The impact of the Working Time Regulations on medical education and training
What were the key findings?
Since 2009, and the full implementation of the Working Time Regulations, doctors in training have been restricted to working no more than 48 hours a week, with the hours averaged over 26 weeks.
We commissioned the University of Durham to explore the impact of these restrictions, which are intended to promote health and safety by restricting the hours doctors work, on medical education and training within the UK.
The research comprised a series of organisational case studies, seeking the views of trainees, deanery and Trust/Health Board staff from across the UK, and a supporting literature review.
The literature review, which includes evidence from outside the UK where longer hours are more common, demonstrates a link between working long hours and fatigue, and provides evidence to support the adverse impact of fatigue on patient safety.
The case studies, although based on a small number of 82 doctors in training across the UK, found that while the regulations have led to fewer hours, some problems such as stress and fatigue, still remain. In addition, the report notes that some doctors in training are working long hours in their busiest shifts increasing the potential for mistakes.
The majority of doctors in training welcomed the many benefits associated with the Regulations. However, with an increasing tension between service delivery and education and training, a number of individuals reported having to undertake learning activities in their own time.
Doctors in training generally felt unable to challenge bad rotas and working practices and there was a perception that existing quality management processes were not sufficiently sensitive to these issues, with concerns also raised over the accuracy of processes for monitoring hours worked.
The research concludes by noting that the Working Time Regulations were not a simple intervention, but a change to an already complex system (which includes the New Deal Regulations). As such, any solutions to ongoing concerns will need to be similarly systematic.