HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eric Lim Steven Tsui Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lim, E. Search for Related Content PubMed PubMed Citation Articles by Lim, E. Related Collections Education Professional affairs

Eur J Cardiothorac Surg 2006;30:574-577
© 2006 Elsevier Science NL

Impact of the European Working Time Directive on exposure to operative cardiac surgical training

Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge CB3 8RE, UK

Received 19 December 2005; received in revised form 10 April 2006; accepted 19 April 2006.

^_* Corresponding author. Tel.: +44 1480 830 541; fax: +44 1480 830 336. (Email: eric.lim{at}cvsnet.org).

Objective: To evaluate the impact of the reduced working hours, an anticipated decline in case load and increasing patient risk profile, we performed a cohort study to determine the factors that influenced operative surgical training. Methods: A historic cohort study design was utilised, and data were acquired from a prospective operative surgical database a year before, and a year after the introduction of the European Working Time Directive (EWTD) compliant rota (1st August 2004). Logistic regression was used to determine the predictors of operative surgical training, and individual variables were ranked by likelihood ratio. Results: In total, 3312 cardiac surgical operations were performed over a 2-year period between 3rd August 2003 and 31st July 2005. The proportion of cases performed by trainees was 39% (626/1587) in the year before and 40% (695/1725) in the year after the introduction of WTD compliant rota. There were no differences in operative risk (logistic EuroSCORE of 8, P = 0.853). Independent predictors for surgery performed by a trainee (in descending order of influence) were the consultant in charge ( 273.1; P < 0.001), procedure performed ( 163.5; P < 0.001), increasing seniority of trainee ( 142.3; P < 0.001), revision surgery ( 45.9; P < 0.001), lower EuroSCORE ( 17.6; P < 0.001), and better ventricular function ( 7.8; P = 0.020). The odds ratio of an operation performed by a trainee increased after the introduction of the EWTD compliant rota to 1.19 (95% CI 1.00–1.41; P = 0.045). Conclusions: With a successful institution-specific training module and a commitment to training, exposure to operative surgical training can be sustained despite shortening of working hours.

Key Words: Cardiac surgery • Training • Working time directive

This article has been cited by other articles:

				D. West European Working Time Directive implementation and cardiothoracic training: larger centers may optimise training Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 958 - 958. [Full Text] [PDF]

				C.-A. Mestres, J. M. Revuelta, and A. C. Yankah Reply to Sadaba et al. Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 960 - 960. [Full Text] [PDF]

				E. Lim Reply to West Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 958 - 959. [Full Text] [PDF]

				T. F. Molnar The price to pay: perversions in (cardio)thoracic surgical training Eur. J. Cardiothorac. Surg., March 1, 2007; 31(3): 569 - 569. [Full Text] [PDF]

				C.-A. Mestres, J. M. Revuelta, and A. C. Yankah Reply to Thomas F. Molnar Eur. J. Cardiothorac. Surg., March 1, 2006; 31(3): 570 - 570. [Full Text] [PDF]