monitoring exercises.
- 18% reported that they had lied on monitoring forms in order to comply with EWTD requirements. The main reason cited was fear of angering their supervisors which could lead to impaired job prospects.
- 8% felt that EWTD had improved patient safety.
- 62% reported that they regularly work in excess of 48 hours.

The main reasons cited were to gain more experience and excessive clinical workload.

Conclusions:
English junior doctors feel that EWTD is deterimental to their education and is endangering patients. Perhaps most worryingly, a large majority report feeling pressurised to report compliance with EWTD regulations while a sizeable minority admit lying on forms. EWTD and its regulation mechanisms must be examined and improved if it is to improve patient safety and enable educational opportunity.

Keywords:

Medical management, human resources, junior doctors.