title: Have restricted working hours reduced junior doctors' experience of fatigue? A focus group and telephone interview study.
abstract: OBJECTIVE
  To explore the effects of the UK Working Time Regulations (WTR) on trainee doctors' experience of fatigue.
  
  
  METHODS
  Qualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data.
  
  
  METHODS
  9 deaneries in all four UK nations; secondary care.
  
  
  METHODS
  82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry.
  
  
  RESULTS
  Implementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity.
  
  
  CONCLUSIONS
  Long-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors' true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.
authors.affiliation: Centre for Medical Education Research, Durham University, Durham, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Morrow
authors.forename: Bryan
authors.initials: B
authors.lastname: Burford
authors.forename: Madeline
authors.initials: M
authors.lastname: Carter
authors.forename: Jan
authors.initials: J
authors.lastname: Illing
mesh_terms: D001291:Attitude of Health Personnel; D005221:Fatigue; D005260:Female; D017144:Focus Groups; D033161:Government Regulation; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital; D010820:Physicians; D006113:United Kingdom; D014937:Work / Q000331:legislation & jurisprudence; D014940:Work Schedule Tolerance
keywords: Doctors in Training; Fatigue; Junior Doctors; Working Hours Restrictions; Working Time Regulations