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Adherence to the European Working Time Directive and its influence on clinical experience

  • Conor McLernon (a1), Floriana Coccia (a2) and Ashokkumar G. Patel (a3)
Abstract
Aims and Method

To identify deficits in senior house officer (SHO) on-call experience since the advent of accident and emergency (A&E) liaison nurse cover, by retrospectively examining records of 267 A&E patients between October 2004 and January 2005. We collated our data in terms of presenting symptoms.

Results

The majority (59%) of A&E referrals received no SHO attention. In particular, SHOs had no involvement in 69% of ‘social’ presentations, 72% of presentations involving drug or alcohol misuse and 63% of presentations with associated suicidality, self-harm or overdose.

Clinical Implications

Clinical experience is being lost in key areas, and is not yet being replaced via other routes. There is a pressing need to consider methods to ensure development of these skills, at the same time as adhering to the European Working Time Directive.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Brown, N. & Bhugra, D. (2005) The European Working Time Directive. Psychiatric Bulletin, 29, 161163.
Callaghan, R., Hanna, G., Brown, N., et al (2005) On call: a valuable training experience for senior house officers? Psychiatric Bulletin, 29, 5961.
Chesser, S., Bowman, K. & Phillips, H. (2002) The European Working Time Directive and the training of surgeons. BMJ, 325 (suppl.), S69.
Department of Health (2001) The Mental Health Policy Implementation Guide. Department of Health.
Griffin, G. & Bisson, J. I. (2001) Introducing a nurse-led deliberate self-harm assessment service. Psychiatric Bulletin, 25, 212214.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Adherence to the European Working Time Directive and its influence on clinical experience

  • Conor McLernon (a1), Floriana Coccia (a2) and Ashokkumar G. Patel (a3)
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eLetters

EWTD and Supervision

Vishal Agrawal, SpR in Psychiatry
25 September 2007

There has been lot of scepticism about the introduction of European working time directives (EWTD) for junior doctors. The fears have mainly been around the quality of training they would receive. McLernon et al also explore this in their article and feel clinical experience is being lost in some key areas.

We took a look at the effect of EWTD on trainee supervision in South Essex Partnership NHS Foundation Trust. A survey was conducted in July 2003, when we had just introduced the partial shift system, and repeated in February 2007. All SHOs were asked about their supervision experience. Regular weekly supervision rate had dropped from 75% in 2003 to 68% in 2007. The main reasons for this was lack of time due to on call commitments, planned leaves and day off after night shifts. However, therewere some improvements following the survey in 2003. These centred mainly on the quality of supervision offered. There was an increase in percentageof trainees receiving individual supervision and a drop in those receivinggroup supervision. Also, there was an increase in number of trainees having supervision for the stipulated one hour.

Trainees were taking an active role in deciding what topics they wanted to discuss in the supervision. This is especially relevant in post MMC world where trainees will have to take the initiative for work placed based assessments and supervision will provide a suitable platform for developing strategies to help complete these assessments
... More

Conflict of interest: None Declared

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New Ways of Working need New Ways of Training

Ramneesh Puri, ST3 Psychiatry
14 August 2007

McLernon et al have highlighted a very relevant and in some ways contentious issue through this article. Being a "transition SHO" i have personal experience of the concerns related to the impact of EWTD working on the training of junior doctors.

Since the advent of the EWTD an average junior doctor spends only just over half of his/her 6 month post in the ward under the supervision of his/her consultant. Annual leave,study leave (MRCpsych course and other courses),2-3 weeks of nights (depending on the rota)and the consultant's leaves being the factors responsible.Add to this the fact that lots of oncalls are now non resident "second on-calls" where juniors are rarely called to assess patients, it almost seemslike a training crisis.

However it is important that hasty conclusions are not drawn and the impact on training is not exaggarated. The old system of "long weekends" assessing "revolving door patients" coming in drunk in the A&Es had its own pitfalls and wasn't entirely suited to delivering rounded training.

It is also important to realise that seeing scores of acute emergencies doesn't necessarily prepare juniors better for the MRCPsych exam. What is needed is a better understanding of the theoretical basis of illnesses along with an ability to propose management plans for complex presentations taking into account all the relevant bio-psycho-social factors. This needs observational and experiental learning in multidisciplinary enviornments both on the wards and in the community.

The New Ways of Working (NWW) policy document of the Department of Healthplaces clear emphasis on the changing role of psychiatrists. We will be increasingly dealing with fewer patients and expected to case-manage only complex cases. It is the other members of the multidisciplinary team who would take up the care coordinator roles for a majority of our current patients.The new Mental Health bill is already a step towards this.

Its therefore important that we move on in our attitudes towards our own training. The training needs of the doctors of tomorrow should not be defined by the duties of the doctors of yesterday. Our new ways of workingshould be the breeding ground for our new ways of training. Only then will we be able to play a continuing constructive role towards our patients' management.
... More

Conflict of interest: None Declared

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