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50 Hour Surgery Resident Work Week Seen as Failure in Switzerland


There has been much written about patient safety being negatively affected by overworked residents. This has resulted in reduced hours for residents. While not all countries regulate working hours, in those that do the maximum hours per week for a doctor in training can range from as little as 37 hours in Denmark to 80 hours in the United States.

There has been concern especially in the surgery training programs that the reduction in work hours would negatively impact the quality of surgical training. This concern is the focus of an article in the June issue of Archives of Surgery.

In an attempt to look at how these restrictions affect training and patient care, Daniel Oertli, MD, of University Hospital Basel in Basel, Switzerland, and colleagues conducted an anonymous survey of residents and consultants in 52 of the country's 93 surgical departments. Of the 281 residents and 337 consultants, 405 responded.

In Switzerland, beginning January 1, 2005 residents hours were limited to 50 hours a week. Daily day and night work time has to be limited to 14 hours, including all breaks, and rest time each day must equal or exceed 11 consecutive hours. Residents are not allowed to work more than two hours a day of overtime except in rare cases and overtime can't exceed 140 hours a year.

Oertli and colleagues found that only 8.1 % of residents and only 4.9% of surgical consultants feel the change has been beneficial to surgical training.

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More then half of those who responded to the survey (62.8% or residents, 77% of consultants) felt the limited workweek had a negative effect on surgical training.

Both residents and consultants (76.9% and 73.4%, respectively) noted that operating time had gone down. This has long been one of the issues critics of shortened work hours for surgical residents worry will lead to reduced surgical skills.

More consultant than residents (70.1% compared to 43% ) thought the quality of patient care had gone down.

Both residents and consultants (58.4% and 81.5% respectively) noted the residents' quality of life had improved.

Oertli and colleagues fell the 50 hour restriction is a failure in Switzerland, but this one study will not settle the questions over the issue of surgical residents' work hours. Controversy over resident fatigue leading to medical errors that compromise patient safety and reduced hours leading to reduced surgical skills will continue for now.

Source references:
Businger A, et al "Effect of the 50-hour workweek limitation on training of surgical residents in Switzerland" Arch Surg 2010; 145(6): 558-63.

Jackson GP, Tarpley JL "How long does it take to train a surgeon?" BMJ 2009; 339: b4260.