title: Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.
abstract: BACKGROUND
  In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents.
  
  
  METHODS
  This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure.
  
  
  RESULTS
  In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference.
  
  
  CONCLUSIONS
  Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands.
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Erasmus MC University Medical Center, Rotterdam. Electronic address: c.hopmans@erasmusmc.nl.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Hopmans
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Ikazia Hospital, Rotterdam.
authors.forename: Pieter T
authors.initials: PT
authors.lastname: den Hoed
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Amphia Hospital, Breda.
authors.forename: Lijckle
authors.initials: L
authors.lastname: van der Laan
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Maasstad Hospital, Rotterdam.
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Reinier de Graaf Groep, Delft.
authors.forename: Maarten
authors.initials: M
authors.lastname: van der Elst
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Sint Franciscus Gasthuis, Rotterdam.
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, IJsselland Hospital, Capelle aan den IJssel.
authors.forename: Imro
authors.initials: I
authors.lastname: Dawson
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Erasmus MC University Medical Center, Rotterdam.
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Erasmus MC University Medical Center, Rotterdam.
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.affiliation: Department of Surgery of the hospitals representing general surgical training region IV in the Netherlands, Erasmus MC University Medical Center, Rotterdam.
authors.forename: Jan N M
authors.initials: JN
authors.lastname: IJzermans
mesh_terms: D002983:Clinical Competence; D013502:General Surgery / Q000193:education* / Q000592:standards; D006767:Hospitals, District; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000706:statistics & numerical data; D016014:Linear Models; D009426:Netherlands; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D016526:Workload / Q000592:standards*