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Shorter Working Hours May Compromise Surgeon Training

Analysis argues that patient safety may be suffering and that a new approach is needed

FRIDAY, Nov. 6 (HealthDay News) -- Although restricting trainee surgeons' working hours may improve the trainees' quality of life, it may also compromise their education and undermine patient safety, according to an article published Nov. 5 in BMJ.

Gretchen Purcell Jackson, M.D., and John L. Tarpley, M.D., of Vanderbilt Children's Hospital in Nashville, Tenn., describe how restrictions on trainees' working hours range from as low as 37 hours a week in Denmark to 80 in the United States, with the European Working Time Directive restricting trainees to 48 hours of work per week in the European Union. However, they also point out that acquiring elite levels of expertise requires 10,000 hours of practice and 10 years of intensive work.

Studies show alarmingly negative trends in terms of patient safety after the introduction of restricting surgeons' working hours, the authors state, citing the example of a significant increase of both preventable and non-preventable complication rates and a doubling of missed injuries at a level one trauma center after the introduction of an 80-hour maximum working week.

"The U.S. rules permit 80 hours a week on average over four weeks, and we recommend flexibility, discretion, and common sense for regulations of shift lengths and periods of rest," the authors write. "If enough hands-on patient care as well as operative experience cannot be achieved during a restricted working week, surgical training should be extended, perhaps with incremental accreditation so that earlier independence for minor procedures offsets a longer period of instruction."

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