The Lost Generation: Impact of the 56-hour EWTD on Current Surgical Training

The reform of specialist surgical training – the New Deal (1991), the Calman report (1993) and the implementation of the European Working Time Directive (EWTD, 1998) – has resulted in shorter training periods with reduced working hours. The Calman reform aimed to improve and structure training with regular assessment and supervision whereas the New Deal and the EWTD have concentrated predominantly on a reduction in hours. The adoption of full or partial shift work to provide surgical cover at night compliant to a 56-hour working week, as stipulated by phase one of the EWTD, has resulted in daytime hospital attendance for surgical trainees of an average three days per week despite almost universal acknowledgement of the limited training opportunities available at night.